Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Am J Gastroenterol. 2011 Apr;106(4):794-9. doi: 10.1038/ajg.2011.39. Epub 2011 Mar 1.
Patients with chronic ulcerative colitis (UC) often refuse colectomy, despite data indicating that it might improve quality of life. We hypothesized that perceived utility values are different for patients living with UC compared with UC patients after total proctocolectomy. Our aims were to compare the perceived utility assigned by UC patients with and without a colectomy to standardized chronic UC and post-colectomy scenarios, and to compare the utility of actual health states among groups.
We surveyed patients in a tertiary referral center from three groups, including non-UC, UC patients without colectomy, and UC patients who were post-colectomy. We measured the Time-Trade-Off (TTO) utilities of subjects for standardized scenarios, describing moderate UC and a post-colectomy state. Among all UC patients (with and without colectomy), we measured TTO utility for their own health state.
Responses were obtained from 150 patients per group (n=450). The non-UC patients considered UC and colectomy scenarios equally (0.92), which was similar to UC patients without colectomy (0.90 and 0.91). Post-colectomy patients strongly preferred the colectomy scenario to the UC scenario (0.86 vs. 0.92, P<0.001). The median utility of UC patients without colectomy for their actual health state was higher than that of post-colectomy patients (0.96 and 0.92, P<0.05). Patients with more social support were more likely to have undergone colectomy compared with patients with little social support (odds ratio=1.20 per dependent/supporter).
Patients living with UC prefer their actual health state to a perceived UC scenario or a post-colectomy scenario. Patients who have undergone colectomy equate the quality of life in their actual state with that in a post-colectomy scenario, and prefer each to a perceived chronic UC state. Given the variety of preferences and the importance of social support, opportunities to interact with UC patients who have previously undergone colectomy could help patients living with UC and their physicians to navigate these complex choices.
尽管数据表明结肠切除术可能会改善生活质量，但患有慢性溃疡性结肠炎（UC）的患者经常拒绝结肠切除术。我们假设，与接受全结肠直肠切除术的 UC 患者相比，患有 UC 的患者对感知效用值有不同的看法。我们的目的是比较未接受结肠切除术和接受结肠切除术的 UC 患者对标准化慢性 UC 和术后场景的感知效用，并比较各组之间实际健康状况的效用。
我们从三个组中调查了一家三级转诊中心的患者，包括非 UC、未接受结肠切除术的 UC 患者和接受结肠切除术的 UC 患者。我们测量了受试者对标准化场景的时间权衡（TTO）效用，描述了中度 UC 和术后状态。在所有 UC 患者（接受和未接受结肠切除术）中，我们测量了他们自己健康状况的 TTO 效用。
每组获得了 150 名患者的回复（n=450）。非 UC 患者认为 UC 和结肠切除术场景同样重要（0.92），这与未接受结肠切除术的 UC 患者相似（0.90 和 0.91）。接受结肠切除术的患者强烈倾向于选择结肠切除术场景而不是 UC 场景（0.86 与 0.92，P<0.001）。未接受结肠切除术的 UC 患者对其实际健康状况的中位数效用高于接受结肠切除术的患者（0.96 和 0.92，P<0.05）。与社交支持较少的患者相比，社交支持较多的患者更有可能接受结肠切除术（优势比=每依赖/支持者增加 1.20）。
患有 UC 的患者更愿意接受自己的实际健康状况，而不是感知的 UC 场景或术后场景。接受结肠切除术的患者将自己实际状态的生活质量等同于术后场景的生活质量，并更喜欢感知到的慢性 UC 状态。鉴于各种偏好和社交支持的重要性，与以前接受过结肠切除术的 UC 患者互动的机会可以帮助患有 UC 的患者及其医生应对这些复杂的选择。
