Boyd N F, Sutherland H J, Heasman K Z, Tritchler D L, Cummings B J
Department of Medicine, Ontario Cancer Institute, Toronto, Canada.
Med Decis Making. 1990 Jan-Mar;10(1):58-67. doi: 10.1177/0272989X9001000109.
The goal of this study was to examine sources of variation in the utilities assigned to health states. The authors selected a common clinical problem, carcinoma of the rectum, and examined the utilities assigned to colostomy, a common outcome of treatment for that disease. After preparing and validating a description of colostomy and its effects on patients' lives, utilities for the state were obtained from five groups of individuals. These comprised two groups of patients who received treatment for rectal cancer, a group of physicians and surgeons specializing in the treatment of this disease, and two groups of healthy subjects, none of whom were health professionals. Of the patients who had been treated for rectal cancer, one group had been treated surgically with the formation of colostomies and the other had been treated with radiotherapy and none had a colostomy. Utilities for colostomy were elicited using the standard gamble, category rating, and a treatment choice questionnaire. The groups differed substantially in the utilities assigned to colostomy. In general, patients with colostomies and physicians assigned significantly higher utilities than did patients who did not themselves have a colostomy. The clinical significance of these differences was examined in a simplified clinical decision problem that compared surgery (with colostomy) and radiotherapy (without colostomy) as primary treatment. The expected clinical value of these treatment alternatives was substantially influenced by the differences observed in utilities for colostomy. These results emphasize the importance of patient utilities in clinical decision making and the need to gain greater understanding of the factors that influence the utilities that patients assign to health states.
本研究的目的是探讨赋予健康状态的效用值的变异来源。作者选择了一个常见的临床问题——直肠癌，并研究了赋予结肠造口术（该疾病常见的治疗结果）的效用值。在准备并验证了关于结肠造口术及其对患者生活影响的描述后，从五组个体中获取了该状态的效用值。这五组包括两组接受直肠癌治疗的患者、一组专门治疗该疾病的内科医生和外科医生，以及两组健康受试者，其中没有健康专业人员。在接受直肠癌治疗的患者中，一组接受了形成结肠造口术的手术治疗，另一组接受了放射治疗，且均无结肠造口。使用标准博弈法、类别评定法和治疗选择问卷来获取结肠造口术的效用值。在赋予结肠造口术的效用值方面，这些组之间存在显著差异。一般来说，有结肠造口术的患者和医生赋予的效用值显著高于没有结肠造口术的患者。在一个简化的临床决策问题中，研究了这些差异的临床意义，该问题比较了手术（有结肠造口术）和放射治疗（无结肠造口术）作为主要治疗方法。这些治疗方案的预期临床价值受到结肠造口术效用值中观察到的差异的显著影响。这些结果强调了患者效用值在临床决策中的重要性，以及更深入了解影响患者赋予健康状态的效用值的因素的必要性。
