Patients' willingness-to accept risk of medical treatments.

STUDY OBJECTIVES

Recent research has brought into question patients willingness to accept immediate treatment risk for the possibility of increased 5-year survival. This study was designed to assess whether patients are able to identify the probability of initial mortality they would be willing to accept in order to increase their chance of long-term survival.

DESIGN

Cross-sectional structured interviews with continuity clinic patients.

SETTING

A university-based Department of Veterans Affairs Medical Center general medicine clinic.

PARTICIPANTS

128 consecutive patients (mean age = 65.4 years (s.d. = 11.27, range of ages = 30-83)), seen in the second half of 1992.

MEASUREMENTS AND RESULTS

In a hypothetical setting, patients were presented with a pair of curves representing expected survival over a 5-year period for I two alternative treatments. The disease and treatments were not identified. In one curve, there was a 10% peri treatment mortality rate and a 37% 5-year survival; in the second curve, there was a 0% peritreatment mortality rate and a 22% 5-year survival. Once patients selected the treatment they preferred based on the curve pair, they were asked whether they were willing to accept an initial risk higher than the one they had selected. Of the 128 patients, 26.6% (34/128) selected the treatment with a 0% mortality in the peritreatment period. For these 34 patients, their mean initial acceptable probability of death was 3.75% (s.d. = 2.32, range 0-9). Of the 94 study patients who selected the 5-year curve with 10% mortality in the peritreatment period, the mean initial risk they were willing to accept was 14.73% (s.d. = 9.12, range = 10-70). Older patients were less willing than younger patients to accept probabilities at higher than the given immediate peritreatment risks for both treatments (chi square = 4.330, d.f. = 1, P < 0.04).

CONCLUSIONS

Patients are not as uncomfortable at taking immediate risks of death for a 5-year survival benefit. Patients report a willingness to accept risk of immediate death for 5-year survival benefits.