Tsevat J, Cook E F, Green M L, Matchar D B, Dawson N V, Broste S K, Wu A W, Phillips R S, Oye R K, Goldman L
Harvard Medical School, Boston, Massachusetts.
Ann Intern Med. 1995 Apr 1;122(7):514-20. doi: 10.7326/0003-4819-122-7-199504010-00007.
To assess 1) the health values and health ratings of seriously ill hospitalized patients, their surrogate decision makers, and their physicians; 2) the determinants of health values; and 3) whether health values change over time.
Prospective, longitudinal, multicenter study.
5 academic medical centers.
1438 seriously ill patients with at least one of nine diseases who had a projected overall 6-month mortality rate of 50%; their surrogates; and their physicians.
Time-tradeoff utilities (reflecting preferences for a shorter but healthy life) and health ratings.
At study day 3, patients had a mean time-tradeoff utility of 0.73 +/- 0.32 (median [25th, 75th percentile], 0.92 [0.63, 1.0]), indicating that they equated living 1 year in their current state of health with living 8.8 months in excellent health. However, scores varied widely; 34.8% of patients were unwilling to exchange any time in their current state of health for a shorter life in excellent health (utility, 1.0), and 9.0% were willing to live 2 weeks or less in excellent health rather than 1 year in their current state of health (utility, 0.04). Health rating scores averaged 57.8 +/- 24.0 (median [25th percentile, 75th percentile], 60 [50, 75]) on a scale of 0 (death) to 100 (perfect health). The patients' mean time-tradeoff score exceeded that of their paired surrogates (n = 1041) by 0.08 (P < 0.0001). Time-tradeoff scores were related to psychosocial well-being; health ratings; desire for resuscitation and extension of life rather than relief of pain and discomfort; degree of willingness to live with constant pain; and perceived prognosis for survival and independent functioning. Scores of surviving patients increased by an average of 0.06 after 2 months (P < 0.0001) and 0.08 after 6 months (P < 0.0001).
Health values of seriously ill patients vary widely, are higher than patients' surrogates believe, are related to few other preference and health status measures, and increase over time.
评估1）重症住院患者、其替代决策者及其医生的健康价值观和健康评分；2）健康价值观的决定因素；3）健康价值观是否随时间变化。
前瞻性、纵向、多中心研究。
5个学术医疗中心。
1438例患有9种疾病中至少一种且预计总体6个月死亡率为50%的重症患者；他们的替代者；以及他们的医生。
时间权衡效用（反映对较短但健康生活的偏好）和健康评分。
在研究第3天，患者的平均时间权衡效用为0.73±0.32（中位数[第25百分位数，第75百分位数]，0.92[0.63，1.0]），这表明他们将在当前健康状态下活1年等同于在极佳健康状态下活8.8个月。然而，评分差异很大；34.8%的患者不愿意用当前健康状态下的任何时间来换取在极佳健康状态下较短的生命（效用为1.0），9.0%的患者愿意在极佳健康状态下活2周或更短时间，而不是在当前健康状态下活1年（效用为0.04）。健康评分在0（死亡）至100（完美健康）的量表上平均为57.8±24.0（中位数[第25百分位数，第75百分位数]，60[50，75]）。患者的平均时间权衡得分比其配对的替代者（n = 1041）高出0.08（P < 0.0001）。时间权衡得分与心理社会幸福感、健康评分、对复苏和延长生命而非缓解疼痛和不适的渴望、忍受持续疼痛的意愿程度以及对生存和独立功能的预期预后有关。存活患者的得分在2个月后平均增加0.06（P < 0.0001），在6个月后平均增加0.08（P < 0.0001）。
重症患者的健康价值观差异很大，高于患者替代者的认知，与其他偏好和健康状况指标关系不大，且随时间增加。
