公众对预防与治疗的偏好：要是一盎司预防仅值一盎司治疗会怎样？

Public preferences for prevention versus cure: what if an ounce of prevention is worth only an ounce of cure?

作者信息

Ubel P A, Spranca M D, Dekay M L, Hershey J C, Asch D A

机构信息

Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.

出版信息

Med Decis Making. 1998 Apr-Jun;18(2):141-8. doi: 10.1177/0272989X9801800202.

DOI:10.1177/0272989X9801800202

PMID:9566447

Abstract

BACKGROUND

The belief that small preventive efforts bring large benefits may explain why many people say they value prevention above all other types of health care. However, it often takes a great deal of preventive medicine to prevent a bad outcome. This study explores whether people value prevention or cure more when each brings the same magnitude of benefit and examines whether preferences for prevention or cure vary according to the severity of the disability of the patients who can receive the preventive or curative intervention.

METHODS

289 prospective jurors were presented with a policy dilemma involving how best to allocate funds to benefit people with varying levels of disability. Each project was said to influence the functional ability of 100 nursing home residents, either by improving their level of function or by preventing their level of function from declining.

RESULTS

When given a choice between preventive and curative interventions, more subjects preferred the preventive intervention (37% vs 21%, p=0.002). However, when the strength of people's preferences was taken into account, the preference for preventive interventions was not statistically significant (p=0.135). With both preventive and curative interventions, the subjects preferred helping patients with more severe disabilities (p < 0.005 for both comparisons). This preference for helping more severely disabled patients did not differ for prevention and cure (p=0.663).

CONCLUSION

When the magnitude of benefit was held constant, the subjects slightly preferred prevention over cure. In addition, they preferred directing limited resources toward those with greater disabilities, regardless of whether those resources were targeted toward prevention or cure. These findings suggest that previously stated preferences for prevention over cure may result from a belief that small efforts at prevention will be repaid by large reductions in the later need for cure.

摘要

背景

认为小小的预防措施能带来巨大益处的观念，或许可以解释为何许多人表示他们认为预防比其他任何类型的医疗保健都更有价值。然而，往往需要大量的预防医学措施才能预防不良后果。本研究探讨当预防和治愈带来相同程度的益处时，人们更看重预防还是治愈，并考察对于预防或治愈的偏好是否会根据能够接受预防或治疗干预的患者残疾严重程度而有所不同。

方法

向289名未来的陪审员提出一个政策困境，涉及如何以最佳方式分配资金以使不同残疾程度的人受益。据说每个项目都会影响100名疗养院居民的功能能力，要么通过提高他们的功能水平，要么通过防止他们的功能水平下降。

结果

在预防和治疗干预之间进行选择时，更多的受试者更喜欢预防干预（37%对21%，p = 0.002）。然而，当考虑到人们偏好的强度时，对预防干预的偏好没有统计学意义（p = 0.135）。对于预防和治疗干预，受试者都更喜欢帮助残疾更严重的患者（两次比较p均<0.005）。这种对帮助残疾更严重患者的偏好对于预防和治疗并无差异（p = 0.663）。