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Do Nonpatients Underestimate the Quality of Life Associated with Chronic Health Conditions because of a Focusing Illusion?

Veterans Affairs Medical Center, Ann Arbor, Michigan, Division of General Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Program for Improving Health Care Decisions, Ann Arbor, Michigan

George Loewenstein, PhD

Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania

John Hershey, PhD

Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, the Wharton School, University of Pennsylvania, Philadelphia

Jonathan Baron, PhD

Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Department of Psychology, University of Pennsylvania, Philadelphia

Tara Mohr, BA

Division of General Internal Medicine, University of Pennsylvania, Philadelphia

David A. Asch, MD, MBA

Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Veterans Affairs Medical Center, Philadelphia, Pennsylvania

Christopher Jepson, PhD

Division of General Internal Medicine, University of Pennsylvania, Philadelphia

Background. A number of studies show that the general public often estimates that the quality of life (QOL) associated with various health conditions is worse than patients say it is. These studies raise the possibility that people overestimate the impact that unfamiliar health conditions will have on their quality of life. One possible reason people overestimate this is because they are susceptible to a focusing illusion—when asked to imagine themselves in unfamiliar circumstances, people overestimate the emotional impact of those features of their life that would change. Methods. The authors surveyed members of the general public to test the hypothesis that their QOL ratings of hypothetical health conditions would be higher (indicating a better quality of life) after thinking about how the health condition would affect a broad range of life domains. Across 3 experiments, the authors varied the health conditions people were asked to consider (either paraplegia, below-the-knee amputation, or partial blindness), the life domains they were asked to consider, the response mode with which they evaluated how each health condition would affect each life domain, whether subjects rated the health condition before and after considering life domains or only after, and whether subjects rated their own current quality of life first. Results. Across 3 experiments, using 10 different questionnaire versions, only 1 instance was found in which subjects’ ratings were significantly higher after thinking about the effect of the health condition on life domains than before, and the magnitude of this increase was small. Conclusion. It could not be established that a focusing illusion contributes significantly to the discrepancy in QOL ratings of patients and nonpatients. Further research should explore other factors that could contribute to the discrepancy or other ways of testing for the influence of a focusing illusion.

Key Words: general public survey • utility measurement • quality of life measurement

Medical Decision Making, Vol. 21, No. 3, 190-199 (2001)
DOI: 10.1177/0272989X0102100304


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