Medical Decision Making

 

Advanced Search

Journal Navigation

Journal Home

Subscriptions

Archive

Contact Us

Table of Contents

Register here to gain access to SAGE's 500+ Journals Online

Click here to browse AJSM online!

Sign In to gain access to subscriptions and/or personal tools.
This Article
Right arrow Full Text (PDF)
Right arrow References
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Saved Citations
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (2)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Goldberg, J. H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Goldberg, J. H.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?
Medical Decision Making, Vol. 26, No. 4, 323-337 (2006)
DOI: 10.1177/0272989X06291680

Being There Is Important, but Getting There Matters Too: The Role of Path in the Valuation Process

Julie H. Goldberg, PhD

University of Illinois at Chicago, College of Medicine, Department of Medical Education, M/C 591, 808 South Wood Street, 986 CME, Chicago, IL 60612; 60612; telephone: (312) 996-8077; fax: (312) 413-2048; julieg{at}uic.edu

Purpose. Traditional decision-analytic models presume that utilities are invariant to context. The influence of 2 types of context on patients' utility assessments was examined here the path by which one reaches a health state and personal experience with a health state. Methods. Three groups of patients were interviewed: men older than age 49 years with prostate cancer but no diabetes (CaP), diabetes but no prostate cancer (DM), and neither disease (ND). The utility of erectile dysfunction (ED) was assessed using a standard gamble (SG). Each subject completed 2 SGs: 1) a no-context version that gave no explanation for the cause of ED and 2) a contextualized version in which prostate cancer treatment, the failure to manage diabetes, or the natural course of aging was said to be the cause. Results. Patients with disease assigned higher utilities to ED in a matching context than in discrepant contexts. Regression models found that the valuation process was also sensitive to the match between disease path in the utility assessment and patients' personal experiences. Conclusions. These findings lend insight into why acontextual utility assessments typically used in decision analyses have not been able to predict patient behavior as well as expected. The valuation process appears to change systematically when context is specified, suggesting that unspecified contexts rather than random error may lead to fluctuations in the values assigned to identical health states.

Key Words: decision-analytic models • utility assessments • health state • patient behavior • erectile dysfunction


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 Scand J Public HealthHome page
J. Nexoe, P. A. Halvorsen, and I. S. Kristiansen
Review Article: Critiques of the risk concept -- valid or not?
Scand J Public Health, December 1, 2007; 35(6): 648 - 654.
[Abstract] [PDF]

Home page
 Med Decis MakingHome page
O. Kostopoulou
The transient nature of utilities and health preferences.
Med Decis Making, July 1, 2006; 26(4): 304 - 306.
[PDF]