Discount Functions and the Measurement of Patients' Values
Discount Functions and the Measurement of Patients' Values
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贴现函数和患者价值的衡量
DOI：
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发表时间：
1984
影响因子：
3.6
通讯作者：
J. Christensen
中科院分区：
文献类型：
--
作者：
J. Christensen
本文讨论了测量患者的价值观，为未来的结果，并探讨了一些问题，临床医生面临的管理决策时，试图遵守这些价值观。它提出了一个模型，这意味着病人的偏好随着时间的推移而变化，并且在某些时间段内，病人的值可能不代表他或她的长期偏好。对18名孕妇对避免疼痛和避免麻醉的态度的检查证实了这个模型的预测。在临产前一个月和临产早期，女性倾向于避免在分娩过程中使用麻醉;然而，在活跃的分娩过程中，她们的偏好突然转向避免疼痛（p <0.05）。在产后一个月进行评估时，他们的偏好再次转向避免使用麻醉（p <0.05）。临产前一个月的偏好是产后偏好的最佳预测因素。产妇在活跃产程和产程过渡期的偏好与产后偏好无关。这些结果表明，根据患者的价值观何时被测量，（1）它们可能不代表他或她的长期偏好，（2）它们在决策分析中的使用可能不会最大化患者的长期满意度，因为它们最大化了基于患者冲动反应的决策的概率。这些结果还意味着（3）患者可能会对他们从未经历过的抽象结果进行固有的不太可靠的价值评估，（4）当前和长期价值之间的区别可能会在确定人们是否理性行为时产生问题。
This paper discusses the measurement of patients' values for future outcomes and examines some problems clinicians confront when making management decisions that attempt to comply with those values. It presents a model that implies that a patient's preference varies with the passage of time, and that during certain periods of time a patient's values may not be representative of his or her long-term preference. An examination of the attitudes of 18 pregnant women toward avoiding pain and avoiding anesthesia bore out the predictions of this model. The women preferred to avoid using anesthesia during childbirth when asked one month before labor and during early labor; however, during active labor their preferences suddenly shifted toward avoiding pain (p less than 0.05). Their preference shifted again toward avoiding the use of anesthesia (p less than 0.05) when evaluated at one month postpartum. The women's preferences one month before labor were the best predictors of their postpartum preferences. The women's preferences during active labor and transition phase of labor were unrelated to their postpartum preferences. These results suggest that, depending upon when a patient's values are measured, (1) they may not be representative of his or her long-term preference, and (2) their use in decision analyses may not maximize the patient's long-term satisfaction so much as they maximize the probability that the decision will be based on the patient's impulsive response. These results also imply that (3) patients may make inherently less reliable value assessments of abstract outcomes they have never experienced, and (4) the distinction between current and long-term values can create a problem when determining whether people behave rationally.
影响因子：
5.9
作者：
BECK, JR;KASSIRER, JP;PAUKER, SG
通讯作者：
PAUKER, SG