Whose quality of life? A commentary exploring discrepancies between health state evaluations of patients and the general public
Whose quality of life? A commentary exploring discrepancies between health state evaluations of patients and the general public
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DOI：
10.1023/a:1025119931010
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发表时间：
2003-09-01
影响因子：
3.5
通讯作者：
Jepson, C
中科院分区：
文献类型：
--
作者：
Ubel, PA;Loewenstein, G;Jepson, C
患者和公众对生活质量的估计往往存在差异。这些差异令残疾人社区感到关切，他们担心公众不了解残疾人的生命有多宝贵;政策规划者必须决定在经济分析中使用谁的生活质量估计数;从业者和患者面临困难的医疗决策，他们可能不得不担心人们难以想象不熟悉的健康状况。我们概述了可能导致这些差异的几个因素。不一致性可能会发生，因为患者和公众对健康状态描述的解释不同-例如，对健康状态的发病时间或合并症的存在做出不同的假设。如果患者适应了疾病，而公众没有预测到这种适应，也可能会出现不确定性;因为人们如何使用生活质量量表的反应转变;因为人们忘记考虑不熟悉的健康状态的明显方面的聚焦错觉;因为对比效应，负性生活事件使人们不太受不太严重的负性生活事件的困扰;而且由于不同的Vantage位置，病人从恢复健康的好处来看待他们的疾病，而公众则从失去健康的代价来看待疾病。在决定为经济分析的目的衡量谁的价值以及如何衡量差异时，应考虑到这些潜在的促成因素。
There is often a discrepancy between quality of life estimates from patients and the general public. These discrepancies are of concern to the disability community, who worry that the public does not understand how valuable life can be for people with disabilities; policy planners, who must decide whose quality of life estimates to use in economic analysis; and practitioners and patients facing difficult medical decisions, who may have to worry that people have difficulty imagining unfamiliar health states. We outline several factors that may contribute to these discrepancies. Discrepancies might occur because patients and the public interpret health state descriptions differently - for example, making different assumptions about the recency of onset of the health state, or about the presence of comorbidities. Discrepancies might also arise if patients adapt to illness and the public does not predict this adaptation; because of response shift in how people use quality of life scales; because of a focusing illusion whereby people forget to consider obvious aspects of unfamiliar health states; because of contrast effects, whereby negative life events make people less bothered by less severe negative life events; and because of different vantage points, with patients viewing their illness in terms of the benefits that would result from regaining health, while the public views the illness in terms of the costs associated with losing good health. Decisions about whose values to measure for the purposes of economic analyses, and how to measure discrepancies, should take these potential contributing factors into account.