Preference Shift & Spousal utility for Cancer Treatments

描述(由申请人提供)：使用公用事业进行临床决策或成本效益分析的基本前提是公用事业随时间的推移是稳定的。然而，随着时间的推移，观察到的偏好与陈述的偏好以及参照的差异被称为偏好变化或偏好不稳定，已经被注意到了。偏好(不稳定性一直被认为是对效用理论基本基础的违背。理论家们探索了这种现象的许多原因，比如假设的健康状态与经验的健康状态的差异，最初的启发时不完全的偏好，以及框架或标签效应，仅举几例。然而，以前没有研究过的一个可能与偏好不稳定显著相关的主要因素可能是配偶/伴侣对卫生保健决策的影响。有相当多的文献表明，配偶，特别是女性配偶/伴侣，可能在家庭健康决策中发挥重要作用。也有证据表明，无论结果如何，女性伴侣往往比男性伴侣倾向于更积极的治疗方法。这项研究的目的是为IROI提供试点数据，以评估参加前列腺癌筛查计划的男性与他们的配偶/伴侣之间的偏好差异，并评估当女性配偶/伴侣的信息引起反应时，男性偏好的变化。使用时间权衡技术，伴侣将分别接受采访，然后联合接受采访，以确定他们对前列腺癌取消筛查和治疗方案的偏好，以及偏好的潜在变化。根据我们的试点数据，我们假设丈夫和妻子/伴侣在前列腺癌筛查和治疗方面将表现出显著不同的偏好，妻子在更激进的选择上的效用得分高于他们丈夫的。我们进一步假设，丈夫最初可能会以牺牲生命年的风险为代价，倾向于保持生活质量，但当考虑到妻子/伴侣的影响时，丈夫的偏好将转变为与妻子的偏好更一致。这项研究建立在我们之前广泛的决策工作的基础上，通过检验关于偏好稳定性的理论假设。拟议研究的结果将与结果研究相关，并将应用于临床决策。

DESCRIPTION (provided by applicant): Fundamental to using utilities for clinical decision making or cost-effectiveness analysis is the assumption hat utilities are stable over time. Yet, differences in observed vs. stated preferences and differences in references over time, called preference shifts or preference instability, have been noted. Preference (instability has been explored as a violation of the basic underpinnings of utility theory. Theorists have explored many reasons for this phenomenon such as differences in hypothetical vs. experienced health states, incomplete preferences at initial elicitation, and framing or labeling effects, to name a few. However, one major factor not previously explored that may be significantly associated with what appears as preference instability may be spouse/partner influence on health care decision making. There is considerable literature indicating that spouses, particularly female spouses/partners, may play a significant role in family health decisions. There is also evidence that female partners tend to show a preference for more aggressive therapies than male partners, regardless of outcome. The purpose of this study is to provide pilot data for an IROI to evaluate differences in preferences between men participating in a prostate cancer screening program and their spouses/partners, and to evaluate shifts in men's preference when responses are elicited with input from the female spouse/partner. Using the Time Trade-off technique, partners will be interviewed separately, then jointly, to determine their preferences, and potential shifts in preferences, for prostate cancel screening and treatment options. Based on our pilot data, we hypothesize that husband-wife/partner dyads will express significantly different preferences for prostate cancer-screening and therapies, with the wife's utility scores being higher for more aggressive options than their husband's. We further hypothesize that Husbands may initially state a preference for preserving quality of life at the risk of sacrificing life years, but hen the influence of the wife/partner is accounted for, the husband's preferences will shift to be more concordant with his wife's. This study builds on our previous extensive work in decision-making by testing the theoretical assumption regarding preference stability. The findings of the proposed study will have relevance to outcomes research and will also have application to clinical decision making.