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础是假设公用事业随时间稳定。然而，观察到的偏好与陈述的偏好的差异以及随时间的参考差异，称为偏好转移或偏好不稳定性，已经被注意到。偏好不稳定性被认为是对效用理论基本基础的违背。理论家们已经探索了这种现象的许多原因，例如假设与实际健康状态的差异，初始启发时的不完整偏好，以及框架或标签效应，等等。然而，以前没有研究过的一个可能与偏好不稳定性显著相关的主要因素可能是配偶/伴侣对医疗保健决策的影响。有大量文献表明，配偶，特别是女性配偶/伴侣，可能在家庭健康决定中发挥重要作用。也有证据表明，无论结果如何，女性伴侣往往比男性伴侣更倾向于更积极的治疗方法。本研究的目的是为IROI提供试点数据，以评估参与前列腺癌筛查项目的男性与其配偶/伴侣之间的偏好差异，并评估当女性配偶/伴侣的输入引起反应时，男性偏好的变化。使用时间权衡技术，合作伙伴将单独访谈，然后共同访谈，以确定他们的偏好，以及偏好的潜在变化，前列腺取消筛查和治疗方案。根据我们的试点数据，我们假设夫妻/伴侣二人组对前列腺癌筛查和治疗的偏好会有显著差异，在更积极的选择上，妻子的效用得分高于丈夫。我们进一步假设，丈夫最初可能会在牺牲生命年的风险下表达对保持生活质量的偏好，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更一致。本研究建立在我们之前广泛的决策工作的基础上，通过测试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，也将应用于临床决策。

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.