Preference Shift & Spousal utility for Cancer Treatments

描述（由申请人提供）：使用实用程序进行临床决策或成本效益分析的基础是假设实用程序随时间推移保持稳定。然而，观察到的偏好与陈述的偏好之间的差异以及随着时间的推移参考的差异，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）被认为违反了效用理论的基本基础。理论家已经探索了这种现象的许多原因，例如假设与经验健康状态的差异，初始诱导时的不完整偏好，以及框架或标签效应，仅举几例。然而，一个主要的因素，以前没有探讨，可能是显着相关的偏好不稳定性可能是配偶/伴侣的影响，医疗保健决策。大量文献表明，配偶，特别是女性配偶/伴侣，可能在家庭健康决策中发挥重要作用。还有证据表明，无论结果如何，女性伴侣往往比男性伴侣更喜欢更积极的治疗。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计划的男性与其配偶/伴侣之间的偏好差异，并评估男性偏好在女性配偶/伴侣的输入引起反应时的变化。使用时间权衡技术，将分别采访伴侣，然后联合采访，以确定他们对前列腺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-妻子/伴侣对前列腺癌筛查和治疗的偏好会有显着不同，妻子的效用分数高于丈夫的更具侵略性的选择。我们进一步假设，丈夫最初可能会倾向于以牺牲生命年的风险来保持生活质量，但当考虑到妻子/伴侣的影响时，丈夫的偏好会变得与妻子的更一致。这项研究建立在我们以前的广泛的工作，在决策测试的理论假设偏好稳定性。拟议研究的结果将与结局研究相关，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.