Health values of the seriously ill. SUPPORT investigators.
OBJECTIVE
To assess 1) the health values and health ratings of seriously ill hospitalized patients, their surrogate decision makers, and their physicians; 2) the determinants of health values; and 3) whether health values change over time.


METHODS
Prospective, longitudinal, multicenter study.


METHODS
5 academic medical centers.


METHODS
1438 seriously ill patients with at least one of nine diseases who had a projected overall 6-month mortality rate of 50%; their surrogates; and their physicians.


METHODS
Time-tradeoff utilities (reflecting preferences for a shorter but healthy life) and health ratings.


RESULTS
At study day 3, patients had a mean time-tradeoff utility of 0.73 +/- 0.32 (median [25th, 75th percentile], 0.92 [0.63, 1.0]), indicating that they equated living 1 year in their current state of health with living 8.8 months in excellent health. However, scores varied widely; 34.8% of patients were unwilling to exchange any time in their current state of health for a shorter life in excellent health (utility, 1.0), and 9.0% were willing to live 2 weeks or less in excellent health rather than 1 year in their current state of health (utility, 0.04). Health rating scores averaged 57.8 +/- 24.0 (median [25th percentile, 75th percentile], 60 [50, 75]) on a scale of 0 (death) to 100 (perfect health). The patients' mean time-tradeoff score exceeded that of their paired surrogates (n = 1041) by 0.08 (P < 0.0001). Time-tradeoff scores were related to psychosocial well-being; health ratings; desire for resuscitation and extension of life rather than relief of pain and discomfort; degree of willingness to live with constant pain; and perceived prognosis for survival and independent functioning. Scores of surviving patients increased by an average of 0.06 after 2 months (P < 0.0001) and 0.08 after 6 months (P < 0.0001).


CONCLUSIONS
Health values of seriously ill patients vary widely, are higher than patients' surrogates believe, are related to few other preference and health status measures, and increase over time.
Tsevat
J
J
Harvard Medical School, Boston, Massachusetts.
Cook
E F
EF
Green
M L
ML
Matchar
D B
DB
Dawson
N V
NV
Broste
S K
SK
Wu
A W
AW
Phillips
R S
RS
Oye
R K
RK
Goldman
L
L
D000368:Aged; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology; D016638:Critical Illness / Q000523:psychology*; D003657:Decision Making; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life; D040841:Resource Allocation; D012720:Severity of Illness Index; D012945:Social Values; D013997:Time Factors; D028761:Withholding Treatment