title: Health values of the seriously ill. SUPPORT investigators.
abstract: 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.
authors.affiliation: Harvard Medical School, Boston, Massachusetts.
authors.forename: J
authors.initials: J
authors.lastname: Tsevat
authors.forename: E F
authors.initials: EF
authors.lastname: Cook
authors.forename: M L
authors.initials: ML
authors.lastname: Green
authors.forename: D B
authors.initials: DB
authors.lastname: Matchar
authors.forename: N V
authors.initials: NV
authors.lastname: Dawson
authors.forename: S K
authors.initials: SK
authors.lastname: Broste
authors.forename: A W
authors.initials: AW
authors.lastname: Wu
authors.forename: R S
authors.initials: RS
authors.lastname: Phillips
authors.forename: R K
authors.initials: RK
authors.lastname: Oye
authors.forename: L
authors.initials: L
authors.lastname: Goldman
mesh_terms: 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