Utilities for major stroke: results from a survey of preferences among persons at increased risk for stroke.
BACKGROUND
Patient beliefs, values, and preferences are crucial to decisions involving health care. In a large sample of persons at increased risk for stroke, we examined attitudes toward hypothetical major stroke.


RESULTS
Respondents were obtained from the Academic Medical Center Consortium (n = 621), the Cardiovascular Health Study (n = 321 ), and United Health Care (n = 319). Preferences were primarily assessed by using the time trade off (TTO). Although major stroke is generally considered an undesirable event (mean TTO = 0.30), responses were varied: although 45% of respondents considered major stroke to be a worse outcome than death, 15% were willing to trade off little or no survival to avoid a major stroke.


CONCLUSIONS
Providers should speak directly with patients about beliefs, values, and preferences. Stroke-related interventions, even those with a high price or less than dramatic clinical benefits, are likely to be cost-effective if they prevent an outcome (major stroke) that is so undesirable.
Samsa
G P
GP
Center for Clinical Health Policy Research, Sanford Institute of Public Policy, the Department of Medicine, Duke University, Durham, NC 27705, USA.
Matchar
D B
DB
Goldstein
L
L
Bonito
A
A
Duncan
P W
PW
Lipscomb
J
J
Enarson
C
C
Witter
D
D
Venus
P
P
Paul
J E
JE
Weinberger
M
M
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D005260:Female; D006304:Health Status; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000208:ethnology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D014481:United States