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.
Center for Clinical Health Policy Research, Sanford Institute of Public Policy, the Department of Medicine, Duke University, Durham, NC 27705, USA.
G P
GP
Samsa
D B
DB
Matchar
L
L
Goldstein
A
A
Bonito
P W
PW
Duncan
J
J
Lipscomb
C
C
Enarson
D
D
Witter
P
P
Venus
J E
JE
Paul
M
M
Weinberger
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