Eliciting patient disutilities for the adverse outcomes of cardiopulmonary resuscitation.
BACKGROUND
in helping patients decide about treatments, such as whether to authorize cardiopulmonary resuscitation (CPR), physicians typically present information about the possible outcomes and their likelihoods. The aim of this study was to elicit patient disutilities for the adverse outcomes of cardiopulmonary resuscitation (CPR) using the methodology of NH Anderson's functional theory of cognition and to determine how patients integrate the disutility and the likelihood of an outcome.


METHODS
77 French adults rated scenarios of possible outcomes of CPR on a linear scale with anchors "what would be the best (or worst) for me." In 25 of the 27 scenarios, the result would be either total recovery or one of five adverse outcomes (chest injury, mild reversible brain damage, severe irreversible brain damage, death after intensive care, immediate death) with one of five likelihoods (one to five chances out of ten). In the other two, the only possible result was either total recovery or immediate death.


RESULTS
the mean disutilities relative to 0 for chest injury and 100 for severe brain damage were 13 for mild brain injury, 68 for death after intensive care, and 69 for immediate death. The graphs of the ratings of each adverse outcome in relation to its frequency were fan-shaped, showing that participants integrated this information multiplicatively.


CONCLUSIONS
the functional theory of cognition provides an alternate method of eliciting patient utilities for the outcomes of CPR and supports clinicians' assumption that people combine utility and likelihood multiplicatively.
Departments of Medicine and Pediatrics, Albany Medical College, Albany, NY, USA. paulsorum@cs.com
P C
PC
Sorum
M T
MT
Muñoz Sastre
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E
Mullet
A
A
Gamelin
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D003071:Cognition; D003663:Decision Trees; D005260:Female; D006801:Humans; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011788:Quality of Life