title: Agreement between prostate cancer patients and their clinicians about utilities and attribute importance.
abstract: OBJECTIVE
  To examine the agreement between prostate cancer patients' utilities for selected health states and their rankings of the importance of six attributes of the health states and the clinicians' judgements of what would be in the patients' best interests.
  
  
  METHODS
  Patients with newly diagnosed localized prostate cancer individually completed a time trade-off utility assessment shortly after being diagnosed. The health states evaluated were constructed from a multi-attribute utility model that incorporated six aspects of living with the disease and outcomes of treatment. Each patient assessed his current health state and three hypothetical states that might occur in the future, and provided rankings of the importance of the six attributes. The clinicians caring for each patient independently provided their views of what utilities and importance rankings would be in the patient's best interest.
  
  
  RESULTS
  The across-participant correlations between patients' and clinicians' utilities were very low and not statistically significant. Across-participant correlations between patient and clinician importance rankings for the six attributes were also low. Across-health state and across-attribute correlations between utilities or importance rankings were highly variable across patient-clinician pairs.
  
  
  CONCLUSIONS
  In the clinical settings studied, there is not a strong relationship between valuations of current and possible future health states by patients with newly diagnosed prostate cancer and their clinicians. Implications of these results for substituted judgement, when clinicians advise their patients or recommend a treatment strategy, are discussed.
authors.affiliation: Department of Medical Education, University of Illinois at Chicago, Chicago, IL, USA. aelstein@uic.edu
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Elstein
authors.forename: Gretchen B
authors.initials: GB
authors.lastname: Chapman
authors.forename: Joan S
authors.initials: JS
authors.lastname: Chmiel
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Knight
authors.forename: Cheeling
authors.initials: C
authors.lastname: Chan
authors.forename: Robert B
authors.initials: RB
authors.lastname: Nadler
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Kuzel
authors.forename: Amy K
authors.initials: AK
authors.lastname: Siston
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
mesh_terms: D003657:Decision Making; D006304:Health Status; D006801:Humans; D008297:Male; D010358:Patient Participation; D010817:Physician-Patient Relations; D011471:Prostatic Neoplasms / Q000503:physiopathology* / Q000628:therapy; D016896:Treatment Outcome; D014481:United States