title: Considering the balance: development of a scale to assess patient views on trade-offs in competing health outcomes.
abstract: OBJECTIVE
  To describe the development of a scale assessing participant attitudes regarding two commonly encountered trade-offs: quality versus quantity of life and present versus future health.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Community.
  
  
  METHODS
  Three hundred and fifty-seven community-dwelling adults aged 65 and older.
  
  
  METHODS
  An initial set of 20 items rated on a 5-point Likert scale of agreement was reduced using principal components analysis. Construct validity was evaluated through comparison of the scale with other tools addressing the same trade-offs and analysis of participant characteristics associated with attitudes favoring quality over quantity of life and present over future health. Internal consistency was assessed using Cronbach alpha. Test-retest reliability was assessed using intraclass correlation coefficients (ICCs).
  
  
  RESULTS
  The scale consists of two subscales, each addressing one trade-off, with a total of 10 items. All factor loadings were 0.5 and greater, and subscale scores were significantly different (P ≤ .05) in the expected directions when comparing with other tools and with participant race, education, and religious identity. Internal consistency was good (Cronbach α 0.85 and 0.84), and test-retest reliability was fair (ICCs 0.63 and 0.47). Subscale score medians fell near the middle of each scale, with narrow interquartile ranges, but more than 15% of the sample scored at an extreme of each subscale.
  
  
  CONCLUSIONS
  This new scale captures views on two common trade-offs in health care. Although test-retest reliability was modest, its high validity suggests that this tool can be used to familiarize people with common trade-offs and further explore influences on attitudes.
authors.affiliation: Department of Medicine, Yale University School of Medicine, New Haven, Connecticut 06516, USA. siobhan.case@yale.edu
authors.forename: Siobhan M
authors.initials: SM
authors.lastname: Case
authors.forename: Virginia R
authors.initials: VR
authors.lastname: Towle
authors.forename: Terri R
authors.initials: TR
authors.lastname: Fried
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002908:Chronic Disease / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003237:Connecticut; D003657:Decision Making; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006292:Health Priorities / Q000706:statistics & numerical data*; D006801:Humans; D008136:Longevity; D008297:Male; D011594:Psychometrics / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology*; D015203:Reproducibility of Results
keywords: comorbidity; decision-making; geriatric assessment and methods; health priorities; quality of life