title: Relationship between universal health outcome priorities and willingness to take medication for primary prevention of myocardial infarction.
abstract: OBJECTIVE
  To determine how well universal health outcome priorities represent individuals' preferences in specific clinical situations.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Community.
  
  
  METHODS
  Community-dwelling adults aged 65 and older (N = 357).
  
  
  METHODS
  Participants used three tools assessing universal health outcome priorities related to two common trade-offs: quality versus quantity of life and future health versus present inconveniences and burdens of treatment. The tools' ability to identify participants who were unwilling to take a medication that reduced the risk of myocardial infarction but caused dizziness and fatigue was analyzed.
  
  
  RESULTS
  There were consistent and significant associations between unwillingness to take the medication and prioritizing quality of life or future health for all three tools in the expected direction (P < .05). Despite these associations, the positive (PPV) and negative predictive values for the tools were generally modest (0.49-0.83). The tool with the most specific statements resembling the medication scenario had the best specificity (0.97) and PPV (0.83).
  
  
  CONCLUSIONS
  Universal health outcome priorities only modestly identified older persons who would be unwilling to take a medication for primary prevention of myocardial infarction that causes adverse effects. Although tools that are the most general in their assessment of priorities have the benefit of being applicable across the widest range of scenarios, tools with greater specificity may be necessary to inform individual treatment decisions.
authors.affiliation: Department of Medicine, Yale University, New Haven, Connecticut.
authors.forename: Siobhan M
authors.initials: SM
authors.lastname: Case
authors.forename: John
authors.initials: J
authors.lastname: O'Leary
authors.forename: Nancy
authors.initials: N
authors.lastname: Kim
authors.forename: Mary E
authors.initials: ME
authors.lastname: Tinetti
authors.forename: Terri R
authors.initials: TR
authors.lastname: Fried
mesh_terms: D000368:Aged; D001294:Attitude to Health; D015331:Cohort Studies; D003237:Connecticut; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000517:prevention & control*; D010358:Patient Participation; D057240:Patient Preference; D011237:Predictive Value of Tests; D011322:Primary Prevention; D011788:Quality of Life; D012680:Sensitivity and Specificity; D064232:Visual Analog Scale
keywords: cardiovascular diseases; comorbidity; control; decision-making; geriatric assessment/methods; health priorities; prevention