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Biomedical subjects

H J Sutherland

Publications and source records attributed to H J Sutherland.

97 records · Page 6Linked to original sources
PubMed1982

Attitudes toward quality of survival. The concept of "maximal endurable time".

The purpose of this study was to examine attitudes toward the duration of survival in different health states. Health professionals were asked to consider hypothetical situations in which a specified period of time would be spent in a defined health state. Preferences for these different situations were assessed using two methods--a Preference Questionnaire and a Certainty Equivalence method. The results obtained indicated that attitudes toward duration of survival depended strongly on the amount of time to be spent in a hypothetical health state, and on the quality of the state. As the duration of survival increased, or the state under consideration became more dysfunctional, a higher proportion of raters expressed a preference for immediate death over further survival in the dysfunctional state. These results contradict the view that time preference curves always increase monotonically, independent of the quality of survival. Instead, subjects appeared to identify a variable, the "maximal endurable time" in a given state. When this time was exceeded, attitudes toward additional increments of survival changed dramatically.

Attitude to Health↗
PubMed1982

The measurement of patients' values in medicine.

The standard gamble, derived from decision theory, is considered a criterion method for obtaining patients' values for different health states. In this method, a rater's value for a health state is obtained by determining, in a hypothetical setting, his readiness to remain in that state or take a risky choice with different outcomes of known value. According to the expected utility criterion, a rater's utility or value for a particular state should not be influenced by changes in the gamble outcomes. The standard gamble was used to obtain 64 patients' judgments of a set of health states, first with the outcomes of perfect health or death, and subsequently with other health states as outcomes. The changes in gamble outcomes significantly influenced reported values for health states, indicating that the standard gamble is internally inconsistent. This observation poses a major limitation to its use as a value measurement method in medicine.

Adult↗
PubMed1981

Prospective evaluation of physical examination of the breast.

The reliability of physical examination of the breast was evaluated by determining the extent of agreement among four experienced breast surgeons who examined the same 100 patients. The consequences of disagreements among surgeons were assessed by determining the diagnostic accuracy of each examiner. Despite differences in the frequency with which each surgeon found abnormalities or masses, or recommended mammography or biopsy, the diagnostic accuracy of the surgeons was very similar, and most disagreements concerned the findings in patients who did not have breast cancer. Breast examination carried out by more than one surgeon may reduce the frequency with which biopsy is performed in patients who do not have breast cancer.

Biopsy↗
PubMedDate not supplied

Whose utilities for decision analysis?

The goal of this study was to examine sources of variation in the utilities assigned to health states. The authors selected a common clinical problem, carcinoma of the rectum, and examined the utilities assigned to colostomy, a common outcome of treatment for that disease. After preparing and validating a description of colostomy and its effects on patients' lives, utilities for the state were obtained from five groups of individuals. These comprised two groups of patients who received treatment for rectal cancer, a group of physicians and surgeons specializing in the treatment of this disease, and two groups of healthy subjects, none of whom were health professionals. Of the patients who had been treated for rectal cancer, one group had been treated surgically with the formation of colostomies and the other had been treated with radiotherapy and none had a colostomy. Utilities for colostomy were elicited using the standard gamble, category rating, and a treatment choice questionnaire. The groups differed substantially in the utilities assigned to colostomy. In general, patients with colostomies and physicians assigned significantly higher utilities than did patients who did not themselves have a colostomy. The clinical significance of these differences was examined in a simplified clinical decision problem that compared surgery (with colostomy) and radiotherapy (without colostomy) as primary treatment. The expected clinical value of these treatment alternatives was substantially influenced by the differences observed in utilities for colostomy. These results emphasize the importance of patient utilities in clinical decision making and the need to gain greater understanding of the factors that influence the utilities that patients assign to health states.

Attitude of Health Personnel↗
PubMedDate not supplied

Benign and malignant breast disease: the relationship between women's health status and health values.

The study purpose was to determine whether differences in the weights assigned to various dimensions of health by 90 women in three subgroups (benign breast disease, breast cancer receiving chemotherapy, and breast cancer receiving other therapies) were associated with differences in self-reported health status in these dimensions. Two methods, one direct and the other indirect, were used to elicit values for mobility, depression, and social support. Two different scales also provided self-reports of health status in each of these dimensions. These measures, in conjunction with sociodemographic variables, were used to test for status-value relationships. No statistically significant association between health values and health status was observed. The absence of any detectable association may have been a result of methodologic difficulties in assessing broadly defined dimensions of health. A possible solution would be to use "individualized" dimensions that are uniquely important to the individual, and to take into account such factors as possible influences of past health status and values, and possible gaps between expected health status and health status actually experienced.

Activities of Daily Living↗
PubMedDate not supplied

What attitudes and beliefs underlie patients' decisions about participating in chemotherapy trials?

The theory of reasoned action, which postulates that personal attitudes and external social influences predict intentions to undertake a behavior, was used as a conceptual framework for developing a questionnaire to elicit beliefs and attitudes associated with the decision to participate in a hypothetical cancer chemotherapy trial. After completing the questionnaire, two-thirds of the 150 respondents indicated they would enroll in such a trial if it were available. Considerable variation existed in both "universal" and "trial-specific" beliefs and attitudes underpinning their intentions. A substantial amount of the variance in "intention" to participate was explained by "attitude" alone (75%). Social influences, although statistically significant, made a mere 1% additional contribution. One interpretation is that subjective expected-utility theory, which essentially predicts beliefs or "attitude," is a better model. The authors conclude that both theories may be criticized regarding how well they capture the rationality and nuances of decision behavior.

Adult↗