USING A TRADE-OFF TECHNIQUE TO ASSESS PATIENTS TREATMENT PREFERENCES FOR BENIGN PROSTATIC HYPERPLASIA

The probability-tradeoff technique may be used to assess treatment pre ferences in dichotomous choices. In this feasibility study, it was use d to elicit benign prostatic hyperplasia (BPH) patients' attitudes tow ards three different treatments. Eighty-seven male outpatients used ra ting scales and the standard gamble to indicate the extents to which t hey were free of BPH symptoms. Paired descriptions of ''watchful waiti ng'' (WW), treatment with an alpha blocker (AB), and transurethral res ection of the prostate (TURP) were presented, and the probability-trad eoff technique was used to obtain treatment-preference scores. The tra deoff task identified six internally consistent preference-order subgr oups. The majority (n = 55; 63.2%) were in the two subgroups in which TURF was the]east-preferred treatment. Compared with the other respond ents, the members of these two subgroups reported significantly higher utilities for their BPH symptom status (89 vs 79; t = 2.87; p < 0.000 5). Within each subgroup, preference scores for the middle- and top-ra nked treatments were computed relative to the bottom-ranked treatment; for both WW and AB, significant across-subgroup differences were obse rved. In this preliminary study the probability-tradeoff technique was feasible, able to identify unique preference-order subgroups, and abl e to generate apparently meaningful preference scores in a clinical si tuation involving three alternative treatments. Further development of tradeoff tasks as the value-clarification component of decision aids for individual patients seems warranted.