PATIENT PARTICIPATION IN CLINICAL DECISION-MAKING FOR TREATMENT OF T3LARYNGEAL-CANCER - A COMPARISON OF STATE AND PROCESS UTILITIES

Purpose: To study the use of two different approaches, and feasibility of four commonly used utility assessment methods to assess preference s for treatment of TS-laryngeal cancer by surgery or radiation therapy (RT), Methods: Utility assessment methods, namely, time trade-off (TT O), standard reference gamble (SRG), rating scale (RS), and direct com parison (DC), were used to assess utilities in two groups of former ca ncer patients (n = 10 for both), a group of clinicians (n = 9), and a group from the general population (n = 10). For the treatment modaliti es, ie, surgery and RT, two types of scenarios were developed and used : the state scenario, which describes a stable health state after trea tment, and the process scenario, which describes a dynamic process, Fi rst, utilities were assessed based on state scenarios, Next, responden ts were thoroughly informed and educated with respect to the relevant aspects of both treatment modalities. Subsequently, utilities were aga in assessed, but now based on the process scenarios, The outcome of ea ch approach wets calculated and expressed in a quality-adjusted life-e xpectancy (QALE) score for each treatment modality, and the treatment with the highest outcome was said to be the preferred treatment modali ty. Results: In general, a higher QALE score for each treatment modali ty was found for clinicians and for the general population as compared with the former-cancer-patient groups. When the outcome of both appro aches was compared on an individual level dependent on the utility ass essment method, 32% to 43% of respondents showed an inconsistent treat ment preference, Conclusion: The approach to assess utilities and the extent to which respondents are informed about treatment modalities ha ve a major effect on individual treatment preferences. (C) 1995 by Ame rican Society of Clinical Oncology.