MEASURING PREFERENCES FOR HEALTH STATES WORSE THAN DEATH

Previous research indicates that persons assigning values to ranges of health states consider some states to be worse than death. In a study of decisions regarding life-sustaining treatments, the authors adapte d and assessed existing methods for their ability to identify and quan tify preferences for health states near to or worse than death in a po pulation of well adults and nursing home residents. The cognitive burd ens involved in these decisions were also evaluated. Hypothetical heal th states based on six attributes of functional status were constructe d to describe severe constant pain, dementia, and coma. The methods of rank order, category scaling, time tradeoff, and standard gamble were adapted to quantify states worse than death. Cognitive burden was ass essed using completion rates, interviewer assessments, respondents' se lf-reporting, and investigators' evaluations. For both respondent grou ps, all methods showed similar degrees of cognitive burden for those a ble to complete the tasks and were similar in their ability to identif y and quantify preferences. The majority of nursing home residents, ho wever, were unable to complete or comprehend the measurement tasks. Mo st respondents evaluated their current health and severe constant pain as better than death; dementia and coma were more often considered eq ual to or worse than death. These results indicate that respondents ca n and do evaluate some health states as worse than death. The authors recommend systematic inclusion of states worse than death to describe a more complete range of preference values and routine assessment of t he cognitive burdens of assessment techniques to evaluate methodologie s.