Differences in health values among patients, family members, and providersfor outcomes in schizophrenia

OBJECTIVE. The objectives of this study were to determine whether there are important differences in how patients, family members, and health care pro viders (HCPs) value health outcomes in schizophrenia and to assess the degr ee to which such differences, if they exist, could adversely affect clinica l and policy decision making. METHODS. Participants viewed videotaped depictions of simulated patients wi th mild and moderate symptoms of schizophrenia, with and without a common a dverse drug effect (pseudoparkinsonism), and then provided standard gamble and visual analog scale ratings of desirability of these states. SUBJECTS. A convenience sample of unrelated patients (n = 148), family memb ers of patients (n = 91), and HCPs (nurses, psychologists, doctors of pharm acy, and doctors of medicine; n = 99) was drawn from geographically and cli nically diverse environments. RESULTS. Patients' and family members' utilities for health states averaged 0.1 to 0.15 units higher than those of HCPs (P <0.002 for differences betw een groups, ANOVA for multiple observations). The disutility of adverse dru g effects was less for health professionals than patients and family member s (P = 0.008). Health professionals tended to prefer states with mild sympt oms with extrapyramidal side effects to states with moderate symptoms. Pati ents and family members found these states equally preferable (P <0.007 for differences between groups). CONCLUSIONS. There are systematic differences in values for health outcomes between patients and HCPs with regard to states with adverse effects of an tipsychotic drugs. Family members of patients in general had values that we re more similar to those of patients than were those of health professional s. The results emphasize the importance of participation by patients (or fa mily member proxies) in clinical decision making and guideline development.