Eliciting patient disutilities for the adverse outcomes of cardiopulmonaryresuscitation

Background: in helping patients decide about treatments, such as whether to authorize cardiopulmonary resuscitation (CPR), physicians typically presen t information about the possible outcomes and their likelihoods. The aim of this study was to elicit patient disutilities for the adverse outcomes of cardiopulmonary resuscitation (CPR) using the methodology of NH Anderson's functional theory of cognition and to determine how patients integrate the disutility and the likelihood of an outcome. Methods: 77 French adults rate d scenarios of possible outcomes of CPR on a linear scale with anchors 'wha t would be the best (or worst) for me.' In 25 of the 27 scenarios, the resu lt would be either total recovery or one of five adverse outcomes (chest in jury, mild reversible brain damage, severe irreversible brain damage, death after intensive care, immediate death) with one of five likelihoods (one t o five chances out of ten). In the other two, the only possible result was either total recovery or immediate death. Results. the mean disutilities re lative to 0 for chest injury and 100 for severe brain damage were 13 for mi ld brain injury, 68 for death after intensive care, and 69 for immediate de ath. The graphs of the ratings of each adverse outcome in relation to its f requency were fan-shaped, showing that participants integrated this informa tion multiplicatively. Conclusions: the functional theory of cognition prov ides an alternate method of eliciting patient utilities for the outcomes of CPR and supports clinicians' assumption that people combine utility and li kelihood multiplicatively. (C) 2001 Elsevier Science Ireland Ltd. All right s reserved.