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J Gerontol B Psychol Sci Soc Sci. 2002 Nov;57(6):S348-54.

Assessment of patient preferences: integrating treatments and outcomes.

Author information

  • 1Clinical Epidemiology Unit, West Haven Veterans Affairs Connecticut Healthcare System, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut 06516, USA. terri.fried@yale.edu

Abstract

OBJECTIVES:

The purpose of this study was to develop a patient-centered measure of treatment preference applicable across a range of diseases and treatment decisions.

METHODS:

Instrument development was based on previous research supplemented by open-ended interviews and focus groups. Psychometric properties of the instrument were determined by administration to 125 persons aged 60 or older with a limited life expectancy secondary to congestive heart failure, chronic obstructive pulmonary disease, or cancer. Test-retest and inter-rater reliability were established using intraclass correlation coefficients. Construct validity was established by examining associations of the measure with a single-item question regarding treatment goals and with age, ethnicity, and functional impairment, characteristics known to be associated with preferences. The Willingness to Accept Life-Sustaining Treatment instrument (WALT) consists of 6 scenarios in which respondents weigh treatment burden against treatment outcomes expressed in terms of the likelihood of different health states and length of life following treatment.

RESULTS:

Inter-rater reliability ranged from .73 to .95 and test-retest reliability from .49 to .93. WALT scores were significantly associated with a simpler measure of preference and with age, ethnicity, and functional impairment.

CONCLUSIONS:

The WALT measures patients' treatment preferences, assessed in the context of treatment burden and multiple aspects of treatment outcome with sound psychometric properties.

PMID:
12426443
[PubMed - indexed for MEDLINE]
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