Sir,
I found the paper by Dr Sculpher and collagues highly interesting and
relevant, but what strikes me is the hypothetical nature of the decision
making. I am afraid people tend to value things differently when they
actually experience the situation - which is the shortcoming of utility
assessment. A more relevant approach would be conducting a trial of actual
patients choosing the treatment for themselves. We have tried to adopt
such a strategy in a trial where the intervention was different level of
guidance for choosing the treatment (Auvinen et al. BJU Int 2004;93:52-
56). Patients who received a treatment recommendation were more frequently
treated surgically than those for whom no preference between treatment
options was given by the physician. This result is in accordance with the
findings by Sculpher and others. However, I feel more knowledge can be
gained by applying a rigoristic study design in research into patient
participation in decision-making ("empirical ethics").
Competing interests:
None declared
Competing interests:
No competing interests
14 April 2004
Anssi Auvinen
professor of epidemiology
Tampere School of Public Health, FIN-33014 University of Tampere, FINLAND
Rapid Response:
Interesting, but hypothetical
Sir,
I found the paper by Dr Sculpher and collagues highly interesting and
relevant, but what strikes me is the hypothetical nature of the decision
making. I am afraid people tend to value things differently when they
actually experience the situation - which is the shortcoming of utility
assessment. A more relevant approach would be conducting a trial of actual
patients choosing the treatment for themselves. We have tried to adopt
such a strategy in a trial where the intervention was different level of
guidance for choosing the treatment (Auvinen et al. BJU Int 2004;93:52-
56). Patients who received a treatment recommendation were more frequently
treated surgically than those for whom no preference between treatment
options was given by the physician. This result is in accordance with the
findings by Sculpher and others. However, I feel more knowledge can be
gained by applying a rigoristic study design in research into patient
participation in decision-making ("empirical ethics").
Competing interests:
None declared
Competing interests: No competing interests