Agreement between prostate cancer patients and their clinicians about utilities and attribute importance

Arthur S. Elstein*, Gretchen B. Chapman, Joan S. Chmiel, Sara J. Knight, Cheeling Chan, Robert B. Nadler, Timothy M. Kuzel, Amy K. Siston, Charles L. Bennett

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


Purpose: To examine the agreement between prostate cancer patients' utilities for selected health states and their rankings of the importance of six attributes of the health states and the clinicians' judgements of what would be in the patients' best interests. Method: Patients with newly diagnosed localized prostate cancer individually completed a time trade-off utility assessment shortly after being diagnosed. The health states evaluated were constructed from a multi-attribute utility model that incorporated six aspects of living with the disease and outcomes of treatment. Each patient assessed his current health state and three hypothetical states that might occur in the future, and provided rankings of the importance of the six attributes. The clinicians caring for each patient independently provided their views of what utilities and importance rankings would be in the patient's best interest. Results: The across-participant correlations between patients' and clinicians' utilities were very low and not statistically significant. Across-participant correlations between patient and clinician importance rankings for the six attributes were also low. Across-health state and across-attribute correlations between utilities or importance rankings were highly variable across patient-clinician pairs. Conclusion: In the clinical settings studied, there is not a strong relationship between valuations of current and possible future health states by patients with newly diagnosed prostate cancer and their clinicians. Implications of these results for substituted judgement, when clinicians advise their patients or recommend a treatment strategy, are discussed.

Original languageEnglish (US)
Pages (from-to)115-125
Number of pages11
JournalHealth Expectations
Issue number2
StatePublished - Jun 2004


  • Preferences
  • Substituted judgement
  • Utility assessment
  • Values

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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