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Wednesday, 20 October 2004

This presentation is part of: Poster Session - Utility Theory; Health Economics; Patient & Physician Preferences; Simulation; Technology Assessment

THE HAPPINESS GAP: A MATTER OF CONTEXT?

Heather M. Pond, PhD1, Angela Fagerlin, PhD2, Christine Goldstein, MSW2, Dylan M. Smith, PhD2, George Loewenstein, PhD3, and Peter A. Ubel, MD2. (1) VA Ann Arbor Health Care System, Program for Improving Health Care Decisions, Ann Arbor, MI, (2) University of Michigan, Internal Medicine, Ann Arbor, MI, (3) Carnegie Mellon University, Department of Social & Decision Sciences, Pittsburgh, PA

Purpose: When healthy non-patients are asked to estimate the happiness associated with a given health condition, their estimates typically differ from those made by patients who have experience with that condition. This happiness gap might occur because patients� experience provides contextual knowledge about the relative severity of the condition that is unavailable to non-patients � they are better able to appreciate the emotional impact of mild versus severe disease. This study tested whether non-patients distinguish more between different lung conditions when provided with contextual information about disease severity and whether increased discrimination reduces the happiness gap.

Method: We recruited a convenience sample of 240 non-patients from a hospital cafeteria, and 158 patients with chronic bronchitis or emphysema from a hospital pulmonary clinic. Patients and non-patients were randomly assigned either to provide QoL estimates for each of 5 lung conditions of varying severity (context condition), or only 1 of these possible conditions (no context information). QoL estimates were made on a scale of 0 (as bad as death) to 100 (perfect health).

Results: Non-patients� QoL ratings for the 5 lung conditions were more broadly distributed in the context condition (range = 45.15) than the no context condition (range = 15.81). However, non-patients ratings were still more narrowly distributed than patients ratings in both the context (range = 66.89) and the no context condition (range = 28.66), and the happiness gap was not eliminated in the context condition.

Conclusions: Providing contextual information to non-patients about the relative severity of a given health condition increases their discrimination among these conditions, but does not eliminate the gap between patients� and non-patients� ratings. Contextual information does not equalize patients� and non-patients� perceptions of emphysema and thus cannot readily account for the happiness gap.


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