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Wednesday, 18 October 2006


Alan Schwartz, PhD1, Ariel Leifer1, Gordon B. Hazen, PhD2, and Paul S. Heckerling, MD1. (1) University of Illinois at Chicago, Chicago, IL, (2) Northwestern University, Evanston, IL

Purpose. Based on Hazen's (2004) goal-related utility proposition, we sought to determine whether differences in life goals may affect willingness to consider trading life years or health quality for goal achievement.

Methods. We conducted random-digit dialing telephone interviews with 50 Chicago-area residents (“community study”) and in-person interviews with 100 inpatients at the University of Illinois Hospital and Jesse Brown Veteran Affairs Hospital (“patient study”). Participants provided up to five goals. For each, they reported (1) how long the goal might take to achieve, (2) whether they would prefer a shorter lifetime with certain goal achievement to their full lifetime without goal achievement, and (3) whether they would prefer lower quality of health with certain goal achievement to full health without goal achievement.

Results. The 685 goals were classified independently by two investigators into four broad categories (family, wealth, professional, and other) comprising seven basic subcategories, with 95% agreement in basic classification. Mixed logistic regression models were fitted to evaluate odds ratios for willingness to trade life years or health for goals.

In each study, respondents were significantly more willing overall to trade life years than health. Controlling for moderate intra-respondent correlation in willingness to trade life years or health for the goals provided, there were significant effects of goal category. Respondents were more likely to be willing to trade life years (community OR=7.39, 95% CI [2.42, 22.5]; patient OR=3.26 [1.63,6.52]) or health (community OR=5.11 [1.67,15.6]; patient OR=1.92 [1.04,3.55]) to achieve family goals than other categories of goals. This effect was significantly stronger for men than women. Patients were also less willing to trade health for wealth-related goals than other categories (OR=0.55 [0.31,0.99]). There were no differences in either study by age, ethnicity, time horizon for goal, or, in the patient study, hospital site.

Conclusions. We derive a typology of life goals and offer healthy and hospitalized respondents simple qualitative tradeoff choices. Our results support Hazen's hypothesis that standard time-tradeoff assessments may be systematically influenced by respondents' goals. People with family-related goals that depend on health quality may be more willing to trade life years beyond when they expect to achieve the goal, and may appear to report a lower quality of life, regardless of their experience of quality of health, than those without such goals.

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See more of The 28th Annual Meeting of the Society for Medical Decision Making (October 15-18, 2006)