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Monday, 16 October 2006


Ahmed M. Bayoumi, MD, MSc, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada

Purpose: Computer-assisted utility elicitation programs are convenient and may ameliorate some measurement biases. We surveyed study participants about the acceptability and cognitive burden of one such program.

Methods: We incorporated a paper-based survey into a utility elicitation study in which patients living with Human Immunodeficiency Virus Infection rated standardized scenarios using the Rating Scale (RS), Time Trade-off (TTO), and Standard Gamble (SG) tasks. An interviewer guided respondents through the program which incorporated audio recordings of health state descriptors and appropriate visual aids: a feeling thermometer for the RS, horizontal bars (representing time in best health and time traded) for the TTO, and black sad / white happy faces (representing the probabilities of best health / death). For each task, we asked respondents to rate: a) whether the tasks were difficult to understand; b) whether the visual aids were helpful; c) whether the questions were difficult to understand; and d) whether the questions were emotionally upsetting. In addition, we asked respondents general questions about utility elicitation and using a computer. Responses were rated on a 5-point Likert scale. In the current analysis we report the proportion of respondents who expressed any agreement with the statements.

Results: We surveyed 107 respondents, of whom 95% were male and 76% were white. The mean (± standard deviation) age was 44.0± 9.1. For each of the RS, SG, and TTO, the proportion of respondents who found the tasks difficult to understand were 16%, 11%, and 9%, respectively; who found the visual aids helpful were 79%, 77%, and 79%; who found the tasks unrealistic were 15%, 15%, and 17%; and who found the tasks emotionally upsetting were 9%, 12%, and 14% (TTO and SG were significantly more upsetting than the RS by the Wilcoxon signed-rank test). Respondents were generally positive about the utility elicitation exercises: 64% agreed with the statement that “these sorts of exercises would help me in making decisions about my medical care,” 91% found the computer easy to use, and only 2% said that they did not like answering questions on a computer.

Conclusions: Respondents found computer-based elicitation interviews with integrated visual aids to be accessible, understandable, and generally acceptable. The SG and TTO were slightly more upsetting than the RS, but were comparable to each other.

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