This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

The Importance of Patients' Preferences

Michael J. Barry, MD; Albert G. Mulley, Jr, MD, MPP; Floyd J. Fowler, PhD; John W. Wennberg, MD

JAMA. 1988;259(20):3010-3017.

Abstract
The rate of resection for benign prostatic hypertrophy shows considerable variability among small geographic areas. To help inform the decision to recommend prostatectomy to men with prostatism without signs of chronic retention, we performed a decision analysis to compare the expected outcomes with immediate transurethral resection and watchful waiting. Data used in the model originated from the medical literature, Medicare claims data, and patient interview studies. In our base-case analysis for 70-year-old men, immediate surgery resulted in the loss of 1.01 months of life expectancy, but when adjustments were made for quality of life, immediate surgery was favored with a net utility benefit of 2.94 quality-adjusted life-months. However, the analysis was particularly sensitive to the degree of disutility attributed to the index symptoms of prostatism. We conclude that patient preferences should be the dominant factor in the decision whether to recommend prostatectomy.

(JAMA 1988;259:3010-3017)

Author Affiliations
From the General Internal Medicine Unit, Massachusetts Genera! Hospital, and Harvard Medical School (Drs Barry and Mulley) and The Center for Survey Research, University of Massachusetts (Dr Fowler), Boston; and Dartmouth Medical School, Hanover, NH (Dr Wennberg). Dr Mulley is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine.

Footnotes
Reprint requests to the General Internal Medicine Unit, Massachusetts General Hospital, Bulfinch 1, Fruit St, Boston, MA02114 (Dr Barry).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

When Informed, All Women Do Not Prefer Breast Conservation
Throckmorton and Esserman
JCO 2009;27:484-486.
FULL TEXT  

A Perspective on the Patient's Role in Treatment Decisions
Sepucha and Mulley
Med Care Res Rev 2009;66:53S-74S.
ABSTRACT  

Meeting Seniors' Information Needs: Using Computer Technology
Campbell
Home Health Care Management Practice 2008;20:328-335.
ABSTRACT  

Are Patient Decision Aids the Best Way to Improve Clinical Decision Making? Report of the IPDAS Symposium
Holmes-Rovner et al.
Med Decis Making 2007;27:599-608.
ABSTRACT  

Population-based assessment of the surgical management of locally advanced colorectal cancer.
Govindarajan et al.
JNCI J Natl Cancer Inst 2006;98:1474-1481.
ABSTRACT | FULL TEXT  

Cost-effectiveness Analysis in the Assessment of Diagnostic Imaging Technologies
Gazelle et al.
Radiology 2005;235:361-370.
ABSTRACT | FULL TEXT  

Decision Aids for Benign Prostatic Hyperplasia: Applicability across Race and Education
Rovner et al.
Med Decis Making 2004;24:359-366.
ABSTRACT  

Standard Consultations Are Not Enough to Ensure Decision Quality Regarding Preference-Sensitive Options
O'Connor et al.
JNCI J Natl Cancer Inst 2003;95:570-571.
FULL TEXT  

"What Should I Do, Doc?": Some Psychologic Benefits of Physician Recommendations
Ubel
Arch Intern Med 2002;162:977-980.
FULL TEXT  

Sexual dysfunction in men after treatment for lower urinary tract symptoms: evidence from randomised controlled trial
Brookes et al.
BMJ 2002;324:1059-1059.
ABSTRACT | FULL TEXT  

Patient Preferences and Health Disparities
Katz
JAMA 2001;286:1506-1509.
FULL TEXT  

The Cost-Effectiveness of Sildenafil
Smith and Roberts
ANN INTERN MED 2000;132:933-937.
ABSTRACT | FULL TEXT  

Cost-effectiveness of MR Imaging and Core-Needle Biopsy in the Preoperative Work-up of Suspicious Breast Lesions
Hrung et al.
Radiology 1999;213:39-49.
ABSTRACT | FULL TEXT  

Physicians as Double Agents: Maintaining Trust in an Era of Multiple Accountabilities
Shortell et al.
JAMA 1998;280:1102-1108.
FULL TEXT  

Current Concepts Review - Decision Analysis
BERNSTEIN
JBJS 1997;79:1404-14.
FULL TEXT  

Rapid Approximation of Confidence Intervals for Markov Process Decision Models: Applications in Decision Support Systems
Cher and Lenert
J. Am. Med. Inform. Assoc. 1997;4:301-312.
ABSTRACT | FULL TEXT  

Incorporating Risk Attitude into Markov-process Decision Models:: Importance for Individual Decision Making
Cher et al.
Med Decis Making 1997;17:340-350.
ABSTRACT  

Using a Trade-off Technique to Assess Patients' Treatment Preferences for Benign Prostatic Hyperplasia
Llewellyn-Thomas et al.
Med Decis Making 1996;16:262-272.
ABSTRACT  

Health Perceptions: Real and Imagined
KANE
American Behavioral Scientist 1996;39:707-716.
ABSTRACT  

Medicine--Molecular, Monetary, or More Than Both?
Eisenberg
JAMA 1995;274:331-334.
ABSTRACT  

Life Expectancy Biases in Clinical Decision Modeling
Kuntz and Weinstein
Med Decis Making 1995;15:158-169.
ABSTRACT  

Creating Practice Guidelines: The Dangers of Over-Reliance on Expert Judgment
Kane
J Law Med Ethics 1995;23:62-64.
 

Guidelines, enthusiasms, uncertainty, and the limits to purchasing
McKee and Clarke
BMJ 1995;310:101-104.
FULL TEXT  

A Comparison of Transurethral Surgery with Watchful Waiting for Moderate Symptoms of Benign Prostatic Hyperplasia
Wasson et al.
NEJM 1995;332:75-79.
ABSTRACT | FULL TEXT  

Incorporating Patients' Preferences into Medical Decisions
Kassirer
NEJM 1994;330:1895-1896.
FULL TEXT  

Practice Guidelines: A New Reality in Medicine: III. Impact on Patient Care
Woolf
Arch Intern Med 1993;153:2646-2655.
ABSTRACT  

A Decision Analysis of Alternative Treatment Strategies for Clinically Localized Prostate Cancer
Fleming et al.
JAMA 1993;269:2650-2658.
ABSTRACT  

Benign Prostatic Hyperplasia: Its Natural History, Epidemiologic Characteristics, and Surgical Treatment
Oesterling
Arch Fam Med 1992;1:257-266.
ABSTRACT  

Assessing Symptom Improvement After Elective Prostatectomy for Benign Prostatic Hypertrophy
Flood et al.
Arch Intern Med 1992;152:1507-1512.
ABSTRACT  

Prudent Strategies for Elective Red Blood Cell Transfusion
Welch et al.
ANN INTERN MED 1992;116:393-402.
ABSTRACT  

Problems of Comorbidity in Mortality After Prostatectomy
Concato et al.
JAMA 1992;267:1077-1082.
ABSTRACT  

Further Issues in Small Area Variations Analysis
Stano
Journal of Health Politics, Policy and Law 1991;16:573-588.
ABSTRACT  

Should the Health Care Forest Be Selectively Thinned by Physicians or Clear Cut by Payers?
Welch
ANN INTERN MED 1991;115:223-226.
ABSTRACT  

Decision-making Studies in Patient Management: Twenty Years Later
Beck
Med Decis Making 1991;11:112-115.
ABSTRACT  

Small Area Variations: A Critical Review of Propositions, Methods, and Evidence
Folland and Stano
Med Care Res Rev 1990;47:419-465.
 

Quality-Adjusted Life-Years: Ethical Implications for Physicians and Policymakers
La Puma and Lawlor
JAMA 1990;263:2917-2921.
ABSTRACT  

Outcomeology
Zimmerman
Arch Ophthalmol 1990;108:341-343.
ABSTRACT  

The Medical Outcomes Study: An Application of Methods for Monitoring the Results of Medical Care
Tarlov et al.
JAMA 1989;262:925-930.
ABSTRACT  

The Politics of Organ Transplantation: A Parable of Our Time
Rettig
Journal of Health Politics, Policy and Law 1989;14:191-227.
ABSTRACT  

"Technically Correct and Morally Good": Ethics and Decision Analysis
Friedman
Med Decis Making 1989;9:65-67.
 

Non-expepimental Methods in the Assessment of Ettieaey
Wennberg
Med Decis Making 1988;8:175-176.
 

Symptom Status and Quality of Life Following Prostatectomy
Fowler et al.
JAMA 1988;259:3018-3022.
ABSTRACT  

An Assessment of Prostatectomy for Benign Urinary Tract Obstruction: Geographic Variations and the Evaluation of Medical Care Outcomes
Wennberg et al.
JAMA 1988;259:3027-3030.
ABSTRACT  

WHEN TO PERFORM PROSTATECTOMY: LET THE PATIENT DECIDE
JWatch General 1988;1988:6-6.
FULL TEXT