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Saroj Saigal, MD, FRCP; Barbara L. Stoskopf, RN, MHSc; David Feeny, PhD; William Furlong, MSc; Elizabeth Burrows, MBA; Peter L. Rosenbaum, MD, FRCP; Lorraine Hoult, BA

JAMA. 1999;281:1991-1997.

Context  In neonatal intensive care, parents make important clinical management decisions in conjunction with health care professionals. Yet little information is available on whether preferences of health care professionals and parents for the resulting health outcomes differ.

Objective  To measure and compare preferences for selected health states from the perspectives of health care professionals (ie, neonatologists and neonatal nurses), parents of extremely low-birth-weight (ELBW) or normal birth-weight infants, and adolescents who were either ELBW or normal birth-weight infants.

Design  Cross-sectional cohort study.

Setting and Participants  A total of 742 participants were recruited and interviewed between 1993 and 1995, including 100 neonatologists from hospitals throughout Canada; 103 neonatal nurses from 3 regional neonatal intensive care units; 264 adolescents (aged 12-16 years), including 140 who were ELBW infants and 124 sociodemographically matched term controls; and 275 parents of the recruited adolescents.

Main Outcome Measure  Preferences (utilities) for 4 to 5 hypothetical health states of children were obtained by direct interviews using the standard gamble method.

Results  Overall, neonatologists and nurses had similar preferences for the 5 health states, and a similar proportion rated some health states as worse than death (59% of neonatologists and 68% of nurses;P=.20). Health care professionals rated the health states lower than did parents of ELBW and term infants (P<.001). Overall, 64% of health care professionals and 45% of parents rated 1 or more health states to be worse than death (P<.001). Differences in mean utility scores between health care professionals and parents and adolescent respondents were most pronounced for the 2 most severely disabled health states (P<.001).

Conclusions  When asked to rate the health-related quality of life for the hypothetical conditions of children, health care professionals tend to provide lower utility scores than do adolescents and their parents. These findings have implications for decision making in the neonatal intensive care unit.

Author Affiliations: Departments of Pediatrics (Drs Saigal and Rosenbaum and Mss Stoskopf, Burrows, and Hoult) and Clinical Epidemiology and Biostatistics and the Centre for Health Economics and Policy Analysis (Dr Feeny and Mr Furlong), McMaster University and Children's Hospital at Hamilton Health Sciences Corporation, Hamilton, Ontario (Drs Saigal and Rosenbaum and Mss Stoskopf, Burrows, and Hoult). Dr Feeny is now with the University of Alberta and the Institute of Pharmaco-Economics, Edmonton, Alberta, and he and Mr Furlong are also with Health Utilities Inc, Dundas, Ontario. Ms Burrows is now with Monash University, Melbourne, Australia.

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