Abstract
6129 Background: Measuring patient preferences for health states related to prostate cancer treatment outcomes provides valuable input to help patients make informed treatment decisions. The most accepted method for direct utility assessment is the standard reference gamble (SG). Methods: A pilot study was conducted with 21 newly diagnosed prostate cancer patients at a VA medical center. Each patient completed 6 standard gambles with health states including training exercises with mild and severe arthritis, current health, urinary incontinence, impotence, and both incontinence and impotence. They also rated each state using a visual analogue scale (VAS). The research assistant assessed patient comprehension. Responses were considered invalid if (1) they were inconsistent if combined symptoms were rated as better than either symptom alone, (2) the subject rated all scenarios at 0.5, (3) rank order of states differed from VAS, or (4) the subject rated all scenarios equal to perfect health AND the research assistant judged that there was incomprehension. Literacy was assessed in 19 of the subjects using the Rapid Estimate of Adult Literacy in Medicine (REALM). For comparative purposes, 5 urologists provided preferences for the same scenarios. Results: The mean REALM score (59) corresponded with 7th-8th grade literacy (low literacy is defined as < than 9th grade). Only 57% (12) patients gave potentially valid responses. There was a trend toward better performance in high literacy patients that did not reach statistical significance (χ2 p = 0.37). All urologists gave valid responses. Conclusions: Standard reference gamble assessments of utilities may be difficult to accurately assess in a VA population, particularly in patients with low literacy. Utilities directly elicited from low literacy patients should be done with caution, particularly when used to guide shared clinical decision-making or policy formation. No significant financial relationships to disclose.
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