Considering the Balance:: Development of a Scale to Assess Patient Views on Trade-Offs in Competing Health Outcomes

• Autores: Siobhan M. Case, Virginia Towle, Terri R. Fried
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 61, Nº. 8, 2013, págs. 1331-1336
• Idioma: inglés
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• Resumen

  • Objectives: To describe the development of a scale assessing participant attitudes regarding two commonly encountered trade-offs: quality versus quantity of life and present versus future health.

    Design: Observational cohort study.

    Setting: Community.

    Participants: Three hundred and fifty-seven community-dwelling adults aged 65 and older.

    Measurements: An initial set of 20 items rated on a 5-point Likert scale of agreement was reduced using principal components analysis. Construct validity was evaluated through comparison of the scale with other tools addressing the same trade-offs and analysis of participant characteristics associated with attitudes favoring quality over quantity of life and present over future health. Internal consistency was assessed using Cronbach alpha. Test�retest reliability was assessed using intraclass correlation coefficients (ICCs).

    Results: The scale consists of two subscales, each addressing one trade-off, with a total of 10 items. All factor loadings were 0.5 and greater, and subscale scores were significantly different (P ? .05) in the expected directions when comparing with other tools and with participant race, education, and religious identity. Internal consistency was good (Cronbach ? 0.85 and 0.84), and test�retest reliability was fair (ICCs 0.63 and 0.47). Subscale score medians fell near the middle of each scale, with narrow interquartile ranges, but more than 15% of the sample scored at an extreme of each subscale.

    Conclusion: This new scale captures views on two common trade-offs in health care. Although test�retest reliability was modest, its high validity suggests that this tool can be used to familiarize people with common trade-offs and further explore influences on attitudes.