British Journal of Anaesthesia, 2003, Vol. 90, No. 4 526-527
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia
Correspondence |
Patient preferences for immediate postoperative recovery
Hershey, PA, USA
Editor—I would like to thank Drs Eberhart, Morin, Wulf, and Geldner1 for having taken an interest in patient preferences for immediate postoperative recovery states, and specifically for having validated my preliminary results.2 Although not published as a full report, the study has continued, with a near-doubling of subjects, but with very similar results.3 The qualitatively similar, but quantitatively different results reported by Eberhart and colleagues,1 may reflect their simplification of the simulation scenarios.
There does not appear to be much point in administering the simulation to patients just before anaesthesia, as Eberhart and colleagues did, especially as there was no plan to use the results to modify the anaesthetic management to suit their patients’ preferences. However, given that meeting patients’ preferences is a goal of high-quality care,4 it is tantalizing to wonder whether patients would actually regard care of higher quality if it were tailored specifically to address their preferences.
An additional comment is warranted regarding the notion of willingness-to-pay that I introduced into patient-preference studies,2 and which others1 5 6 have emulated. The naïve reader may conclude erroneously that the goal is to identify a price that the patient might actually be asked to pay, beyond whatever their insurance covers. Actually, the methodology is an approach to assessing societal benefit of a technology (e.g. prophylactic antiemetic therapy), acknowledging that financial resources are limited, whereas potential opportunities for spending are unlimited. Willingness-to-pay offers one of the few ways in the evaluation of health care interventions to perform a true cost– benefit analysis, which is rarely possible because cost–benefit analysis requires that all health outcomes be valued solely in monetary terms. One might hope that these studies will usher in greater interest in evaluating care from the patient’s perspective.
F. K. Orkin
Hershey, PA, USA
References
1 Eberhart LHJ, Morin AM, Wulf H, Geldner G. Patient preferences for immediate postoperative recovery. Br J Anaesth 2002; 89: 760–1
2 Orkin FK. What do patients want? Preferences for immediate postoperative recovery. Anesth Analg 1992; 74: S225
3 Orkin FK. Preferences and willingness to pay for postanesthetic recovery states. Med Decis Making 1997; 17: 543
4 Gerteis M, Edgman-Levitan S, Daley J, Delbanco TL, eds. Through the Patient’s Eyes: Understanding and Promoting Patient-Centered Care. San Francisco: Jossey-Bass, 1993; 19–44
5 Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999; 89: 652–8
6 Gan TJ, Sloan FJ, Dear G, El-Moalem HE, Lubarksy DA. How much are patients willing to pay to avoid postoperative nausea and vomiting? Anesth Analg 2001; 92: 393–400
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