Quality of life after cerebrovascular stroke: a systematic study of patients' preferences for different functional outcomes

Objectives. To elicit valid quality of life estimates and the highest acceptable treatment risk of different outcomes after stroke. This is a prerequisite for rational medical decision-making, especially when considering treatments like thrombolysis. Subjects. Healthy people, non-stroke medical patients and stroke survivors aged 20-84 years (n = 158) Interventions. Subjects were interviewed by a physician using three different methods ('standard gamble', 'time trade-off and 'direct scaling') supported by an interactive computer program. Main outcome measures. We measured utility, a numerical value ranging from 0.00 (death) to 1.00 (perfect health), representing the strength of the patient's preference for an outcome. When using the standard gamble method, risk is also introduced into the measurement. Results. People's preferences for stroke outcomes varied widely, and the estimates were influenced by assessment method. We found that previous stroke, marital status and age were the only independent variables influencing the utility given. Subjects in our population over the age of 45 were very comparable to the real population at risk for acute stroke regarding these three variables, and they assigned a median utility of 0.91 (10th percentile, 0.65; 90th percentile, 0.99) to a minor stroke and 0.61 (10th percentile, 0.08; 90th percentile, 0.95) to a major stroke using the standard gamble method. Conclusions. Most people do not feel that suffering from stroke is an overwhelming catastrophe and they do not accept treatment options with very high risks.