Worse Than Death: Survey of Public Perceptions of Disability Outcomes After Hypothetical Traumatic Brain Injury.
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Worse Than Death: Survey of Public Perceptions of Disability Outcomes After Hypothetical Traumatic Brain Injury.

Wilson, Jo Ellen;Shinall, Myrick C;Leath, Taylor C;Wang, Li;Harrell, Frank E;Wilson, Laura D;Nordness, Mina F;Rakhit, Shayan;de Riesthal, Michael R;Duff, Melissa C;Pandharipande, Pratik P;Patel, Mayur B;
annals of surgery 2020
435
wilson2020worseannals

Abstract

The aim of this study was to determine the health utility states of the most commonly used traumatic brain injury (TBI) clinical trial endpoint, the Extended Glasgow Outcome Scale (GOSE).Health utilities represent the strength of one's preferences under conditions of uncertainty. There are insufficient data to indicate how an individual would value levels of disability after a TBI.This was a cross-sectional web-based online convenience sampling adaptive survey. Using a standard gamble approach, participants evaluated their preferences for GOSE health states 1 year after a hypothetical TBI. The categorical GOSE was studied from vegetative state (GOSE2) to upper good recovery (GOSE8). Median (25th percentile, 75th percentile) health utility values for different GOSE states after TBI, ranging from -1 (worse than death) to 1 (full health), with 0 as reference (death).Of 3508 eligible participants, 3235 (92.22%) completed the survey. Participants rated lower GOSE states as having lower utility, with some states rated as worse than death, though the relationship was nonlinear and intervals were unequal between health states. Over 75% of participants rated a vegetative state (GOSE2, absence of awareness and bedridden) and about 50% rated lower severe disability (GOSE3, housebound needing all-day assistance) as conditions worse than death.In the largest investigation of public perceptions about post-TBI disability, we demonstrate unequally rated health states, with some states perceived as worse than death. Although limited by selection bias, these results may guide future comparative-effectiveness research and shared medical decision-making after neurologic injury.

Keywords

analytische psychologie und träume kernqualitäten von träumen psicoterapia psychotherapieintegration psychotherapy integration traumarbeit analytical psychology and dreams cerebro soñante cerveau en train de rêver cervello sognante core qualities of dreams cualidades centrales de sueños dreamwork integración integrazione psicoterapeutica intégration en psychothérapie lavoro sui sogni psicologia analitica e sogni psicología analítica y sueños psychologie analytique et rêves qualità fondamentali dei sogni qualités essentielles des rêves the dreaming brain trabajo de sueños travail sur les rêves träumendes gehirn аналитическая психология и сновидения интеграция психотерапевтических подходов ключевые качества сновидений работа со сновидениями сновидящий мозг 做梦脑 分析心理学和梦 心理治疗整合 梦的工作 梦的核心特征

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DOI:
10.1097/SLA.0000000000003389

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ID: 85892
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