Preferences and Values

“Utility” is a quantitative measurement that describes how much value a person derives from something. In health, utility describes a person’s preference for living in a particular state of health–how much a person likes living in one health state versus another. Utility is measured on a scale of 0 to 1, where 0 corresponds to how much we “like” being dead and 1 corresponds to how much we “like” being in perfect, ideal health. All other health states fall between these two extremes, and are therefore described as a number greater than 0 and less than 1.  So for example, having cancer may have a utility of 0.82, and having HIV might have a utility of 0.90.  Both states of health are less than ideal, but are far better than being dead.

Quality of life describes how we feel about our lives–are we happy? Are we satisfied? Do we feel accomplished? Are we safe and secure? There are many, varied concepts included in quality of life that all describe how we feel about ourselves.  Health related quality of life focuses in on our health–are we healthy? Are we satisfied with our health status? Can we see, hear, and walk? Are we anxious or depressed? HRQOL refers to just the health aspect of our lives, acknowledging that health is intricately tied to our lives in general, and it is difficult to disentangle health related quality of life from quality of life in general.

Spillover is just that–something that “spills over” the brim of one thing and onto another. In health, spillover effects refer to how an illness affects someone other than the patient, and usually we mean family members and caregivers.  Family spillover effects are the effects of a patient’s illness on their family members–the anxiety and stress that comes along with having an ill child, the fatigue and depression of caring for a parent with Alzheimer’s disease, and conversely the satisfaction and fulfillment of being there to support a spouse with cancer.

Choices can be worded in a way that highlights the positive or negative aspects of the same decision, leading to changes in their relative attractiveness. This technique was part of Tversky and Kahneman’s development of prospect theory, which framed gambles in terms of losses or gains (Kahneman & Tversky, 1979). Different types of framing approaches have been identified, including risky choice framing (e.g. the risk of losing 10 out of 100 lives vs. the opportunity to save 90 out of 100 lives), attribute framing (e.g. beef that is described as 95% lean vs. 5% fat), and goal framing (e.g. motivating people by offering a $5 reward vs. imposing a $5 penalty) (Levin, Schneider, & Gaeth, 1998).