A Dartmouth Atlas Project Topic Brief Preference-sensitive Care

Preference-sensitive care comprises treatments that involve significant tradeoffs affecting the patient’s quality and/or length of life. decisions about these interventions – whether to have them or not, which ones to have – ought to reflect patients’ personal values and preferences, and ought to be made only after patients have enough information to make an informed choice. sometimes, as with the options for treating early stage breast cancer, the scientific evidence on the main outcome – survival – is quite good; other times, as with treatment options following prostate cancer, the evidence is much weaker. the surgical options for the treatment of early stage breast cancer , for example, usually include mastectomy (complete removal of the breast) or lumpectomy (” breast-sparing surgery, ” a local excision of the tumor). a series of clinical trials have shown that the impact on survival is about the same for both approaches. But the other outcomes are quite different. the consequences for women who choose mastectomy include the loss of the breast and, for some, using a prosthesis or undergoing recon-structive surgery. For women who choose breast-sparing surgery, the consequences can include having radiation and/or chemotherapy and living with the risk of local recurrence, which will require further surgery. which treatment a woman chooses should depend on her own, rather than her physician’s, opinion about these outcomes. there is unwarranted variation in the practice of medicine and the use of medical resources in the united states. there is underuse of effective care, misuse of preference-sensitive care, and overuse of supply-sensitive care. the variations in rates of these kinds of procedures described in the Dartmouth Atlas of Health Care suggest that local medical opinion has a strong influence on the choice of treatment. there are striking variations in the proportion of early stage breast cancer patients who undergo lumpectomy. In an early study (1992-93), we found regions in which virtually no medi-care women underwent lumpectomy, but one region in which almost 50% did. sometimes, adjoining regions had strikingly different rates. For example, in the Elyria, ohio hospital referral region, 48% of medicare women had breast-sparing surgery unwarranted Variation: the overuse, underuse, and misuse of care there is unwarranted variation in the practice of medicine and the use of medical resources in the united states. there is underuse of effective care, misuse of preference-sensitive care, and overuse of supply-sensitive care. n underuse of most kinds of effective …