Chest
Volume 117, Issue 6, June 2000, Pages 1551-1559
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Clinical Investigations
SURGERY
Patient Preferences Regarding Possible Outcomes of Lung Resection

https://doi.org/10.1378/chest.117.6.1551Get rights and content

Context

Lung resection can lead to significant postoperative complications: Although many reports describe the likelihood of postoperative problems, such as atelectasis, pneumonia, and prolonged ventilator dependence, it is unclear whether patients perceive these outcomes as sufficiently severe to influence their decisions about surgery.

Objective

To assess patients’ preferences regarding possible outcomes of lung resection, including traditional complications reported in the lung surgery literature and outcomes that describe functional limitation.

Design

Utility analysis.

Setting

A community hospital internal medicine clinic, a private internal medicine practice, and a private pulmonary practice.

Participants

Sixty-four patients, aged 50 to 75 years, who were awaiting appointments at the designated clinic sites.

Main outcome measure

Patients’ strength of preference regarding potential outcomes of lung resection as derived from health utility scores.

Results

Common postoperative complications were assigned high utility scores by patients. On a scale for which 1.0 represents perfect health and 0 represents death, postoperative atelectasis, pneumonia, and 3 days of mechanical ventilation were all rated >0.75. Scores describing limited physical function were strikingly low. Specifically, activity limited to bed to chair movement and the need for complete assistance with activities of daily living were all assigned utility scores <0.2. Twenty-four-hour oxygen dependence was scored at 0.33. Presence or absence of pulmonary illness did not predict scores for any outcome.

Conclusions

Whether patients suffer from chronic lung disease or not, they do not regard the postoperative outcomes reported in the lung surgery literature as sufficiently morbid to forego important surgery. However, physical debility is perceived as extremely undesirable, and anticipation of its occurrence could deter surgery. Therefore, identification of preoperative predictors of postoperative physical debility would be invaluable for counseling patients who face difficult decisions about lung resection.

Section snippets

Materials and Methods

The methods used in this report are described in detail elsewhere.14 Sixty-four patients aged 50 to 75 years were interviewed between September 1996 and April 1997 while awaiting appointments at three sites: the general internal medicine clinic of a community teaching hospital (n = 15), a private internal medicine practice (n = 20), and a pulmonary medicine practice (n = 29). Consecutive patients aged 50 to 75 years, regardless of current health or medical diagnoses, were recruited at the

Results

Demographic data are reported in Table 1 . Notably, 60% of participants were women, 20% were African Americans, and the average age was 60 years. Forty-four percent of the patients regarded themselves to be in good health compared with 36% who considered their health to be poor. As previously mentioned, all 29 pulmonary clinic patients had to report lung-related functional limitation or past mechanical ventilation to be enrolled in the study.

Utility scores with 95% confidence intervals (CIs)

Discussion

Individuals who require lung resection are often long-term smokers who at baseline suffer from respiratory debility because of chronic lung disease. Many attempts have been made to identify patients in this group who are likely to encounter postoperative complications.1, 23, 45, 67, 89, 1011, 1213, 1617, 1821, 2223, 2425, 26 Death is certainly an important complication, and past reports suggest that patients with advanced lung disease identified by a predicted postoperative FEV1 < 40% and

Patient Questionnaire Scenarios (all scenarios have the intermediate outcome in italics)

1. You have been diagnosed as having a small lung cancer in the middle of your right lung. To cure the cancer and restore your normal life expectancy, a treatment is available. However, with the treatment, there is a chance of dying immediately. If you did not have the treatment, the cancer would progress, you would be dead in 18 months, and the last 6 months would be marked by physical deterioration, such as an inability to walk more than a few steps, and pain that requires narcotic

ACKNOWLEDGMENT

The authors thank the Internal Medicine Program, the Moses Cone Health System, and the Greensboro Area Health Education Center of the University of North Carolina for their financial and logistical support of this project. We also thank Drs. Patrick Wright and Hal Stoneking for their contributions to this project.

References (31)

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Presented, in part, at the national meeting of the Society of General Internal Medicine, Washington, DC, May 3, 1997.

Supported by the Education Committee of the Moses Cone Health System.

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