Anthony Roman

Patient-re ported complications and follow-up treatment after radical prostatectomy

To estimate the probabilities of complications and follow-up treatment, a sample of Medicare patients who underwent radical prostatectomy (1988 through 1990) was surveyed by mail, telephone, and personal interview. Respondents reported their current status with respect to continence and sexual function as well as post-surgical treatments they had had to treat residual or recurrent cancer or surgical complications. Over 30 percent reported currently wearing pads or clamps to deal with wetness; over 40 percent said they drip urine when they cough or when their bladders are full; 23 percent reported daily wetting of more than a few drops. About 60 percent of patients reported having no full or partial erections since their surgery, and only 11 percent had any erections sufficient for intercourse during the month prior to the survey. Six percent had surgery after the radical prostatectomy to treat incontinence; 15 percent had treatments or used devices to help with sexual function; 20 percent report having had post-surgical treatment for urethral strictures. In addition 16 percent, 22 percent, and 28 percent reported follow-up treatment for cancer (radiation or androgen deprivation therapy) at two, three, and four years after radical prostatectomy. These estimates of complication and follow-up treatment rates are generally higher, and almost certainly more representative for older men, than estimates previously published. Patients and physicians may want to weight heavily the complications and need for follow-up treatments when considering radical prostatectomy for prostate cancer.

Mode Effects in a Survey of Medicare Prostate Surgery Patients

There have been numerous studies of how the mode of survey data collection affects the answers respondents give. Some studies have found that telephone, personal interview, and mail surveys usually yield comparable results when responding samples are comparable. However, there are some differences that have been attributed to mode. When differences are found, selfadministered responses have been likely to yield more socially undesirable responses than responses to interviewers (Hochstim, 1967; Locander, 1976; Aquilino, 1990; Turner, et al., 1992; Fowler, 1993). When telephone and personal interviews are compared, telephone interviews may yield fewer socially undesirable responses, when differences occur (Henson, 1977; Singer, 1981; de Leeuw, 1988 ). There are at least three possible explanations for these differences: 1) Respondents are less willing to articulate socially undesirable answers to an interviewer than to write them down. 2) Respondents answer questions differently in self-administration (when they can see the whole scales and subsequent questions) than in an oral interview. 3) There is more time to reflect and consult with others in a mail survey than in an interview.

Measuring public priorities for insurable health care.

The goal of this research was to develop and evaluate a way to measure the value people place on various medical services in their decisions about what health insurance should cover. A vignette approach to measuring consumer values was developed. People were asked to assign priority and desire to have insurance cover 64 different services. A national probability sample of 206 adults was interviewed by telephone. Their ratings were compared with those of a sample of 47 corporate benefits officers of Fortune 500 companies. Priorities were not significantly associated with respondent characteristics. They were positively correlated with independent assessments of the seriousness of the patients condition and the likely efficacy of the services. Priorities and desire to cover were virtually the same when respondents were asked about insurance for a low-income population as for a general population. Two-thirds of the ratings of the public were the same as those of benefit officers. The public gave higher ratings than benefits officers to long-term care and services to relieve worries, and the public gave lower ratings to the value of treatment of substance abuse and services when the patient could be viewed as at fault. This pilot test indicates this is an efficient, feasible, useful strategy for measuring the extent to which people value various medical services that could contribute to the process of making decisions about health insurance coverage.