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Do Nonpatients Underestimate the Quality of Life Associated with Chronic Health Conditions because of a Focusing Illusion?

Author

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  • Peter A. Ubel

    (Veterans Affairs Medical Center, Ann Arbor, Michigan, Division of General Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Program for Improving Health Care Decisions, Ann Arbor, Michigan)

  • George Loewenstein

    (Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania)

  • John Hershey

    (Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, the Wharton School, University of Pennsylvania, Philadelphia)

  • Jonathan Baron

    (Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Department of Psychology, University of Pennsylvania, Philadelphia)

  • Tara Mohr

    (Division of General Internal Medicine, University of Pennsylvania, Philadelphia)

  • David A. Asch

    (Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Veterans Affairs Medical Center, Philadelphia, Pennsylvania)

  • Christopher Jepson

    (Division of General Internal Medicine, University of Pennsylvania, Philadelphia)

Abstract

Background . A number of studies show that the general public often estimates that the quality of life (QOL) associated with various health conditions is worse than patients say it is. These studies raise the possibility that people overestimate the impact that unfamiliar health conditions will have on their quality of life. One possible reason people overestimate this is because they are susceptible to a focusing illusion—when asked to imagine themselves in unfamiliar circumstances, people overestimate the emotional impact of those features of their life that would change. Methods . The authors surveyed members of the general public to test the hypothesis that their QOL ratings of hypothetical health conditions would be higher (indicating a better quality of life) after thinking about how the health condition would affect a broad range of life domains. Across 3 experiments, the authors varied the health conditions people were asked to consider (either paraplegia, below-the-knee amputation, or partial blindness), the life domains they were asked to consider, the response mode with which they evaluated how each health condition would affect each life domain, whether subjects rated the health condition before and after considering life domains or only after, and whether subjects rated their own current quality of life first. Results . Across 3 experiments, using 10 different questionnaire versions, only 1 instance was found in which subjects’ ratings were significantly higher after thinking about the effect of the health condition on life domains than before, and the magnitude of this increase was small. Conclusion . It could not be established that a focusing illusion contributes significantly to the discrepancy in QOL ratings of patients and nonpatients. Further research should explore other factors that could contribute to the discrepancy or other ways of testing for the influence of a focusing illusion.

Suggested Citation

  • Peter A. Ubel & George Loewenstein & John Hershey & Jonathan Baron & Tara Mohr & David A. Asch & Christopher Jepson, 2001. "Do Nonpatients Underestimate the Quality of Life Associated with Chronic Health Conditions because of a Focusing Illusion?," Medical Decision Making, , vol. 21(3), pages 190-199, May.
    • Handle: RePEc:sae:medema:v:21:y:2001:i:3:p:190-199
    DOI: 10.1177/0272989X0102100304
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    References listed on IDEAS

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    1. Gibbons, F. X., 1999. "Social comparison as a mediator of response shift," Social Science & Medicine, Elsevier, vol. 48(11), pages 1517-1530, June.
    2. Sprangers, Mirjam A. G. & Schwartz, Carolyn E., 1999. "Integrating response shift into health-related quality of life research: a theoretical model," Social Science & Medicine, Elsevier, vol. 48(11), pages 1507-1515, June.
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    3. van Praag, Bernard M. S. & Ferrer-i-Carbonell, Ada, 2001. "Age-Differentiated QALY Losses," IZA Discussion Papers 314, Institute of Labor Economics (IZA).
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    5. Peña-Longobardo, L.M. & Rodríguez-Sánchez, B. & Oliva-Moreno, J., 2021. "The impact of widowhood on wellbeing, health, and care use: A longitudinal analysis across Europe," Economics & Human Biology, Elsevier, vol. 43(C).
    6. Cass R. Sunstein, 2008. "Illusory Losses," The Journal of Legal Studies, University of Chicago Press, vol. 37(S2), pages 157-194, June.
    7. Paul Dolan, 2011. "Thinking about it: thoughts about health and valuing QALYs," Health Economics, John Wiley & Sons, Ltd., vol. 20(12), pages 1407-1416, December.
    8. Paul Dolan & Daniel Kahneman, 2008. "Interpretations Of Utility And Their Implications For The Valuation Of Health," Economic Journal, Royal Economic Society, vol. 118(525), pages 215-234, January.
    9. Damschroder, Laura J. & Zikmund-Fisher, Brian J. & Ubel, Peter A., 2005. "The impact of considering adaptation in health state valuation," Social Science & Medicine, Elsevier, vol. 61(2), pages 267-277, July.
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    11. A. Pickard & Rima Tawk & James Shaw, 2013. "The effect of chronic conditions on stated preferences for health," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(4), pages 697-702, August.
    12. Octave Jokung & Serge Macé, 2013. "Long-term health investment when people underestimate their adaptation to old age-related health problems," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(6), pages 1003-1013, December.
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    14. Björn Sossong & Stefan Felder & Malte Wolff & Klaus Krüger, 2017. "Evaluating the consequences of rheumatoid arthritis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(6), pages 685-696, July.

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