Utility Structure of a Medical Decision-Making Problem

This paper investigates the utility structure of decision outcomes in the treatment of cleft lip and cleft palate. Utilities are assessed by questionnaire from 119 individuals representing 13 clinical specialties, as well as members of the families of cleft lip and palate children. The results of the survey demonstrate the validity of certain utility independence assumptions used to simplify the assessment of multiattribute utility functions. We found significant differences in utilities among clinicians, grouped according to their specialty and the treatment facility to which they are affiliated. Members of the families of cleft lip and palate children also differed with certain clinical specialty groups. The paper concludes with a discussion of the differences in the assessed utility functions and their implications for clinical decision making.