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.
Brickman P, Coates D, Janoff-Bulman R.Lottery winners and accident victims: is happiness relative?J Personality Soc Psych. 1978;36:917-927.
2.
Sackett DL, Torrance GW. The utility of different health states as perceived by the general public. J Chronic Diseases. 1978;31:697—704.
3.
Boyd NF, Sutherland HJ, Heasman KZ, Tritchler DL, Cummings BJ. Whose utilities for decision analysis?Med Dec Making. 1990;10:58—67.
4.
Gold MR, Siegel J, Russell LB, Weinstein M, eds. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press, 1996.
5.
Gilbert DT, Pinel EC, Wilson TD, Blumberg SJ, Wheatley TP. Immune neglect: a source of durability bias in affective forecasting. J Personality Soc Psych. 1998;75:617-638.
6.
Wilson TD, Wheatley T, Meyers JM, Gilbert DT, Axsom D.Focalism: A source of durability bias in affective forecasting. J Personality Soc Psych. 2000;78:821-836.
7.
Schkade DA, Kahneman D.Does living in California make people happy? A focusing illusion in judgments of life satisfaction. Psych Sci. 1998;9:340-346.
8.
Sieff EM, Dawes RM, Loewenstein G.Anticipated versus actual responses to HIV test results. Am J Psych. 1999;112(2):297-311.
9.
Loewenstein G, Frederick S.Predicting reactions to environmental change. In: Bazerman andothers, eds. Environment, Ethics, and Behavior: The Psychology of Environmental Valuation and Degradation. San Francisco: New Lexington, 1997.
10.
Froberg DG, Kane RL. Methodology for measuring health-state preferences-III: population and context effects. J Clin Epidemiol. 1989;42(6):585-592.
11.
Tversky A, Kahneman D.Judgment under uncertainty: heuristics and biases. Science. 1974;185:1124-1131.
12.
Wilson TD, Houston CE, Etling KM, Brekke N.A new look at anchoring effects: basic anchoring and its antecedents. J Exp Psych: General. 1996;125:387-402.
13.
Frederick S, Loewenstein G.Hedonic adaptation. In: Kahneman ED, Diener E, Schwarz N, eds. Well-Being: The Foundations of Hedonic Psychology. New York: Russell Sage, 1999.
14.
Loewenstein G, Schkade D.Wouldn’t it be nice? Predicting future feelings. In: Kahneman ED, Diener E, Schwarz N, eds. Well-Being: The Foundations of Hedonic Psychology. New York: Russell Sage, 1999.
15.
Gibbons FX. Social comparison as a mediator of response shift. Soc Sci Med. 1999;48(11):1517-1530.
16.
Sprangers MA, Schwartz CE. Integrating response shift into health-related quality of life research: a theoretical model. Soc Sci Med. 1999;48(11):1507-1515.
