06 Apr Patients and Caregivers May Differ On End-of-Life Choices
Medical Research: What is the background for this study? What are the main findings?
Dr. Malhotra: Patients with advanced cancer often have to make difficult decisions, such as how much to spend on moderately life- extending treatments. This and other end-of-life decisions are also influenced by their informal caregivers. In this study, we aim to understand the relative value that advanced cancer patients and their caregivers place on various aspects of end-of-life care. We conducted a cross-sectional survey of 211 patients with stage IV cancer and their primary informal caregivers. Participants were asked to choose their most-preferred end-of-life scenarios out of a series of options that varied along key dimensions, including years of life remaining, degree of pain experienced, place of death, level of burden on caregivers, quality of healthcare experience, cost, and source of payment (cash, Medisave, or family members’ cash or Medisave). Using the results, we quantified patients and caregivers willingness to pay to improve their end of life experience. We found that the patients’ willingness to pay to extend their life by one year was valued at S$18,570, which is lower than their willingness to pay to avoid severe pain (S$22,199), or to die at home (S$31,256). Caregivers had a three-fold greater willingness to pay than patients to extend life by one year and for most of the other features considered. These results suggest that health insurers and physicians may be putting too much emphasis on life extending treatments for these patients. Further, there is a need to elicit patient preferences during treatment decision making as opposed to just relying on caregiver input.
Medical Research: What should clinicians and patients take away from your report?
Dr. Malhotra: Clinicians need to involve patients directly in decision making for their own treatment rather than just relying on caregivers input.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Malhotra: The research team is planning to extend this research to test patient decision aids that can help ensure that patients’ end-of-life experience is most consistent with their preferences. In addition, an e-learning program will be designed for physicians to teach them how to best communicate with patients regarding their goals of care.
Comparison of preferences for end-of-life care among patients with advanced cancer and their caregivers: A discrete choice experiment Palliat Med 0269216315578803, first published on March 24, 2015 doi:10.1177/026921631557880
MedicalResearch.com Interview with: Prof. Chetna Malhotra M.B.B.S., M.D. M.P.H. (2015). Patients and Caregivers May Differ On End-of-Life Choices