Population Preferences for Treatment in Life-Limiting Illness: Valuing the Way Time Is Spent at the End of Life

Patricia Kenny, Deborah J. Street and Jane Hall
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Patricia Kenny: University of Technology Sydney (Centre for Health Economics Research & Evaluation [CHERE]), Sydney, Australia
Deborah J. Street: University of Technology Sydney (Centre for Health Economics Research & Evaluation [CHERE]), Sydney, Australia
Jane Hall: University of Technology Sydney (Centre for Health Economics Research & Evaluation [CHERE]), Sydney, Australia

Medical Decision Making, 2025, vol. 45, issue 7, 849-861

Abstract: Introduction Societal preferences over different health states are used to guide service planning, but there has been little investigation of treatment preferences at the end of life. This study aimed to examine population preferences for active treatment or palliation for cancer patients when life expectancy is limited and the relative importance of time spent in hospital or with functional limitation. Methods We used a discrete choice experiment that presented respondents with a series of hypothetical patients who had died, describing their last few months of life. Respondents selected the end-of-life alternative they thought best. Data were collected from 1,502 Australian adults participating in an online survey panel. Latent class analysis was used to identify groups with different preference patterns. Results Four preference groups were identified along with an additional group that we termed inattentive , as they appeared to respond at random. Among the 1,070 respondents assigned to 1 of the 4 preference groups, 33.5% favored longer overall survival regardless of how that time was spent; 26.1% were willing to accept a shorter survival time for less time in the hospital or completely incapacitated at home, and they had a stronger preference for palliative care in older patients; 22.5% strongly supported the use of palliative care regardless of the age of the patients, preferring less time in the hospital or time at home with any functional limitations; and 17.9% had a strong preference to not use palliative care. Conclusions Our results show distinct heterogeneity in population preferences for end-of-life care. Policy goals and service planning should acknowledge this heterogeneity and provide end-of-life support services that offer the flexibility to enhance patient choice. Many current funding approaches are not consistent with the philosophy of patient-centered care. Policy makers can and should be exploring innovative approaches to improve efficiency and equity. Highlights Social preferences, based on a general population survey, vary across palliative and active care approaches. Preferences for palliative care and willingness to tolerate time in hospital and time at home with activity limitations varied within the groups willing to trade quality and quantity of life. Policy, resource allocation, and funding methods should accommodate this variability.

Keywords: Discrete choice experiment; palliative care; community preferences (search for similar items in EconPapers)
Date: 2025
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:45:y:2025:i:7:p:849-861

DOI: 10.1177/0272989X251346203

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