Community Preferences for the Care of Older People at the End of Life: How Important is the Disease Context?
- Publisher:
- ADIS INT LTD
- Publication Type:
- Journal Article
- Citation:
- Patient, 2024, 17, (4), pp. 407-419
- Issue Date:
- 2024-07
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Full metadata record
Field | Value | Language |
---|---|---|
dc.contributor.author |
Kenny, P |
|
dc.contributor.author | Street, DJ | |
dc.contributor.author |
Hall, J |
|
dc.contributor.author | Agar, MR | |
dc.contributor.author |
Phillips, J |
|
dc.date.accessioned | 2024-07-18T04:34:28Z | |
dc.date.available | 2024-01-25 | |
dc.date.available | 2024-07-18T04:34:28Z | |
dc.date.issued | 2024-07 | |
dc.identifier.citation | Patient, 2024, 17, (4), pp. 407-419 | |
dc.identifier.issn | 1178-1653 | |
dc.identifier.issn | 1178-1661 | |
dc.identifier.uri | http://hdl.handle.net/10453/179783 | |
dc.description.abstract | BACKGROUND: Population preferences for care at the end of life can inform palliative care policy and direction. Research investigating preferences for care at the end of life has focused predominantly on the context of advanced cancer, with relatively little attention to other life-limiting illnesses that are common causes of death. OBJECTIVES: We aimed to investigate preferences for the care of older people at the end of life in three different disease contexts. The purpose was to understand if population preferences for care in the last 3 weeks of life would differ for patients dying from cancer, heart failure or dementia. METHODS: Three discrete choice experiments were conducted in Australia with a general population sample using similar methods but different end-of-life disease contexts. Some attributes were common across the three experiments and others differed to accommodate the specific disease context. Each survey was completed by a different panel sample aged ≥45 years (cancer, n = 1548; dementia, n = 1549; heart failure, n = 1003). Analysis was by separate mixed logit models. RESULTS: The most important attributes across all three surveys were costs to the patient and family, patient symptoms and informal carer stress. The probability of choosing an alternative was lowest (0.18-0.29) when any one of these attributes was at the least favourable level, holding other attributes constant across alternatives. The cancer survey explored symptoms more specifically and found patient anxiety with a higher relative importance score than the symptom attribute of pain. Dementia was the only context where most respondents preferred to not have a medical intervention to prolong life; the probability of choosing an alternative with a feeding tube was 0.40 (95% confidence interval 0.36-0.43). CONCLUSIONS: This study suggests a need for affordable services that focus on improving patient and carer well-being irrespective of the location of care, and this message is consistent across different disease contexts, including cancer, heart failure and dementia. It also suggests some different considerations in the context of people dying from dementia where medical intervention to prolong life was less desirable. | |
dc.format | Print-Electronic | |
dc.language | eng | |
dc.publisher | ADIS INT LTD | |
dc.relation.ispartof | Patient | |
dc.relation.isbasedon | 10.1007/s40271-024-00675-w | |
dc.rights | info:eu-repo/semantics/openAccess | |
dc.subject | 11 Medical and Health Sciences | |
dc.subject.classification | 32 Biomedical and clinical sciences | |
dc.subject.classification | 42 Health sciences | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Male | |
dc.subject.mesh | Female | |
dc.subject.mesh | Aged | |
dc.subject.mesh | Terminal Care | |
dc.subject.mesh | Middle Aged | |
dc.subject.mesh | Australia | |
dc.subject.mesh | Dementia | |
dc.subject.mesh | Aged, 80 and over | |
dc.subject.mesh | Neoplasms | |
dc.subject.mesh | Heart Failure | |
dc.subject.mesh | Patient Preference | |
dc.subject.mesh | Caregivers | |
dc.subject.mesh | Palliative Care | |
dc.subject.mesh | Choice Behavior | |
dc.subject.mesh | Surveys and Questionnaires | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Neoplasms | |
dc.subject.mesh | Dementia | |
dc.subject.mesh | Palliative Care | |
dc.subject.mesh | Terminal Care | |
dc.subject.mesh | Choice Behavior | |
dc.subject.mesh | Aged | |
dc.subject.mesh | Aged, 80 and over | |
dc.subject.mesh | Middle Aged | |
dc.subject.mesh | Caregivers | |
dc.subject.mesh | Australia | |
dc.subject.mesh | Female | |
dc.subject.mesh | Male | |
dc.subject.mesh | Heart Failure | |
dc.subject.mesh | Patient Preference | |
dc.subject.mesh | Surveys and Questionnaires | |
dc.title | Community Preferences for the Care of Older People at the End of Life: How Important is the Disease Context? | |
dc.type | Journal Article | |
utslib.citation.volume | 17 | |
utslib.location.activity | New Zealand | |
utslib.for | 11 Medical and Health Sciences | |
pubs.organisational-group | University of Technology Sydney | |
pubs.organisational-group | University of Technology Sydney/Faculty of Health | |
pubs.organisational-group | University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation | |
pubs.organisational-group | University of Technology Sydney/Strength - CHT - Health Technologies | |
pubs.organisational-group | University of Technology Sydney/Faculty of Health/IMPACCT | |
pubs.organisational-group | University of Technology Sydney/Faculty of Health/Centre for Health Economics Research and Evaluation | |
pubs.organisational-group | University of Technology Sydney/All Manual Groups | |
pubs.organisational-group | University of Technology Sydney/All Manual Groups/Centre for Health Economics Research and Evaluation (CHERE) | |
pubs.organisational-group | University of Technology Sydney/All Manual Groups/Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT) | |
utslib.copyright.status | open_access | * |
dc.rights.license | This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0/ | |
dc.date.updated | 2024-07-18T04:34:23Z | |
pubs.issue | 4 | |
pubs.publication-status | Published | |
pubs.volume | 17 | |
utslib.citation.issue | 4 |
Abstract:
BACKGROUND: Population preferences for care at the end of life can inform palliative care policy and direction. Research investigating preferences for care at the end of life has focused predominantly on the context of advanced cancer, with relatively little attention to other life-limiting illnesses that are common causes of death. OBJECTIVES: We aimed to investigate preferences for the care of older people at the end of life in three different disease contexts. The purpose was to understand if population preferences for care in the last 3 weeks of life would differ for patients dying from cancer, heart failure or dementia. METHODS: Three discrete choice experiments were conducted in Australia with a general population sample using similar methods but different end-of-life disease contexts. Some attributes were common across the three experiments and others differed to accommodate the specific disease context. Each survey was completed by a different panel sample aged ≥45 years (cancer, n = 1548; dementia, n = 1549; heart failure, n = 1003). Analysis was by separate mixed logit models. RESULTS: The most important attributes across all three surveys were costs to the patient and family, patient symptoms and informal carer stress. The probability of choosing an alternative was lowest (0.18-0.29) when any one of these attributes was at the least favourable level, holding other attributes constant across alternatives. The cancer survey explored symptoms more specifically and found patient anxiety with a higher relative importance score than the symptom attribute of pain. Dementia was the only context where most respondents preferred to not have a medical intervention to prolong life; the probability of choosing an alternative with a feeding tube was 0.40 (95% confidence interval 0.36-0.43). CONCLUSIONS: This study suggests a need for affordable services that focus on improving patient and carer well-being irrespective of the location of care, and this message is consistent across different disease contexts, including cancer, heart failure and dementia. It also suggests some different considerations in the context of people dying from dementia where medical intervention to prolong life was less desirable.
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