Objective-We sought to test whether variations across regions in end-of-life (EOL) treatment intensity are associated with regional differences in patient preferences for EOL care.Research Design-Dual-language (English/Spanish) survey conducted March to October 2005, either by mail or computer-assisted telephone questionnaire, among a probability sample of 3480 Medicare part A and/or B eligible beneficiaries in the 20% denominator file, age 65 or older on July 1, 2003. Data collected included demographics, health status, and general preferences for medical care in the event the respondent had a serious illness and less than 1 year to live. EOL concerns and preferences were regressed on hospital referral region EOL spending, a validated measure of treatment intensity.Results-A total of 2515 Medicare beneficiaries completed the survey (65% response rate). In analyses adjusted for age, sex, race/ethnicity, education, financial strain, and health status, there were no differences by spending in concern about getting too little treatment (39.6% in lowest spending quintile, Q1; 41.2% in highest, Q5; P value for trend, 0.637) or too much treatment (44.2% Q1, 45.1% Q5; P = 0.797) at the end of life, preference for spending their last days in a hospital (8.4% Q1, 8.5% Q5; P = 0.965), for potentially life-prolonging drugs that made them feel worse all the time (14.4% Q1, 16.5% Q5; P = 0.326), for palliative drugs, even if they might be life-shortening (77.7% Q1, 73.4% Q5; P = 0.138), for mechanical ventilation if it would extend their life by 1 month (21% Q1, 21.4% Q5; P = 0.870) or by 1 week (12.1% Q1, 11.7%; P = 0.875).Conclusions-Medicare beneficiaries generally prefer treatment focused on palliation rather than life-extension. Differences in preferences are unlikely to explain regional variations in EOL spending. Previous studies have shown that regions with greater overall EOL spending do not have better outcomes; mortality, quality of care, and patient satisfaction among cohorts of patients with common serious conditions are sometimes worse, 2,3 as are perceptions of the quality of EOL care among bereaved family members. 4 In contrast, higher spending regions do have a greater regional supply of specialists, 5 hospital and ICU beds, 6-9 and other technologies. 10,11 Physicians who practice in high-intensity regions have a greater tendency to recommend tests, referrals, and treatments for patients described in structured vignettes and are less likely to refer to hospice. 12,13 It is unknown whether these differences in supply and physician practice style reflect differences in preferences for treatment among patients who reside in these highspending regions. Yet, the policy prescriptions for addressing these regional variations depend critically on whether they are the consequence of differences across regions in patient preferences, the consequence of physician "enthusiasm" or "supplier-induced demand," or other factors related to the supply of health care capacity. 14-16We sought to determine whether EOL tr...

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BACKGROUND: Studies using local samples suggest that racial minorities anticipate a greater preference for lifesustaining treatment when faced with a terminal illness. These studies are limited by size, representation, and insufficient exploration of sociocultural covariables.

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A number of wearable 'lifelogging' camera devices have been released recently, allowing consumers to capture images and other sensor data continuously from a first-person perspective. Unlike traditional cameras that are used deliberately and sporadically, lifelogging devices are always 'on' and automatically capturing images. Such features may challenge users' (and bystanders') expectations about privacy and control of image gathering and dissemination. While lifelogging cameras are growing in popularity, little is known about privacy perceptions of these devices or what kinds of privacy challenges they are likely to create.To explore how people manage privacy in the context of lifelogging cameras, as well as which kinds of first-person images people consider 'sensitive,' we conducted an in situ user study (N = 36) in which participants wore a lifelogging device for a week, answered questionnaires about the collected images, and participated in an exit interview. Our findings indicate that: 1) some people may prefer to manage privacy through in situ physical control of image collection in order to avoid later burdensome review of all collected images; 2) a combination of factors including time, location, and the objects and people appearing in the photo determines its 'sensitivity;' and 3) people are concerned about the privacy of bystanders, despite reporting almost no opposition or concerns expressed by bystanders over the course of the study.