Seriously Ill Patients’ Willingness to Trade Survival Time to Avoid High Treatment Intensity at the End of Life

Rubin, Edward L.; Buehler, Anna E.; Halpern, Scott D.

doi:10.1001/jamainternmed.2020.0681

Cited by 35 publications

(36 citation statements)

References 4 publications

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“…Patients preferred to pay the highest (RMB256,895.45) to obtain enhanced quality of life rather than life extension. These results present a more detailed and complicated picture of trade-offs between life extension and quality of life among terminal cancer patients, which complements and extends previous research [7,10,19]. Waller et al found Australian inpatients preferred end-of-life care reducing pain and discomfort as much as possible, even if it meant not living longer [7].…”

Section: Discussionsupporting

confidence: 81%

“…Rubin et al found that 86.7% of U.S. hospitalized seriously ill patients would trade at least one year of a five-year lifespan to avoid a scenario where they died in the ICU with moderate pain and suffering [19].…”

Section: Discussionmentioning

confidence: 99%

“…To reveal terminal cancer patients' preferences for the end-of-life care, we undertook a discrete choice experiment. DCE is a powerful method to examine preferences over hypothetical alterative scenarios in the health field [8,9,13,[18][19][20], where each scenario comprises a number of attributes (days of hospital stay, days of extended life, quality of life improvement, adverse treatment reaction, place of death and out-of-pocket expenses) and each attribute has different levels, as shown in Table 1. Willingness to pay and probability analysis were undertaken based on the discrete choice model.…”

Section: Methodsmentioning

confidence: 99%

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Preferences for End-of-life Care among Terminal Cancer Patients in China: A Discrete Choice Experiment

Leng

Maitland

Wang

et al. 2021

Preprint

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Background Knowing terminal cancer patients’ treatment preferences will improve patient-centered health care, better inform surrogates and medical staff of patient preferences and enhance the quality of end-of-life (EoL) care. In China, little is known about terminal cancer patients’ preferences. We aimed to examines the preferences for EoL care of terminal cancer patients. Methods Data on 183 terminal cancer patients aged over 50 years old was collected by discrete choice experiment (DCE). Each DCE scenario described six attributes: hospitalization days,life extension, quality of life (QoL), adverse treatment reactions, place of death preference and out-of-pocket payments.Patient preferences were derived using a mixed logit model and the marginal willingness to pay (WTP) were estimated from the regression coefficients. Results Patients’ preferences for moderate survive time, better quality of life, lower risk of adverse reaction, home death and lower payments were all statistically significant in driving choice between treatment models. Extending life and QoL were the most important attributes. Patients were willing to pay RMB256,895.45 to improve QoL from a bad level to a very good level, significantly higher than their willingness to pay for half additional life year (RMB233,446.16) and one additional life year (RMB182,298.76). This indicates that patients were not willing to blindly pursue life extension and neglect the QoL,but preferred to trade off life extension for QoL. The predicted uptake of optimal end-of-life care scenario was 91.04%. Conclusions Our study contributes to the development of patient-centered preferences for end-of-life care models that improve advanced terminal patient’s care and provide empirical evidence for physicians and surrogates to operationalize end-of-life care trade-offs.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Preferences for End-of-life Care among Terminal Cancer Patients in China: A Discrete Choice Experiment

Leng

Maitland

Wang

et al. 2021

Preprint

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“…It is likely that patients’ perspectives differ from physicians’ in this respect as a recent study has shown that patients are willing to trade survival time to avoid end of life in an ICU. 17 Family opinion has been shown to significantly influence ICU admission decisions. 14 18 19 Family can either act as useful healthcare surrogates or make requests in response to their own needs.…”

Section: Discussionmentioning

confidence: 99%

Physicians’ perspective on potentially non-beneficial treatment when assessing patients with advanced disease for ICU admission: a qualitative study

et al. 2021

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ObjectiveThe use of intensive care at the end of life can be high, leading to inappropriate healthcare utilisation, and prolonged suffering for patients and families. The objective of the study was to determine which factors influence physicians’ admission decisions in situations of potentially non-beneficial intensive care.DesignThis is a secondary analysis of a qualitative study exploring the triage process. In-depth interviews were analysed using an inductive approach to thematic content analysis.SettingData were collected in a Swiss tertiary care centre between March and June 2013.Participants12 intensive care unit (ICU) physicians and 12 internists routinely involved in ICU admission decisions.ResultsPhysicians struggled to understand the request for intensive care for patients with advanced disease and full code status. Physicians considered patients’ long-term vital and functional prognosis, but they also resorted to shortcuts, that is, a priori consensus about reasons for admitting a patient. Family pressure and unexpected critical events were determinants of admission to the ICU. Patient preferences, ICU physician’s expertise and collaborative decision making facilitated refusal. Physicians were willing to admit a patient with advanced disease for a limited amount of time to fulfil a personal need.ConclusionsIn situations of potentially non-beneficial intensive care, the influence of shortcuts or context-related factors suggests that practice variations and inappropriate admission decisions are likely to occur. Institutional guidelines and timely goals of care discussions with patients with advanced disease and their families could contribute to ensuring appropriate levels of care.

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“…11 The majority (87%) of seriously ill older adults who are hospitalized express that they would even trade 1 year of a 5-year lifespan to avoid dying in the ICU. 12 Unfortunately, the outcomes after ED intubation among seriously ill older adults are not as good as many patients think they will be, which may be predicted from prognosis calculators. 13,14 One in 3 older adults dies in the hospital after intubation.…”

Section: Familiarity With the Patient's Prognosis Is Essential Beforementioning

confidence: 99%

Managing Code Status Conversations for Seriously Ill Older Adults in Respiratory Failure

Ouchi

Lawton

Bowman

et al. 2020

Annals of Emergency Medicine

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Seriously Ill Patients’ Willingness to Trade Survival Time to Avoid High Treatment Intensity at the End of Life

Abstract: Arbor), with survey formatting and deployment. He was not compensated for his work.

Cited by 35 publications

References 4 publications

Preferences for End-of-life Care among Terminal Cancer Patients in China: A Discrete Choice Experiment

Preferences for End-of-life Care among Terminal Cancer Patients in China: A Discrete Choice Experiment

Physicians’ perspective on potentially non-beneficial treatment when assessing patients with advanced disease for ICU admission: a qualitative study

Managing Code Status Conversations for Seriously Ill Older Adults in Respiratory Failure

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