title: Are Asians comfortable with discussing death in health valuation studies? A study in multi-ethnic Singapore.
abstract: BACKGROUND
  To characterize ease in discussing death (EID) and its influence on health valuation in a multi-ethnic Asian population and to determine the acceptability of various descriptors of death and "pits"/"all-worst" in health valuation.
  
  
  METHODS
  In-depth interviews (English or mother-tongue) among adult Chinese, Malay and Indian Singaporeans selected to represent both genders and a wide range of ages/educational levels. Subjects rated using 0-10 visual analogue scales (VAS): (1) EID, (2) acceptability of 8 descriptors for death, and (3) appropriateness of "pits" and "all-worst" as descriptors for the worst possible health state. Subjects also valued 3 health states using VAS followed by time trade-off (TTO). The influence of sociocultural variables on EID and these descriptors was studied using univariable analyses and multiple linear regression (MLR). The influence of EID on VAS/TTO utilities with adjustment for sociocultural variables was assessed using MLR.
  
  
  RESULTS
  Subjects (n = 63, 35% Chinese, 32% Malay, median age 44 years) were generally comfortable with discussing death (median EID: 8.0). Only education significantly influenced EID (p = 0.045). EID correlated weakly with VAS/TTO scores (range: VAS: -0.23 to 0.07; TTO: -0.14 to 0.11). All subjects felt "passed away", "departed" and "deceased" were most acceptable (median acceptability: 8.0) while "sudden death" and "immediate death" were least acceptable (median acceptability: 5.0). Subjects clearly preferred "all-worst" to "pits" (63% vs. 19%, p < 0.001).
  
  
  CONCLUSIONS
  Singaporeans were generally comfortable with discussing death and had clear preferences for several descriptors of death and for "all-worst". EID is unlikely to influence health preference measurement in health valuation studies.
authors.affiliation: Department of Rheumatology and Immunology, Singapore General Hospital, Republic of Singapore. hweelin.wee@gmail.com
authors.forename: Hwee-Lin
authors.initials: HL
authors.lastname: Wee
authors.forename: Shu-Chuen
authors.initials: SC
authors.lastname: Li
authors.forename: Feng
authors.initials: F
authors.lastname: Xie
authors.forename: Xu-Hao
authors.initials: XH
authors.lastname: Zhang
authors.forename: Nan
authors.initials: N
authors.lastname: Luo
authors.forename: Yin-Bun
authors.initials: YB
authors.lastname: Cheung
authors.forename: David
authors.initials: D
authors.lastname: Machin
authors.forename: Kok-Yong
authors.initials: KY
authors.lastname: Fong
authors.forename: Julian
authors.initials: J
authors.lastname: Thumboo
mesh_terms: D000328:Adult; D044466:Asian People / Q000523:psychology* / Q000706:statistics & numerical data; D001293:Attitude to Death / Q000208:ethnology*; D003142:Communication; D018864:Cultural Diversity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011578:Psycholinguistics; D011594:Psychometrics; D011788:Quality of Life; D012044:Regression Analysis; D012846:Singapore; D011795:Surveys and Questionnaires; D014505:Urban Population; D026712:Value of Life