title: End-of-life medical treatment choices: do survival chances and out-of-pocket costs matter?
abstract: BACKGROUND
  Out-of-pocket medical expenditures incurred prior to the death of a spouse could deplete savings and impoverish the surviving spouse. Little is known about the public's opinion as to whether spouses should forego such end-of-life (EOL) medical care to prevent asset depletion.
  
  
  OBJECTIVE
  To analyze how elderly and near elderly adults assess hypothetical EOL medical treatment choices under different survival probabilities and out-of-pocket treatment costs.
  
  
  METHODS
  Survey data on a total of 1143 adults, with 589 from the Asset and Health Dynamics Among the Oldest Old (AHEAD) and 554 from the Health and Retirement Study (HRS), were used to study EOL cancer treatment recommendations for a hypothetical anonymous married woman in her 80s.
  
  
  RESULTS
  Respondents were more likely to recommend treatment when it was financed by Medicare than by the patient's own savings and when it had 60% rather than 20% survival probability. Black and male respondents were more likely to recommend treatment regardless of survival probability or payment source. Treatment uptake was related to the order of presentation of treatment options, consistent with starting point bias and framing effects.
  
  
  CONCLUSIONS
  Elderly and near elderly adults would recommend that the hypothetical married woman should forego costly EOL treatment when the costs of the treatment would deplete savings. When treatment costs are covered by Medicare, respondents would make the recommendation to opt for care even if the probability of survival is low, which is consistent with moral hazard. The sequence of presentation of treatment options seems to affect patient treatment choice.
authors.affiliation: Population Aging Research Center of the Population Studies Center, University of Pennsylvania, Philadelphia, PA 19104-6298, USA. chao69@wharton.upenn.edu
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Chao
authors.forename: José A
authors.initials: JA
authors.lastname: Pagán
authors.forename: Beth J
authors.initials: BJ
authors.lastname: Soldo
mesh_terms: D000368:Aged; D002755:Choice Behavior; D005260:Female; D005382:Financing, Personal; D017048:Health Care Costs; D006801:Humans; D008017:Life Expectancy; D008297:Male; D006278:Medicare / Q000191:economics; D009369:Neoplasms / Q000191:economics / Q000628:therapy; D012959:Socioeconomic Factors; D013727:Terminal Care / Q000191:economics*; D014481:United States