title: Comparison of preferences for end-of-life care among patients with advanced cancer and their caregivers: A discrete choice experiment.
abstract: BACKGROUND
  Patients with advanced cancer often have to make difficult decisions, such as how much to spend on moderately life-extending treatments. This and other end-of-life decisions are also influenced by their informal caregivers. Understanding the relative value that patients and their caregivers place on various aspects of end-of-life care can help clinicians tailor treatments to best meet the preferences of their patients.
  
  
  OBJECTIVE
  To quantify willingness to pay of patients with advanced cancer and their caregivers to extend the patients' life by 1 year and to compare this result to their willingness to pay for other end-of-life improvements.
  
  
  METHODS
  Cross-sectional survey using a discrete choice experiment.
  
  
  METHODS
  A total of 211 patients with stage IV cancer and their informal caregivers.
  
  
  RESULTS
  The willingness to pay of patients to extend their life by 1 year (S$18,570; 95% confidence interval: S$6687-S$30,542) was not statistically different from their willingness to pay to avoid severe pain (S$22,199; S$11,648-S$32,450), to die at home (S$31,256; S$21,249-S$41,391), not be a burden on family and friends (S$4051; -S$3543 to S$11,568), or to receive a high-quality health-care experience (S$16,191; S$9266-S$23,037). Consistent with our hypothesis, caregivers had a greater willingness to pay than patients to extend life (S$61,368; S$37,030-S$86,210) and for most other end-of-life improvements.
  
  
  CONCLUSIONS
  Results highlight the importance of pain management, supporting home deaths, and addressing other end-of-life concerns, in addition to efforts to extend life. Differences in willingness to pay of patients and caregivers suggest the need for eliciting patient preferences during treatment decision making as opposed to relying on caregiver input.
authors: Lien Centre for Palliative Care, Duke-NUS Graduate Medical School Singapore, Singapore chetna.malhotra@duke-nus.edu.sg.
authors: Chetna
authors: C
authors: Malhotra
authors: Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore.
authors: Muhammad Assad
authors: MA
authors: Farooqui
authors: Department of Medical Oncology, National Cancer Centre, Singapore.
authors: Ravindran
authors: R
authors: Kanesvaran
authors: Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore.
authors: Marcel
authors: M
authors: Bilger
authors: Lien Centre for Palliative Care, Duke-NUS Graduate Medical School Singapore, Singapore Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore Duke Global Health Institute, Duke University, Durham, NC, USA.
authors: Eric
authors: E
authors: Finkelstein
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers; D003430:Cross-Sectional Studies; D005260:Female; D005382:Financing, Personal; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D059408:Pain Management / Q000191:economics; D057240:Patient Preference / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000191:economics*
keywords: Terminal care; choice behavior; decision making; discrete choice experiment; palliative care; willingness to pay