title: A comparison of attitudes toward length and quality of life between community-dwelling older adults and patients with advanced cancer.
abstract: OBJECTIVE
  Applying prospect theory to end-of-life decision making, we hypothesize that community-dwelling older adults (CDOAs) will be relatively less inclined towards extending length over improving quality of life compared with patients. We also hypothesize that differences in relative inclination for length over quality of life between the 2 groups will decrease with advancing age.
  
  
  METHODS
  We tested these hypotheses by administering the quality-quantity questionnaire to 1067 CDOAs and 320 stage IV cancer patients and applying a linear regression model to assess whether relative inclination for length over quality of life, as estimated by the questionnaire, differed between CDOAs and patients after controlling for differences in sociodemographic characteristics. We also assessed the effect of interaction between age and participant status (CDOA compared to patient) on relative inclination for length over quality of life.
  
  
  RESULTS
  Consistent with prospect theory, a lower proportion of CDOAs (26%) than patients (42%) were relatively more inclined towards length over quality of life. Results were significant even after adjusting for differences in sociodemographics (P < .01). With increasing age, the difference in relative inclination between CDOAs and patients increased (P = .01).
  
  
  CONCLUSIONS
  Findings indicate that attitudes towards length and quality of life differ by life stage. This has implications for end-of-life care decisions made by CDOAs, such as purchasing health or disability insurance and signing advance directives or care plans.
authors.affiliation: Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.|Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
authors.forename: Chetna
authors.initials: C
authors.lastname: Malhotra
authors.affiliation: Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.
authors.forename: Ling
authors.initials: L
authors.lastname: Xiang
authors.affiliation: Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.|Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
authors.forename: Semra
authors.initials: S
authors.lastname: Ozdemir
authors.affiliation: National Cancer Centre, Singapore.
authors.forename: Ravindran
authors.initials: R
authors.lastname: Kanesvaran
authors.affiliation: National University Cancer Institute, Singapore.
authors.forename: Noreen
authors.initials: N
authors.lastname: Chan
authors.affiliation: Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.|Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
authors.forename: Eric Andrew
authors.initials: EA
authors.lastname: Finkelstein
mesh_terms: D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D001294:Attitude to Health; D005260:Female; D006801:Humans; D057187:Independent Living; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology*
keywords: attitude; cancer; decision making; life extension; older adults; prospect theory