Quantifying palliative care
The study found that terminally ill patients and their caregivers differed in their willingness to pay for different end-of-life options
A study led by Professor Eric Finkelstein and Assistant Professor Chetna Malhotra from the Lien Centre for Palliative Care at Duke-NUS Graduate Medical School has found that dying patients were willing to pay more to avoid severe pain or die at home than to extend their life by a year. In contrast, their caregivers were three times more willing to pay to extend the life of the patient. The findings highlight a stark misalignment in the preferences for end-of-life options between the two groups.
The study, recently published in the journal Palliative Medicine, was conducted in collaboration with the National Cancer Centre Singapore. About 211 patients with stage four cancer and their informal caregivers were surveyed for this study.
Participants indicated their preferred end-of-life scenarios from a range of options that factored in years of life remaining; degree of pain experienced; place of death; level of burden on caregivers; quality of healthcare experience; cost; and source of payment.
Results found that patients were willing to pay up to $18,600 to extend their life by one year. However, they were willing to pay higher amounts of $22,200 to avoid severe pain, and $31,300 to die at home. They also valued receiving high quality health care at a slightly lower cost of $16,200. Caregivers, on the other hand, displayed a much greater willingness to pay to extend life by a year, along with other features considered.
Prof Finkelstein pointed out that "addressing other end-of-life concerns, in addition to efforts to extend life, for instance pain management and dying at home, shouldn't be neglected by health insurers and physicians when making decisions on palliative care.
Such concerns may not necessarily be aligned with those of caregivers. Nevertheless, tough decisions on whether to spend on costly treatments with mediocre improvements in length or quality of life are often left to the family caregiver, who places greater value on the extension of life. Asst Prof Malhotra emphasised the need for patients to have more say and hoped that the research would stimulate greater communication between patients, caregivers and doctors.
The team hopes to test decision aids that can help ensure greater alignment between end-of-life care and patient preferences.
