Malhotra Chetna, Farooqui Muhammad Assad, Kanesvaran Ravindran, Bilger Marcel, Finkelstein Eric
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.
Palliat Med. 2015 Oct;29(9):842-50. doi: 10.1177/0269216315578803. Epub 2015 Mar 24.
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.
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.
Cross-sectional survey using a discrete choice experiment.
A total of 211 patients with stage IV cancer and their informal caregivers.
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.
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.
晚期癌症患者常常需要做出艰难的决定，比如在适度延长生命的治疗上花费多少。这类临终决定以及其他临终决定也会受到其非正式照护者的影响。了解患者及其照护者对临终关怀各个方面的相对重视程度，有助于临床医生调整治疗方案，以最好地满足患者的偏好。
量化晚期癌症患者及其照护者为将患者生命延长1年的支付意愿，并将这一结果与他们为其他临终改善措施的支付意愿进行比较。
采用离散选择实验的横断面调查。
总共211名IV期癌症患者及其非正式照护者。
患者将生命延长1年的支付意愿（18,570新元；95%置信区间：6687新元至30,542新元）与他们为避免剧痛的支付意愿（22,199新元；11,648新元至32,450新元）、在家中离世的支付意愿（31,256新元；21,249新元至41,391新元）、不给家人和朋友带来负担的支付意愿（4051新元；-3543新元至11,568新元）或获得高质量医疗体验的支付意愿（16,191新元；9266新元至23,037新元）在统计学上无差异。与我们的假设一致，照护者比患者有更高的支付意愿来延长生命（61,368新元；37,030新元至86,210新元）以及用于大多数其他临终改善措施。
结果凸显了疼痛管理、支持在家中离世以及解决其他临终问题的重要性，此外还有延长生命的努力。患者和照护者支付意愿的差异表明，在治疗决策过程中需要征求患者的偏好，而不是依赖照护者的意见。
