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Valuing End-of-Life Care for Older People with Advanced Cancer: Is Dying at Home Important?

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Abstract

Background

Most health care systems are facing the challenge of providing health services to support the increasing numbers of older people with chronic life-limiting conditions at the end of life. Many policies focus primarily on increasing the proportion of deaths at home.

Objectives

This study aims to investigate preferences for care throughout the latter stages of a life-limiting illness, particularly the importance of location of care, location of death, and the use of life-sustaining measures. It focuses on preferences for the care of an older person with advanced cancer in the last 3 weeks of life.

Methods

A survey using discrete choice experiment (DCE) methods was completed online by a general population sample of 1548 Australians aged 45 years and over. The experiment included 12 attributes, and each respondent completed 11 choice sets. Analysis was by a mixed logit model and latent class analysis (LCA).

Results

The most important attributes influencing care preferences were cost, patient anxiety, pain control, and carer stress (relative importance scores 0.21, 0.19, 0.14, and 0.14, respectively), with less importance given to place of care and place of death (relative importance scores 0.03 and 0.01). The model predicted that 42% would consider receiving most care in hospital better than at home (58%) holding the levels of other attributes constant across the alternatives, while 42% would consider death in hospital better than at home (58%). Three population segments with different preferences were identified by the LCA, the largest (46.5%) prioritised how the patient and carer felt as well as the pain control achieved, the next largest (28.1%) prioritised cost, and the smallest segment (25.4%) prioritised a single room when an inpatient.

Conclusions

This study shows that investment in services to support people at the end of life would be better targeted toward programmes that improve patient and carer wellbeing irrespective of the location of care and death.

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Acknowledgements

We thank Meg Brassil, Imelda Gilmore, Bev Noble, and Noelene Trotter, who provided invaluable advice and assistance with the DCE survey development, drawing on personal experience as end-of-life family carers.

Author information

Authors and Affiliations

  1. Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Broadway, PO Box 123, Sydney, NSW, 2007, Australia

    Patricia Kenny, Deborah J. Street & Jane Hall

  2. Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Sydney, Australia

    Meera Agar & Jane Phillips

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  1. Patricia Kenny
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  2. Deborah J. Street
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  3. Jane Hall
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Corresponding author

Correspondence to Patricia Kenny.

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Funding/support

This study was supported by a National Health & Medical Research Council project grant (ID 1159202).

Conflict of interest

The authors have no conflicts of interest to declare.

Availability of data and material

Data are not publicly available due to the current ethics approval. The authors will consider requests for data access and may submit an ethics amendment application if appropriate.

Ethics approval

The study was approved by the University of Technology Sydney Human Research Ethics Committee (UTS HREC REF NO. ETH19-3313).

Author contributions

All authors contributed to the conception and design of the work, obtaining funding, and interpretation of the results. DS devised the designed experiment for the DCE, and PK analysed the data and drafted the manuscript. All authors contributed to critical revision of the manuscript and approved the final version.

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Kenny, P., Street, D.J., Hall, J. et al. Valuing End-of-Life Care for Older People with Advanced Cancer: Is Dying at Home Important?. Patient 14, 803–813 (2021). https://doi.org/10.1007/s40271-021-00517-z

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