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Preferences for life expectancy discussions following diagnosis with a life-threatening illness: a discrete choice experiment

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Abstract

Purpose

To explore in a sample of adult cancer patients: (1) the relative influence of initiation source, information format and consultation format on preferred approach to life expectancy disclosure using a discrete choice experiment (DCE); and (2) whether patient age, cancer type and perceived prognosis were associated with preferences within the three attributes.

Methods

A DCE survey of adult solid tumour and haematological cancer patients. Participants chose between three hypothetical scenarios about life expectancy disclosure consisting of three attributes: initiation source (i.e. doctor versus patient-initiated discussion), information content (i.e. estimate presented as best-worst-typical length of life case scenario versus median survival time) and consultation format (i.e. two 20-min versus one 40-min consultation). Respondents selected their most preferred scenario within each question.

Results

Three hundred and two patients completed the DCE (78% consent rate). Initiation source was the most influential predictor of patient choice. More preferred a doctor deliver life expectancy information as soon as it is available rather than waiting for the patient to ask (59% vs 41% z = − 7.396, p < 0.01). More patients preferred the two 20-min rather than the one 40-min consultation format (55% vs 45%, z = 4.284, p < 0.01). Information content did not influence choice. Age, cancer type, and patient-perceived prognosis were not associated with preferences.

Conclusion

Healthcare professionals should assess cancer patients’ preferences for engaging in life expectancy discussions as soon as they have this information, and ensure patients have adequate time to consider the information they receive, seek additional information and involve others if they wish.

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Acknowledgements

The authors acknowledge research support from Dr. Heidi Turon. Our thanks to hospital staff, patients and families for their contribution to this research.

Funding

This research was supported by a National Health and Medical Research Council grant (APP1010536), a Strategic Research Partnership Grant (CSR 11-02) from Cancer Council NSW to the Newcastle Cancer Control Collaborative (New-3C) and infrastructure funding from the Hunter Medical Research Institute. AW was supported by an Australian Research Council DECRA (150101262). LM is supported by a Postdoctoral Fellowship grant [PF-16-011] from the Australian National Breast Cancer Foundation.

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Authors and Affiliations

  1. Health Behaviour Research Collaborative, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia

    Amy Waller, Lisa Mackenzie & Rob Sanson-Fisher

  2. Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia

    Amy Waller, Lisa Mackenzie & Rob Sanson-Fisher

  3. Department of Psychology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia

    Laura Wall & Scott D. Brown

  4. Chris O’Brien Lifehouse, University of Sydney, Level 6 North, Missenden Road, Camperdown, NSW, 2050, Australia

    Martin H. N. Tattersall

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  1. Amy Waller
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Correspondence to Amy Waller.

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Waller, A., Wall, L., Mackenzie, L. et al. Preferences for life expectancy discussions following diagnosis with a life-threatening illness: a discrete choice experiment. Support Care Cancer 29, 417–425 (2021). https://doi.org/10.1007/s00520-020-05498-7

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