Cancer patients 'prefer to die at home than extend life'

They are willing to pay more for it than other options, study shows
By Andrea Ng, The Straits Times, 3 Apr 2015

CANCER patients reaching the end of their lives would rather pay more to die at home than spend on treatment to extend their lives or avoid severe pain.

This was the finding of a recent study which was detailed yesterday by researchers from the Lien Centre for Palliative Care at Duke-NUS Graduate Medical School.

They surveyed 211 patients with advanced cancer at the National Cancer Centre Singapore and their informal caregivers and got participants to choose from different hypothetical scenarios to find out more about their end-of-life preferences.

Each scenario included trading off an end-of-life preference in exchange for another.

The results showed that patients and caregivers placed the most emphasis on being able to die at home.

Twenty-nine per cent of patients and 24 per cent of caregivers were willing to sacrifice other options - such as quality of care and amount of care needed - in exchange for the patient being able to die at home.

They would also prefer to make treatment decisions based on where the patient ends his life.

When the results were quantified, patients were only willing to pay up to $18,600 to extend their lives by a year, compared with $31,000 to die at home.

Professor Eric Finkelstein, who led the team along with Assistant Professor Chetna Malhotra, said the results showed that "the healthcare system currently focuses a lot on extending life".

Physicians often offer life-extending treatments, for which health insurance is typically drawn up to help finance.

But with life extension not always the biggest thing on patients' minds, "patients may not be getting the type of care they want", he said.

"What patients want may not matter in Singapore as their voices are last heard."

Prof Finkelstein said the culture here involves caregivers making the decision for their loved ones, unlike in the West.

He cautioned that caregivers may not be the best proxies to make such decisions.

Indeed, the survey found that only 19 per cent of patients and caregivers made decisions based on the same end-of-life preference.

It was found that caregivers had a threefold greater willingness than patients to pay to extend life by one year and for most of the other features considered.

These include the severity of pain, amount of care needed, expected length of survival, quality of healthcare, expected cost of treatment and the place of death.

The researchers hope to shine more light on palliative care and pain management, in addition to current efforts to extend life.

They are also working to develop decision aids for patients to convey to doctors their preferences.

This could take the form of a questionnaire that helps doctors summarise their needs and recommend appropriate care.

Dr Malhotra said: "We hope this research helps foster greater communication between patients, caregivers and doctors."