What matters most to healthy older adults in treatment decision making: a discrete choice experiment

Abstract

Abstract Introduction Shifting to a patient centered approach is crucial for a sustainable healthcare system. Understanding individuals’ priorities is essential for personalized care, especially in critical illness. Treatment decisions are often aimed at disease-specific outcomes such as life extension or survival, while patient-specific outcomes like maintaining independence may be equally vital. How healthy older adults prioritize treatment outcomes in case of a critical illness is currently unknown. Enhanced insight into their priorities can refine healthcare policy, for more personalized care. This study investigated outcomes (attributes) prioritized in hypothetical decision-making by healthy adults over 50 yr. Methods We conducted a Discrete Choice Experiment with individuals aged ≥50, comparing six pairs of hypothetical treatments with five attributes: life expectancy, independence, pain, memory complaints and societal costs. Attribute utility was analyzed using a conditional logit model, and latent class analyses were employed to explore preferences in groups. Results In 333 participants (mean age 70 +/- 7.7) all attributes emerged as impactful with independence being strongest (p < 0.05). Increased life expectancy had positive utility, but only for a two-year increase. Negative utility was found for all other attributes except mild pain and memory complaints. Latent class analyses identified two groups (22.4% and 77.6%). Group one valued life expectancy more (p .019 vs .940), whereas the second group valued independence (p .058 vs.<.001 and societal costs (p.053 vs. <.001) more. Conclusions In a hypothetical case of life-threatening disease, for people aged ≥ 50 life expectancy was not the sole relevant outcome for treatment decisions; pain, independence and societal costs are important and should be discussed in clinical decision making or healthcare policy. Key messages • Older adults find patient-specific outcomes relevant for decision making. • Societal costs are found relevant for decision making for treatment by older adults.