Characterizing the public's preferential attitudes toward end-of-life care options: a role for the threshold technique?

Abstract

Objectives: To assess the Threshold Technique's (TT) feasibility in community-wide surveys of U.S. Medicare beneficiaries' preferences for end-of-life (EOL) care options.

Study setting: Study participants were community-dwelling Medicare beneficiaries in four different regions in the United States.

Study design: During personal interviews, participants considered four EOL scenarios, each presenting a choice between a less intense and more intense care option.

Data collection: Participants selected their initially favored option. Depending on that choice, in the subsequent TT the length of life offered by the more intense option was systematically increased or decreased until the participant "switched" to his or her initially rejected option.

Principal findings: Participants were able to select an initially favored option (in 3 of the 4 scenarios; this was the less intense option). The majority of participants were able to engage with the subsequent TT. In all scenarios, regardless of the increase/decrease in the length of life offered by the more intense option, the majority of participants were unwilling to "switch" to their initially rejected option.

Conclusions: In surveys of populations' preferential attitudes toward EOL care options, the TT was a feasible elicitation method, engaging most participants and measuring the strength of their attitudes. Further methodological work is merited, involving (1) populations with various participant characteristics, and (2) different attributes in the TT task itself.

Keywords: Medicare; Population preferences; end-of-life; survey; threshold technique.