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Current health and preferences for life-prolonging treatments: An application of prospect theory to end-of-life decision making

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  • Winter, Laraine
  • Parker, Barbara

Abstract

As a substantial body of research attests, the acceptability of life-prolonging treatment (e.g., tube feeding) tends to be greater among people in worse health than among healthier ones. Because a decision for or against a life-prolonging treatment represents a choice between two prospects--life (usually in poor health) and death--we propose a decision model, Prospect Theory, as a theoretical account of this phenomenon. Prospect Theory postulates that pairs of distant prospects are less distinguishable than pairs of closer ones. Thus, to healthy individuals, the prospects of death and life in poor health would both be remote, and therefore, the distinction between them, small. To less healthy individuals, however, the difference between the same pairs of prospects would appear greater, and therefore, life-prolonging treatment may be more acceptable. In a cross-sectional study of 304 community-dwelling people, aged 60 years and over in the Philadelphia area, USA, preferences for 4 life-prolonging treatments in 9 health scenarios were examined in relation to participants' current health, operationalized as number of deficits in physical functioning. As predicted, less healthy people expressed stronger preferences for all life-prolonging treatments compared with healthier ones, with differences greatest in the worse-health scenarios. Preferences also varied by health scenario, with any treatment preferred in the better health scenarios. Treatment preferences did not differ by type of treatment, depressed mood or any demographic characteristic except race, with African-Americans expressing stronger treatment preferences. Implications for advance care planning are discussed.

Suggested Citation

  • Winter, Laraine & Parker, Barbara, 2007. "Current health and preferences for life-prolonging treatments: An application of prospect theory to end-of-life decision making," Social Science & Medicine, Elsevier, vol. 65(8), pages 1695-1707, October.
  • Handle: RePEc:eee:socmed:v:65:y:2007:i:8:p:1695-1707
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    References listed on IDEAS

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    1. Gibbons, F. X., 1999. "Social comparison as a mediator of response shift," Social Science & Medicine, Elsevier, vol. 48(11), pages 1517-1530, June.
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    Cited by:

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    2. Finkelstein, Eric A. & Bilger, Marcel & Flynn, Terry N. & Malhotra, Chetna, 2015. "Preferences for end-of-life care among community-dwelling older adults and patients with advanced cancer: A discrete choice experiment," Health Policy, Elsevier, vol. 119(11), pages 1482-1489.
    3. Stolk-Vos, Aline C. & Attema, Arthur E. & Manzulli, Michele & van de Klundert, Joris J., 2022. "Do patients and other stakeholders value health service quality equally? A prospect theory based choice experiment in cataract care," Social Science & Medicine, Elsevier, vol. 294(C).
    4. Octave Jokung & Serge Macé, 2013. "Long-term health investment when people underestimate their adaptation to old age-related health problems," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(6), pages 1003-1013, December.
    5. Heutel, Garth, 2019. "Prospect theory and energy efficiency," Journal of Environmental Economics and Management, Elsevier, vol. 96(C), pages 236-254.
    6. Wolff, Katharina & Larsen, Svein & Øgaard, Torvald, 2019. "How to define and measure risk perceptions," Annals of Tourism Research, Elsevier, vol. 79(C).

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