• Juan Marcos Gonzalez Sepulveda, Drishti Baid, F Reed Johnson, and Eric A Finkelstein.
• Department of Population Health Sciences (J.M.G.S., F.R.J.), Duke University School of Medicine, Durham, North Carolina, USA; Program in Health Services and Systems Research (D.B., E.A.F.), Duke-NUS Medical School, Singapore; Program in Health Services and Systems Research (E.A.F.), Duke University Global Health Institute, Durham, North Carolina, USA.. Electronic address: jm.gonzalez@duke.edu.
• J Pain Symptom Manage. 2022 Apr 1; 63 (4): 457-467.

ContextHealth systems should aim to deliver on what matters most to patients. With respect to end of life (EOL) care, knowledge on patient preferences for care is currently lacking.ObjectivesTo quantify preference weights for key EOL care indicators.MethodsWe developed a discrete choice experiment survey with 13 key indicators related to patients' experience in the last six weeks of life. We fielded the survey to a web-panel of caregiver proxies for recently deceased care recipients. We obtained 250 responses in each of five countries: India, Singapore, Kenya, the UK and the US. Latent-class analysis was used to evaluate preference weights for each indicator within and across countries.ResultsA 2-class latent-class model was the best fit. Class 1 (average class probability = 64.7%) preference weights were logically ordered and highly significant, while Class 2 estimates were generally disordered, suggesting poor data quality. Class 1 results indicated health care providers' ability to control patients' pain to desired levels was most important (11.5%, 95% CI: 10.3%-12.6%), followed by clean, safe, and comfortable facilities (10.0%, 95% CI: 9.0%-11.0%); and kind and sympathetic health care providers (9.8%, 95% CI: 8.8%-10.9%). Providers' support for nonmedical concerns had the lowest preference weight (4.4%, 95% CI: 3.6%-5.3%). Differences in preference weights across countries were not statistically significant.ConclusionResults reveal that not all aspects of EOL care are equally valued. Not accounting for these differences would lead to inappropriate conclusions on how best to improve EOL care.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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