Patients’ and Relatives’ Preferences for Outpatient and Day Care Services Within End-of-Life Care in Germany – A Discrete Choice Experiment

Beate Apolinarski,1,* Lea de Jong,2,* Franziska A Herbst,1 Carolin Huperz,1,3 Hanna AA Röwer,1 Nils Schneider,1 Kathrin Damm,2,* Stephanie Stiel1,* 1Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany; 2Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany; 3Faculty of Engineering and Mathematics, Bielefeld University of Applied Sciences, Bielefeld, Germany*These authors contributed equally to this workCorrespondence: Franziska A Herbst, Hannover Medical School, Institute for General Practice and Palliative Care, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany, Fax +49 511 532 4176, Email [email protected]: In Germany, patients with incurable chronic diseases living at home increasingly have the option of using outpatient and day care hospice and specialized palliative care services. The present study examined and compared patients’ and their relatives’ preferences for end-of-life outpatient and day care services.Patients and Methods: The study used a questionnaire integrating a discrete choice experiment. For six scenarios, participants chose between two hypothetical end-of-life care offers, described by seven attributes. The model compared place of care, frequency and duration of care and support, specialized medical palliative care, accompanied activities, and relieving patient counselling. The model also included optional overnight care and willingness to pay. Patients and the relatives of patients suffering from incurable, chronic diseases who were not yet receiving palliative care were recruited via hospitals and self-help groups (06/2021– 07/2022).Results: The results were based on data from 436 questionnaires (patients: n=263, relatives: n=173). All attributes had a statistically significant impact on choice decisions, with place of care showing the greatest importance. All respondents highly preferred care in the patient’s home over out-of-home care. Patients stressed the importance of special medical (palliative) care and valued accompanied activities, often facilitated by hospice volunteers. Relatives, but not patients, considered the frequency and duration of care highly relevant.Conclusion: The results suggest a higher demand for care in the patient’s home than for out-of-home care. Patients’ and relatives’ high preference for special medical care and the relief of family caregiver burden should be considered in the design of day care services.Keywords: palliative care, hospice care, preferences, discrete choice experiment, medical day care, ambulatory car