OBJECTIVES: To quantify palliative care experts’ preferences to inform prioritization of core end-of-life (EOL) care domains.

METHODS: We used a discrete choice experiment (DCE) survey evaluating 13 aspects of care during patients’ last 6 weeks of life. Palliative-care experts were eligible to participate in the study if they were health care providers, policymakers or academics directly involved in palliative care provision or research. A convenience sample of at least two experts were invited from countries worldwide. In each of 6 DCE choice questions, respondents were asked to consider three hypothetical healthcare provider groups that were rated on each of four aspects of care using a 5-star rating scale. Respondents indicated which group they would choose to care for a terminally-ill patient. Random-parameters logit was used to model data from choice questions and estimate relative importance weights (RI) for the 13 aspects ranging from 0(least)-100(most important).

RESULTS: 193 experts in 120 countries completed the survey. All preference weights were logically ordered and exhibited diminishing value with improvements in quality ratings. RI weights indicated that managing pain and discomfort was the most important (RI=14.4 [95% confidence interval (CI): 11.9-16.8]) aspect of care for experts, followed by providing sympathetic care (RI=9.4 [95% CI: 7.5–11.2]) and access to life-extending treatments (RI=9.0 [95% CI: 7.2–10.8]). Supporting patients’ spiritual/cultural needs (RI=3.9 [95% CI: 2.3–5.5]) and other non-medical concerns (RI=4.9 [95%CI: 3.2–6.6]) were least important.

CONCLUSIONS: Diminishing marginal increases in preference weights suggest that larger improvements in the quality of EOL care can be achieved by moving from poor to moderate quality ratings, rather than moderate to excellent quality ratings. Thus, broad improvements across aspects of care may be more beneficial than focused investments. Beyond prioritizing pain management, our results indicate that providing sympathetic care and access to life-extending treatments are highly, and almost equally, important aspects of care to experts.