Studying Cost as a Factor in the Choice between Quality and Quantity of Life amongst Patients with Cancer and their Caregivers at a Cancer Centre in Singapore

Background: Treatment costs and sociocultural concerns play a significant role in decisions regarding Quantity of Life (QuoL) options that seek to prolong life, such as chemotherapy, or a Quality of Life (QoL) approach where the patient refuses available treatments such as chemotherapy in favour of maximizing comfort and quality of life at the end of life in Singapore. Deciphering the reasons behind such care decisions is often difficult because of local social taboos regarding discussions about death and dying. Objectives: To scrutinize the rationale behind QuoL and QoL within the Singapore context and delineate the impact of cost upon such decisions. Methods: To overcome local sociocultural taboos about discussing death and dying with patients, participants watched a video vignette of a family discussing treatment options for their mother (Mrs Tan) who was recently diagnosed with terminal cancer. Participants were asked what advice they would offer Mrs Tan regarding her treatment plans in the face of a poor prognosis, incurable cancer and costly treatment. Participants were then asked what their advice would be when the costs of treatment was covered by the patient’s insurance policy. Their responses were evaluated using Grounded Theory analysis. Setting/Subjects: 132 oncology patients and their caregivers were recruited from an ambulatory treatment unit at a tertiary oncology centre. Results: 63 (47.7%) of 132 participants advised Mrs Tan to opt for the QoL approach but when treatment costs were covered by insurance, only 5 (3.8%) of 132 participants chose QoL, whilst 108 (81.8%) participants chose QuoL options. Conclusion: Whilst cost is a significant factor in end of life decision making, strong sociocultural influences that perceive QoL approaches as ‘giving up’ ultimately determines the course of care.