Illness in mind.

IntroductionMedical decision making is often guided bydisease-specific outcomes such as life extension or survival. Especially for older adults other outcomes like maintaining independence can be equally vital or more important. Enhanced insight into the priorities of community dwelling older adults can optimize treatment decision making and refine healthcare policy.The aim of this study was is to identify which outcomes are prioritized by adults of 50 years and older when choosing between treatment options with various outcomes in a hypothetical case of a life-threatening disease.MethodsWe conducted a Discrete Choice Experiment (DCE) with individuals aged ≥50, comparing six pairs of hypothetical treatmentoptions with five attributes: life expectancy, independence, pain, memory complaints and societal costs. Attribute utility was analyzed using a conditional logit model, and latent class analyses were employed to explore preferences in groups. Data collection took place at a four-day national fair for people aged 50 or older in Utrecht, Netherlands.ResultsIn total 333 volunteers (233 female, mean 70 yr, SD 7.7) completed the DCE. Most participants prioritized maintaining independence, followed by life expectancy and the avoidance of severe physical or cognitive impairments (p ConclusionsWhen confronted with a (possible) life threatening disease, most people aged ≥ 50 yr prioritize remaining independence and the absence of severe pain and severe memory complaints above life expectancy. A smaller subgroup prioritized life expectancy above other attributes. These attributes – including societal costs – should be taken in to account in individual treatment decision making, in clinical guidelines and national healthcare policy.

引言
临床决策通常以疾病特异性结局为指导依据，例如延长寿命或生存率。对于老年群体而言，维持独立生活能力等其他结局的重要性甚至更高。深入了解社区居住老年人的治疗优先级，有助于优化个体化治疗决策、完善医疗政策。
本研究旨在明确：在假设的致命性疾病场景中，50岁及以上成年人在选择具有不同结局的治疗方案时，更优先考量哪些结局指标。

方法
本研究针对50岁及以上人群开展离散选择实验（Discrete Choice Experiment, DCE），设置6组对比的假想治疗方案，包含5项结局属性：预期寿命、独立生活能力、疼痛程度、记忆障碍以及社会成本。采用条件logit模型分析属性效用，并通过潜类别分析探究不同群体的偏好差异。数据采集于荷兰乌得勒支市一场为期4天的50岁及以上人群全国博览会现场。

结果
总计333名志愿者（233名女性，平均年龄70岁，标准差7.7）完成了本次离散选择实验。多数参与者将维持独立生活能力列为首要优先级，其次为预期寿命以及避免严重躯体或认知功能损害（原文此处p值未完整显示）。

结论
当面临（疑似）致命性疾病时，多数50岁及以上人群将维持独立生活能力、无严重疼痛及记忆障碍置于预期寿命之上。仅少数亚组人群将预期寿命列为最高优先级。上述属性（含社会成本）应纳入个体化治疗决策、临床指南及国家医疗政策的考量范畴。