Preferences for palliative care services for patients with advanced cancer from the demand-supply perspective: A...

Palliative care plays a critical role in improving quality of life for patients with life-limiting illnesses. Despite increasing global policy attention, the design and uptake of palliative-care services remain constrained by limited understanding of how different stakeholders, particularly healthcare providers and patients, value service attributes.

To examine similarities and differences in preferences for palliative-care services between providers and patients with advanced cancer from a dual supply-demand perspective.

A cross-sectional stated-preference study using a discrete choice experiment.

Oncology departments of four public hospitals in eastern, central, northern, and western China.

A total of 1051 respondents, including 538 healthcare providers and 513 patients with advanced cancer.

Seven attributes described palliative-care services: quality of life, family or friend caregiving burden, waiting time, out-of-pocket cost, service type, caregiver support, and decision-making arrangement. Mixed logit models estimated preference weights and marginal willingness to accept and pay. Latent class models explored preference heterogeneity, and simulated choice probabilities assessed preferences under alternative service configurations.

Preferences of both groups were dominated by improvements in quality of life (providers: β = -0.95, 95% CI -1.16 to -0.74; patients: β = 1.73, 95% CI 1.41 to 2.05). Providers additionally valued shared decision-making (β = -0.75, 95% CI -0.95 to -0.56), reduced family caregiving burden (β = 0.27, 95% CI 0.10 to 0.43), integrative traditional Chinese and Western care (β = -0.19, 95% CI -0.33 to -0.05), and lower costs (β = -0.03, 95% CI -0.05 to -0.02). Patients prioritized reductions in caregiving burden (β = 0.57, 95% CI 0.32 to 0.81), Western medicine-based care (β = 0.42, 95% CI 0.21 to 0.63), joint patient-family decision-making (β = 0.50, 95% CI 0.26 to 0.75), availability of respite care (β = 0.23, 95% CI 0.04 to 0.43), and lower costs (β = -0.39, 95% CI -0.45 to -0.33). Latent class analysis identified three provider segments and two patient segments. Differences in supply-demand preferences were also reflected in marginal willingness to accept and willingness to pay. Patients showed larger preference shifts than providers across simulated scenarios.

Both providers and patients favor palliative-care services that enhance quality of life, reduce unpaid family caregiving demands, and lower out-of-pocket costs. However, patients prefer joint patient-family decision-making, Western medicine-based care, and caregiver respite support, whereas providers favor triadic shared decision-making and integrative care models and place comparatively lower priority on caregiver-focused supports. These divergences underscore the importance of integrating both demand- and supply-side perspectives when designing person-centred yet system-feasible palliative-care services in rapidly developing health systems.

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Patients and providers agree quality of life matters most in palliative care but differ on care models and decision-making roles.