Table 1.
Subject Characteristics and Distribution of Responses by Ethnicity
| Median (interquartile range), unless otherwise specified | |||||
| All (n = 63) | Chinese (n = 22) | Malays (n = 20) | Indians (n = 21) | p value | |
| Age (years) | 44 (32, 56) | 45 (32, 56) | 42 (26, 50) | 35 (41, 57) | 0.76 |
| Female (N, %) | 33 (52) | 12 (55) | 10 (50) | 11 (52) | 0.96 |
| Years of education | 10.0 (8.0, 13.0) | 13.0 (10.0, 15.0) | 10.0 (8.0, 12.0) | 10.0 (8.0, 12.0) | 0.019 |
| Presence of chronic medical conditions† (N, %) | 32 (51) | 10 (45) | 9 (45) | 13 (62) | 0.46 |
| Working (N, %) | 38 (60) | 10 (45) | 13 (65) | 15 (71) | 0.19 |
| Healthcare background (N, %)‡ | 9 (15) | 6 (27) | 2 (11) | 1 (5) | 0.11 |
| Religiosity§ | 6.0 (5.0, 8.0) | 5.0 (2.3, 7.0) | 6.5 (5.0, 8.8) | 7.0 (5.0, 10) | 0.036 |
| Ease in discussing death§ | 8.0 (6.0,10) | 8.0 (7.0, 9.0) | 8.0 (5.0, 10) | 8.0 (6.0, 10) | 0.82 |
| Acceptability of descriptors of death§ | |||||
| Passed away | 8.0 (7.0, 10) | 8.0 (7.0, 9.0) | 9.5 (7.0, 10) | 8.0 (6.5, 10) | 0.37 |
| Departed | 8.0 (5.0, 9.0) | 8.0 (7.0, 9.0) | 8.0 (5.0, 10) | 6.0 (4.0, 9.5) | 0.31 |
| Deceased | 8.0 (5.0, 10) | 7.0 (5.8, 8.3) | 9.0 (7.0, 10) | 7.0 (5.0, 10) | 0.20 |
| Demised | 7.0 (5.0, 10) | 7.5 (7.0, 9.0) | 8.0 (5.0, 10) | 6.0 (3.5, 9.5) | 0.27 |
| Death | 7.0 (5.0, 9.0) | 6.5 (5.0, 8.3) | 7.5 (5.0, 10) | 5.0 (4.0, 8.5) | 0.34 |
| Dead | 7.0 (5.0, 9.0) | 6.5 (5.0, 8.3) | 9.5 (5.0, 10) | 6.0 (4.0, 8.0) | 0.084 |
| Sudden death | 5.0 (3.0, 7.0) | 6.0 (3.8, 7.0) | 7.0 (5.0, 10) | 4.0 (1.5, 6.5) | 0.035 |
| Immediate death | 5.0 (2.0, 8.0) | 5.0 (3.0, 7.3) | 6.5 (3.5, 10) | 3.0 (0.5, 7.0) | 0.033 |
| Appropriateness of descriptors of worst health state§ | |||||
| Pits | 4.0 (0, 8.0) | 5.0 (0, 7.3) | 2.5 (0, 5.0) | 6.0 (1.0, 8.5) | 0.17 |
| All-worst | 7.0 (5.0, 9.0) | 7.5 (4.8, 8.0) | 5.0 (1.3, 7.0) | 9.0 (7.0, 10) | <0.001 |
| Preferred descriptor of worst health state (N, %)|| | 0.43 | ||||
| Pits | 12 (19) | 5 (23) | 5 (25) | 2 (10) | |
| All-worst | 40 (63) | 14 (64) | 12 (60) | 14 (67) | |
| Neither | 11 (16) | 3 (12) | 3 (15) | 5 (24) | |
| Health state ratings# | |||||
| Visual analogue scale (range 0 to 10) | |||||
| Mild (11122) | 8.0 (7.0, 10) | 7.8 (6.4, 8.0) | 9.0 (8.0, 10) | 9.0 (7.5, 10) | 0.005 |
| Moderate (23321) | 4.0 (2.0, 5.0) | 3.5 (2.4, 5.0) | 0 (0, 0.5) | 3.0 (1.5, 5.0) | 0.19 |
| Severe (32313) | 1.0 (0, 2.5) | 1.5 (1.0, 2.5) | 0 (1.0, 3.0) | 0 (0, 5.0) | 0.003 |
| Time-trade off scores (range – 19 to 1) | |||||
| Mild (11122) | 0.85 (0.45, 0.95) | 0.88 (0.56, 0.95) | 0.90 (0.50, 1) | 0.80 (0.20, 0.95) | 0.43 |
| Moderate (23321) | 0.00 (-0.67, 0.50) | 0.20 (-0.49, 0.75) | -0.10 (-3.00, 0.50) | -0.11 (-0.55, 0.00) | 0.07 |
| Severe (32313) | -0.25 (-0.82, 0.05) | 0.00 (-0.67, 0.36) | -0.25 (-4.00, 0.06) | -0.33 (-0.75, 0.00) | 0.24 |
IQR – interquartile range. †Self-reported chronic medical conditions included diabetes mellitus, hypertension, heart disease, asthma or lung diseases, bone or muscle illnesses and mental illnesses. ‡Details of subjects working in healthcare-related industry – Chinese: 5 pharmacy students, 1 teaching assistant in pharmacy department of a university; Malays: 1 office assistant in pharmacy department of a university, 1 cleaner in healthcare institution; Indian: 1 hospital inpatient care assistant. §Self-reported on a 0 to 10 Likert-type scale, where a higher score indicates higher religiosity/greater ease in discussing death/higher acceptability/greater appropriateness. ||p value calculated only for subjects who stated a preference. Among all subjects, all-worst was significantly preferred over pits (p < 0.001). # Each EQ-5D health state consists of 5 dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) and 3 levels (1 – no problem, 2 – moderate problem, 3 – severe problem). Health state 11122: No problems in walking about; no problems with selfcare; no problems with performing usual activities; moderate pain or discomfort and moderately anxious or depressed. Health state 23321: Some problems in walking about; unable to wash or dress oneself; unable to perform usual activities; moderate pain or discomfort; not anxious or depressed. Health state 32313: Confined to bed; some problems with self-care; unable to perform usual activities; no pain or discomfort; extremely anxious or depressed.
List of original items used in the study questionnaire:
1. Ease in Discussing Death: This piece of medical information mentions about the risk of dying from a new treatment. Are you comfortable with the idea of talking about death? Why? Prompting questions: Why do you find it difficult to talk about death? Do you fear death? For example, do you avoid thinking about death? Do you believe in life after death?
2. Descriptors of Death: In some health surveys, we need to discuss about death. Some words associated with death that may be found in health surveys include 'death', 'dead', 'passed away', 'deceased', 'departed', etc. In your opinion, on a scale of 0 to 10, how acceptable is each of these words shown on this card? Why?
3. Descriptors of Worst Health State: We have a card here that describes a certain health state. Some people have called it the "pits" state. Some people have called it the "all-worst" state. What does the word 'pits' mean to you? Why? What does the word 'all-worst' mean to you? Why? On a scale of 0 to 10, how suitable is the word 'pits' for describing this health state? On a scale of 0 to 10, how suitable is the word 'all-worst' for describing this health state? Which word do you prefer for describing this health state? Can you think of better suggestions for describing this health state? You may want to make reference to the list of terms that I have here on this card.