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Are Asians comfortable with discussing death in health valuation studies? A study in multi-ethnic Singapore

Wee, H.L., Li, S.C., Xie, F., Luo, X.H.Z.N., Cheung, Y.B., Machin, D., Fong, K.Y. and Thumboo, J. (2006) Are Asians comfortable with discussing death in health valuation studies? A study in multi-ethnic Singapore. Health and Quality of Life Outcomes, 4 (93). ISSN 1477-7525


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To characterize ease in discussing death (EID) and its influence on health valuation in a multi-ethnic Asian population and to determine the acceptability of various descriptors of death and "pits"/"all-worst" in health valuation.


In-depth interviews (English or mother-tongue) among adult Chinese, Malay and Indian Singaporeans selected to represent both genders and a wide range of ages/educational levels. Subjects rated using 0–10 visual analogue scales (VAS): (1) EID, (2) acceptability of 8 descriptors for death, and (3) appropriateness of "pits" and "all-worst" as descriptors for the worst possible health state. Subjects also valued 3 health states using VAS followed by time trade-off (TTO). The influence of sociocultural variables on EID and these descriptors was studied using univariable analyses and multiple linear regression (MLR). The influence of EID on VAS/TTO utilities with adjustment for sociocultural variables was assessed using MLR.


Subjects (n = 63, 35% Chinese, 32% Malay, median age 44 years) were generally comfortable with discussing death (median EID: 8.0). Only education significantly influenced EID (p = 0.045). EID correlated weakly with VAS/TTO scores (range: VAS: -0.23 to 0.07; TTO: -0.14 to 0.11). All subjects felt "passed away", "departed" and "deceased" were most acceptable (median acceptability: 8.0) while "sudden death" and "immediate death" were least acceptable (median acceptability: 5.0). Subjects clearly preferred "all-worst" to "pits" (63% vs. 19%, p < 0.001).


Singaporeans were generally comfortable with discussing death and had clear preferences for several descriptors of death and for "all-worst". EID is unlikely to influence health preference measurement in health valuation studies.

Item Type: Article
Copyright, Publisher and Additional Information: © 2006 Wee et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Institution: The University of Sheffield
Academic Units: The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield)
Depositing User: Sherpa Assistant
Date Deposited: 22 Jan 2007
Last Modified: 15 Jun 2014 06:23
Published Version: http://www.hqlo.com/content/4/1/93
Status: Published
Publisher: BioMed Central
Refereed: Yes
Identification Number: 10.1186/1477-7525-4-93
URI: http://eprints.whiterose.ac.uk/id/eprint/1910

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