Patient preferences vary widely with clues by age and sex

Clinical takeaway: Demographic patterns in risk tolerance, quality-of-life priorities, and decision control are consistent enough to help guide where to start a preference conversation, but varied enough that it still needs to happen.

When treatment matches what patients actually value, outcomes and satisfaction improve. That case for shared decision-making has been settled for two decades. The harder problem is lack of time and support: eliciting preferences during a short visit is slow, and few tools exist for the older adults facing the most complex decisions. A large survey now offers a rough map of where those conversations might begin.

What is considered a patient preference can be broader than clinicians often ask about, extending into fundamental questions around risk tolerance, quality versus length of life, appetite for experimental treatment, and control over decisions. Research to date has mapped these by disease, but more general patterns that could broadly inform patient visits have remained largely unmeasured.

No consensus emerged on most questions, with answers spanning the full scale. Where respondents did agree, they favored quality of life over length of life, roughly one in four at the far quality end, and body function over appearance by an even wider margin.

Sex, age, and education pulled in different directions. Women tended to want more control over decisions and less risk; adults 75 and older often wanted less risk and more physician control; while lower education tracked with deferring to doctors more strongly than any other factor measured.

Patients with cancer were markedly less risk-averse than those without, the strongest link to any health condition measured, and less likely to defer decisions. Those facing some of the hardest decisions appeared the most willing to take risks and keep control.

Data come from the 2016/2017 wave of the English Longitudinal Study of Ageing, which added six general preference questions rated on 0-to-10 scales. The weighted sample of 6,098 adults 50 and older was designed to be nationally representative of England.

"We found that older adults have different views about their health and that age, sex and education each shaped health preferences in different ways. The finding that stood out to me the most was around education - people who had fewer educational opportunities were more likely to leave treatment decisions to their doctors. To me, this highlights the need to explore how we can ensure shared decision-making reaches everyone equally," said Dr. Oby Enwo of Norwich Medical School, University of East Anglia.

Source: Steel N, et al. PLoS One. 2026 Jul 29. General healthcare preferences for people aged 50 and over in England: English longitudinal study of ageing