Ideally, game designers would be familiar with and enjoy a wide variety of play styles, and work towards creating a game that supports as many of those as possible (when trying to make a game meant to have a wide appeal, such as D&D).
In practice they get a list from marketing about the sizes of different target groups and are told to make a game for group X and Y and which supports making supplements for Z years.
I think writing 5E is a lot less creative as some people think. The core decision will be made according to economical data.
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