Physicians’ attitudes towards end-of-life decisions: a comparison between seven countries

Miccinesi, Guido; Fischer, Susanne; Paci, Euǵenio; Onwuteaka‐Philipsen, Bregje D.; Cartwright, Colleen M; Heide, Agnes van der; Nilstun, Tore; Norup, Michael; Mortier, Freddy

doi:10.1016/j.socscimed.2004.08.061

Cited by 154 publications

(155 citation statements)

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“…In addition to fi ve given answers ("no time", "did not receive the questionnaire", "not interested in this subject", "worries about the anonymity" and "addressed physician not working here anymore"), an open-ended question asking for other reasons was added. In the third part, three of the 14 statements from the main questionnaire assessing attitudes towards end of life decisions (Miccinesi et al 2005) were included: 1. "Physicians should comply with a patient's request to withhold or withdraw life-sustaining treatment", 2.…”

Section: End-of-life Decisions Includedmentioning

confidence: 99%

“…Unmeasured variables (such as experiences in end-of-life care) may infl uence willingness to participate. The present article describes the results of a non-responder study conducted within an international "medical end-of-life decision study" (van der Heide et al 2003;Miccinesi et al 2005), in which physicians were asked questions about their attitudes and experiences in this area. First we address the question of whether there are differences between the participants in the main study and the non-responders, regarding demographic characteristics and the number of terminal patients they usually care for.…”

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confidence: 99%

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Responders and non-responders in a study on medical end-of-life decisions in Denmark, the Netherlands, Sweden and Switzerland

et al. 2006

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On behalf of the EURELD consortium SummaryObjectives: To determine the direction and magnitude of participation bias in end-of-life research. Methods:Within the framework of a European survey on medical end-of-life decisions, a non-response study was conducted among physicians in Denmark, the Netherlands, Sweden and Switzerland. People were asked about their attitudes and experiences in the area of medial end-of-life decision. The response rates ranged from 12.8 % (Netherlands) to 39.4 % (Switzerland). The responders (n = 5 403) and the non-responders (n = 866) were compared regarding socio-demographic characteristics, experiences with terminal patients and agreement with attitudes towards "end-of-life decisions". The reasons for non-participation to the study were analyzed.Results: Non-response did not cause socio-demographic distortion, but non-responders had statistically signifi cantly fewer terminal patients than responders. Agreement rates were statistically signifi cantly higher among responders than among non-responders for euthanasia, non-treatment decision and life-preserving statements. Neutral answers were statistically signifi cantly more frequent among non-responders than among responders for life-preserving and euthanasia statements. The most commonly mentioned reason for non-participation was "lack of time". Conclusion:Non-participation does cause an overestimation of proponents of life-shortening, as well as of life-preserving endof-life decisions. Non-responders more often have ambiguous attitudes towards end-of-life decisions than responders.

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Section: End-of-life Decisions Includedmentioning

confidence: 99%

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confidence: 99%

Responders and non-responders in a study on medical end-of-life decisions in Denmark, the Netherlands, Sweden and Switzerland

et al. 2006

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“…Seale's (2009a) review of this literature cites studies showing that, as in studies of the general public, religion makes a difference (see, for example, Georges, Onwuteaka-Philipsen, van der Heide, van der Wal & van der Maas, 2006)) as does medical specialty. Oncologists, geriatricians and palliative care doctors have been found to be particularly opposed to assisted dying (Miccinesi, Fischer, Paci, Onwuteaka-Philipsen, Cartwright, van der Heide et al, 2005;Seale, 2009a) and intensive care physicians most supportive (Dickinson, Lancaster, Clark, Ahmedzai & Noble, 2002 Slome, Mitchell, Charlebois, Benevedes & Abrams (1997) who found that doctors in San Francisco with high 'intention to assist' attitude scores did in fact assist more people with AIDS to die. The present study therefore investigates whether there is an association between doctors' attitudes or beliefs and their reports of decisions which they expect or at least partly intend to end life.…”

Section: Introductionmentioning

confidence: 99%

Hastening death in end-of-life care: A survey of doctors

Seale

2009

Social Science & Medicine

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In end-of-life care the application of medical technology to prolong life at the expense of quality of life is widely debated. A national survey of 3,733 UK doctors reporting on the care of 2,923 people who had died under their care is reported. There was no time to make an 'end-of-life decision' (deciding to provide, withdraw or withhold treatment) for 8.5%. A further 55.2% reported decisions which they estimated would not hasten death and 28.9% reported decisions they had expected to hasten death. A further 7.4% reported deaths where they had to some degree intended to hasten death (=100%). Where patients or someone else had made a request for a hastened death, doctors were more likely to report expecting or at least partly intending to hasten death. Doctors usually made these decisions in consultation with colleagues, relatives and, where feasible, with patients. Intensive care specialists were particularly likely to report a degree of intention to hasten the end of life and to have treated patients lacking the capacity to discuss these decisions. Palliative medicine specialists were the least likely to report decisions they expected or at least partly intended to end life, in spite of reporting a high incidence of requests from their patients for a hastened death. Doctors with strong religious beliefs or who opposed the legalisation of assisted dying were unlikely to report such decisions. Elderly women and those with dementia are groups considered vulnerable in societies where a permissive approach is taken to hastening death in end-of-life care, but doctors describing these deaths were no more likely to report decisions which they expected or at least partly intended to end life. The survey suggests that concerns about the sanctity of life, as well as estimates of the quality of life, enter clinical decision-making.

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“…A growing interest in these issues is becoming evident in Europe, where epidemiological studies on end-of-life (ELD) decisions have been conducted for years. A European study (Eureld) [1] carried out in 2001-2002 was published in The Lancet one year later [2]. The research project was aimed at investigating to what extent end-of-life decision making practices varied in six European countries.…”

Section: Introductionmentioning

confidence: 99%

End-of-life decision making in respiratory failure. The therapeutic choices in chronic respiratory failure in a 7-item questionnaire

Rinnenburger

Alma

Bigioni

et al. 2012

Annali Dell'Istituto Superiore Di Sanità

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Abstract. Introduction. The transition from paternalistic medicine to a healthcare culture centred on the patient's decision making autonomy presents problems of communication and understanding. Chronic respiratory failure challenges patients, their families and caregivers with important choices, such as invasive and non-invasive mechanical ventilation and tracheostomy, which, especially in the case of neuromuscular diseases, can significantly postpone the end of life. Material and Methods. A 7-item questionnaire was administered to 100 patients with advanced COPD, neuromuscular diseases and pulmonary fibrosis, all of them on oxygen therapy and receiving day-hospital treatment for respiratory failure. The objective was to find out whether or not patients, if faced with a deterioration of their health condition, would want to take part in the decision making process and, if so, how and with whom. Results. Results showed that: 90% of patients wanted to be interviewed, 10% preferred not to be interviewed, 82% wanted to be regularly updated on their clinical situation, 75% wanted to be intubated, if necessary, and 56% would also agree to have a tracheostomy. These choices have been confirmed one year later, with 93% of respondents accepting the questionnaire and considering it useful. Conclusions. It is possible to conclude that a simple questionnaire can be a useful tool contributing to therapeutic decision making in respiratory failure.Key words: chronic respiratory failure, COPD, neuromuscular diseases, pulmonary fibrosis, therapeutic decisions, intubation, tracheostomy, end of life.Riassunto (Le decisioni di fine vita nell'insufficienza respiratoria cronica. Le scelte terapeutiche in un questionario di 7 domande). Introduzione. Il cambio dalla medicina paternalistica verso una cultura della salute centrata sull'autonomia decisionale del paziente genera problemi di comunicazione e comprensione. L'insufficienza respiratoria cronica sfida i pazienti, le loro famiglie e i curanti con scelte importanti come la ventilazione meccanica non invasiva o invasiva, che nelle malattie neuromuscolari può notevolmente posticipare la fine della vita. Materiali e Metodi. Un questionario (STIR -Scelte Terapeutiche nell'Insufficienza Respiratoria) con 7 domande è stato somministrato a 100 pazienti con BPCO avanzata, fibrosi polmonare o una malattia neuromuscolare, tutti in ossigenoterapia a lungo termine e in cura presso il Day Hospital. L'obiettivo era di capire se i pazienti con un peggioramento delle loro condizioni di salute volevano partecipare nei processi decisionali e, se sì, come e con chi. Risultati. 90% volevano essere intervistati, il 10% rifiuta di partecipare; 82% vuole essere informato regolarmente sulle proprie condizioni di salute, 75% vuole essere intubato, se necessario, e il 56% accetterebbe anche la tracheostomia. Queste scelte sono state confermate dopo un anno, con 93% di pazienti che accettavano il questionario e lo consideravano utile. Conclusioni. Un semplice questionario può essere un mezzo di aiuto utile...

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Physicians’ attitudes towards end-of-life decisions: a comparison between seven countries

Cited by 154 publications

References 46 publications

Responders and non-responders in a study on medical end-of-life decisions in Denmark, the Netherlands, Sweden and Switzerland

Responders and non-responders in a study on medical end-of-life decisions in Denmark, the Netherlands, Sweden and Switzerland

Hastening death in end-of-life care: A survey of doctors

End-of-life decision making in respiratory failure. The therapeutic choices in chronic respiratory failure in a 7-item questionnaire

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