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End-of-life decision making in Europe and Australia - A physician survey

Onwuteaka-Philipsen, BD ; Fisher, S ; Cartwright, C ; Deliens, L ; Miccinesi, G ; Norup, M ; Nilstun, Tore LU ; van der Heide, A and van der Wal, G (2006) In Archives of Internal Medicine 166(8). p.921-929
Abstract
Background: The frequencies with which physicians make different medical end-of-life decisions (ELDs) may differ between countries, but comparison between countries has been difficult owing to the use of dissimilar research methods. Methods: A written questionnaire was sent to a random sample of physicians from 9 specialties in 6 European countries and Australia to investigate possible differences in the frequencies of physicians' willingness to perform ELDs and to identify predicting factors. Response rates ranged from 39% to 68% (N= 10 139). Using hypothetical cases, physicians were asked whether they would ( probably) make each of 4 ELDs. Results: In all the countries, 75% to 99% of physicians would withhold chemotherapy or intensify... (More)
Background: The frequencies with which physicians make different medical end-of-life decisions (ELDs) may differ between countries, but comparison between countries has been difficult owing to the use of dissimilar research methods. Methods: A written questionnaire was sent to a random sample of physicians from 9 specialties in 6 European countries and Australia to investigate possible differences in the frequencies of physicians' willingness to perform ELDs and to identify predicting factors. Response rates ranged from 39% to 68% (N= 10 139). Using hypothetical cases, physicians were asked whether they would ( probably) make each of 4 ELDs. Results: In all the countries, 75% to 99% of physicians would withhold chemotherapy or intensify symptom treatment at the request of a patient with terminal cancer. In most cases, more than half of all physicians would also be willing to deeply sedate such a patient until death. However, there was generally less willingness to administer drugs with the explicit intention of hastening death at the request of the patient. The most important predictor of ELDs was a request from a patient with decisional capacity (odds ratio, 2.1-140.0). Shorter patient life expectancy and uncontrollable pain were weaker predictors but were more stable across countries and across the various ELDs (odds ratios, 1.1-2.4 and 0.9-2.4, respectively). Conclusion: Cultural and legal factors seem to influence the frequencies of different ELDs and the strength of their determinants across countries, but they do not change the essence of decision making. (Less)
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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Archives of Internal Medicine
volume
166
issue
8
pages
921 - 929
publisher
American Medical Association
external identifiers
  • pmid:16636220
  • wos:000237026000014
  • scopus:33646128249
ISSN
0003-9926
language
English
LU publication?
yes
id
805a9286-fb0f-4f01-8acc-44def856b364 (old id 410972)
alternative location
http://archinte.ama-assn.org/cgi/content/abstract/166/8/921
date added to LUP
2016-04-01 11:37:05
date last changed
2021-08-11 03:58:44
@article{805a9286-fb0f-4f01-8acc-44def856b364,
  abstract     = {Background: The frequencies with which physicians make different medical end-of-life decisions (ELDs) may differ between countries, but comparison between countries has been difficult owing to the use of dissimilar research methods. Methods: A written questionnaire was sent to a random sample of physicians from 9 specialties in 6 European countries and Australia to investigate possible differences in the frequencies of physicians' willingness to perform ELDs and to identify predicting factors. Response rates ranged from 39% to 68% (N= 10 139). Using hypothetical cases, physicians were asked whether they would ( probably) make each of 4 ELDs. Results: In all the countries, 75% to 99% of physicians would withhold chemotherapy or intensify symptom treatment at the request of a patient with terminal cancer. In most cases, more than half of all physicians would also be willing to deeply sedate such a patient until death. However, there was generally less willingness to administer drugs with the explicit intention of hastening death at the request of the patient. The most important predictor of ELDs was a request from a patient with decisional capacity (odds ratio, 2.1-140.0). Shorter patient life expectancy and uncontrollable pain were weaker predictors but were more stable across countries and across the various ELDs (odds ratios, 1.1-2.4 and 0.9-2.4, respectively). Conclusion: Cultural and legal factors seem to influence the frequencies of different ELDs and the strength of their determinants across countries, but they do not change the essence of decision making.},
  author       = {Onwuteaka-Philipsen, BD and Fisher, S and Cartwright, C and Deliens, L and Miccinesi, G and Norup, M and Nilstun, Tore and van der Heide, A and van der Wal, G},
  issn         = {0003-9926},
  language     = {eng},
  number       = {8},
  pages        = {921--929},
  publisher    = {American Medical Association},
  series       = {Archives of Internal Medicine},
  title        = {End-of-life decision making in Europe and Australia - A physician survey},
  url          = {http://archinte.ama-assn.org/cgi/content/abstract/166/8/921},
  volume       = {166},
  year         = {2006},
}