Attitudes to terminal patients' unorthodox therapy: Finnish doctors' responses to a case scenario.
We carried out a postal survey of a sample of Finnish doctors ( n=1182) concerning their attitudes and ethical decisions in end-of-life care. A scenario was presented in which a patient with terminal cancer wished to obtain unorthodox treatment. Factors possibly influencing decision making such as general attitudes, life values and demographics were investigated. The response rate was 62%. The patient's plan to use unorthodox treatment was accepted by 54% of doctors. Gender or speciality did not influence the decision, but doctor's age was a significant factor ( P=0.0005). Doctors aged 35-49 years were more accepting; younger and older ones less accepting. Doctors who had clinical experience in terminal care were more compliant to the patient's plan ( P=0.034). A stepwise logistic regression analysis was used to create a model for explaining not accepting versus accepting the treatment with the background variables. Altogether eight independent significant variables were included in the final model of explaining a doctor's choice in the presented scenario. According to the model the patient's wish was more frequently accepted if the doctor was middle-aged, had clinical experience in terminal care, valued a high standard of living, considered terminal care satisfying, was less critical of health economics, considered advance directives helpful, had a high fear-of-death index score, and valued professional status less.
Hinkka
Heikki
H
Kangasala Health Center, Herttualantie 28, 36200 Kangasala, Finland. hhinkka@sci.fi
Kosunen
Elise
E
Lammi
Ulla-Kaija
UK
Metsänoja
Riina
R
Kellokumpu-Lehtinen
Pirkko
P
D000328:Adult; D000367:Age Factors; D001291:Attitude of Health Personnel; D000529:Complementary Therapies / Q000941:ethics / Q000523:psychology*; D005260:Female; D005387:Finland; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000941:ethics / Q000523:psychology*; D010820:Physicians / Q000941:ethics / Q000523:psychology*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000941:ethics / Q000523:psychology*