End-of-life decision making in Europe and Australia: a physician survey.
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).


CONCLUSIONS
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.
Onwuteaka-Philipsen
Bregje D
BD
Department of Social Medicine, VU University Medical Centre, Amsterdam, the Netherlands. b.philipsen@vumc.nl
Fisher
Susanne
S
Cartwright
Colleen
C
Deliens
Luc
L
Miccinesi
Guido
G
Norup
Michael
M
Nilstun
Tore
T
van der Heide
Agnes
A
van der Wal
Gerrit
G
D001315:Australia; D003657:Decision Making; D005060:Europe; D005260:Female; D006801:Humans; D008017:Life Expectancy; D016224:Living Wills; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000706:statistics & numerical data