Participation of French general practitioners in end-of-life decisions for their hospitalised patients.
OBJECTIVE
Assuming the hypothesis that the general practitioner (GP) can and should be a key player in making end-of-life decisions for hospitalised patients, perceptions of GPs' role assigned to them by hospital doctors in making withdrawal decisions for such patients were surveyed.


METHODS
Questionnaire survey.


METHODS
Urban (districts located near Paris) and rural (southern France) areas.


METHODS
GPs.


RESULTS
The response rate was 32.2% (161/500), and it was observed that 70.8% of respondents believed that their participation in withdrawal decisions for their hospitalised patients was essential, whereas 42.1% believed that the hospital doctors were sufficiently skilled to make withdrawal decisions without input from the GPs. Most respondents were found to believe that they had the necessary skills (91.9%) and enough time (87.6%) to participate in withdrawal decisions. The last case of treatment withdrawal in hospital for one of their patients was described by 40% (65/161) of respondents, of whom only 40.0% (26/65) believed that they had participated actively in the decision process. The major factors in the multivariate analysis were the GP's strong belief that his or her participation was essential (p = 0.01), information on admission of the patient given to the GP by the hospital department (p = 0.007), rural practice (p = 0.03), visit to the patient dying in hospital (p = 0.02) and a request by the family to be kept informed about the patient (p = 0.003).


CONCLUSIONS
Strong interest was evinced among GPs regarding end-of-life issues, as well as considerable experience of patients dying at home. As GPs are more closely corrected to patients' families, they may be a good choice for third-party intervention in making end-of-life decisions for hospitalised patients.
Ferrand
E
E
Service d'Anesthésie Réanimation SAMU 94, Hôpital Henri-Mondor, AP-HP 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil cedex, France. edouard.ferrand@hmn.aphp.fr
Jabre
P
P
Fernandez-Curiel
S
S
Morin
F
F
Vincent-Genod
C
C
Duvaldestin
P
P
Lemaire
F
F
Hervé
C
C
Marty
J
J
D003625:Data Collection; D003657:Decision Making / Q000941:ethics*; D004992:Ethics, Medical; D005065:Euthanasia / Q000941:ethics; D005190:Family; D005602:France; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008505:Medical Staff, Hospital / Q000523:psychology; D010358:Patient Participation; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D013727:Terminal Care / Q000941:ethics*; D028761:Withholding Treatment / Q000941:ethics