title: Attitudes of cancer patients, family caregivers, oncologists and members of the general public toward critical interventions at the end of life of terminally ill patients.
abstract: BACKGROUND
  Whereas most studies have focused on euthanasia and physician-assisted suicide, few have dealt comprehensively with other critical interventions administered at the end of life. We surveyed cancer patients, family caregivers, oncologists and members of the general public to determine their attitudes toward such interventions.
  
  
  METHODS
  We administered a questionnaire to four groups about their attitudes toward five end-of-life interventions--withdrawal of futile life-sustaining treatment, active pain control, withholding of life-sustaining measures, active euthanasia and physician-assisted suicide. We performed multivariable analyses to compare attitudes and to identify sociodemographic characteristics associated with the attitudes.
  
  
  RESULTS
  A total of 3840 individuals--1242 cancer patients, 1289 family caregivers and 303 oncologists from 17 hospitals, as well as 1006 members of the general Korean population--participated in the survey. A large majority in each of the groups supported withdrawal of futile life-sustaining treatment (87.1%-94.0%) and use of active pain control (89.0%-98.4%). A smaller majority (60.8%-76.0%) supported withholding of life-sustaining treatment. About 50% of those in the patient and general population groups supported active euthanasia or physician-assisted suicide, as compared with less than 40% of the family caregivers and less than 10% of the oncologists. Higher income was significantly associated with approval of the withdrawal of futile life-sustaining treatment and the practice of active pain control. Older age, male sex and having no religion were significantly associated with approval of withholding of life-sustaining measures. Older age, male sex, having no religion and lower education level were significantly associated with approval of active euthanasia and physician-assisted suicide.
  
  
  CONCLUSIONS
  Although the various participant groups shared the same attitude toward futile and ameliorative end-of-life care (the withdrawal of futile life-sustaining treatment and the use of active pain control), oncologists had a more negative attitude than those in the other groups toward the active ending of life (euthanasia and physician-assisted suicide).
authors.affiliation: Cancer Management Branch, Research Institute, National Cancer Center, Goyang, Korea. lawyun08@ncc.re.kr
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Yun
authors.forename: Kyung Hee
authors.initials: KH
authors.lastname: Han
authors.forename: Sohee
authors.initials: S
authors.lastname: Park
authors.forename: Byeong Woo
authors.initials: BW
authors.lastname: Park
authors.forename: Chi-Heum
authors.initials: CH
authors.lastname: Cho
authors.forename: Sung
authors.initials: S
authors.lastname: Kim
authors.forename: Dae Ho
authors.initials: DH
authors.lastname: Lee
authors.forename: Soon Nam
authors.initials: SN
authors.lastname: Lee
authors.forename: Eun Sook
authors.initials: ES
authors.lastname: Lee
authors.forename: Jung Hun
authors.initials: JH
authors.lastname: Kang
authors.forename: Si-Young
authors.initials: SY
authors.lastname: Kim
authors.forename: Jung Lim
authors.initials: JL
authors.lastname: Lee
authors.forename: Dae Seog
authors.initials: DS
authors.lastname: Heo
authors.forename: Chang Geol
authors.initials: CG
authors.lastname: Lee
authors.forename: Yeun Keun
authors.initials: YK
authors.lastname: Lim
authors.forename: Sam Yong
authors.initials: SY
authors.lastname: Kim
authors.forename: Jong Soo
authors.initials: JS
authors.lastname: Choi
authors.forename: Hyun Sik
authors.initials: HS
authors.lastname: Jeong
authors.forename: Mison
authors.initials: M
authors.lastname: Chun
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D017028:Caregivers / Q000523:psychology*; D028601:Euthanasia, Active / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D018447:Medical Futility / Q000523:psychology; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010146:Pain / Q000523:psychology; D010820:Physicians / Q000523:psychology*; D011639:Public Opinion; D056910:Republic of Korea; D017236:Suicide, Assisted / Q000523:psychology; D011795:Surveys and Questionnaires; D019452:Terminally Ill / Q000523:psychology*; D028761:Withholding Treatment