title: Sex-based differences in end-of-life decision making in Flanders, Belgium.
abstract: BACKGROUND
  Sex-related differences in end-of-life decisions (EOLD) are underresearched and unexplored.
  
  
  OBJECTIVE
  To investigate whether there are (1) differences in demographic and/or clinical characteristics between male and female decedents; (2) differences between men and women in the prevalence of EOLD with a possible or certain life-shortening effect; (3) differences in EOL decision making between men and women.
  
  
  METHODS
  In 2007, we performed a postmortem survey in Flanders, Belgium among physicians certifying a large representative sample (n=6927) of death certificates. Response rate was 58.4%.
  
  
  RESULTS
  Of patients with nonsudden death, women more often die in a care home than men (31.4% vs. 18.2%) who more often die at home (24.1% vs. 17.9%). Men tend to die more often from cancer than women (45.4% vs. 32.1%). Decisions to withhold or withdraw potentially life-prolonging treatment are more often made in women (28.0% vs. 22.8%, P=0.003); euthanasia and pain and symptoms treatment [alleviation of pain and symptoms (APS)] occur more often in men (3.6% vs. 2.1% euthanasia, P=0.023; 41.8% vs. 36.9% APS, P=0.012). These differences disappear after controlling for confounders. Bivariate associations were found between sex and EOL decision making. Some of them remained after controlling for confounders.
  
  
  CONCLUSIONS
  It is not the patient's sex in itself that determines the likelihood of an EOLD, but the different clinical profiles of men and women at the end of life. Although sex is not a determining factor in the prevalence of EOLD, it influences the decision-making process, indicating that there may be a difference in the way that male and female patients participate in EOL decision making.
authors.affiliation: End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussel, Belgium. tinne.smets@vub.ac.be
authors.forename: Tinne
authors.initials: T
authors.lastname: Smets
authors.forename: Judith A
authors.initials: JA
authors.lastname: Rietjens
authors.forename: Kenneth
authors.initials: K
authors.lastname: Chambaere
authors.forename: Gily
authors.initials: G
authors.lastname: Coene
authors.forename: Reginald
authors.initials: R
authors.lastname: Deschepper
authors.forename: H Roeline
authors.initials: HR
authors.lastname: Pasman
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012959:Socioeconomic Factors; D013727:Terminal Care / Q000706:statistics & numerical data*; D055815:Young Adult