title: Priorities for treatment, care and information if faced with serious illness: a comparative population-based survey in seven European countries.
abstract: BACKGROUND
  Health-care costs are growing, with little population-based data about people's priorities for end-of-life care, to guide service development and aid discussions.
  
  
  OBJECTIVE
  We examined variations in people's priorities for treatment, care and information across seven European countries.
  
  
  METHODS
  Telephone survey of a random sample of households; we asked respondents their priorities if 'faced with a serious illness, like cancer, with limited time to live' and used multivariable logistic regressions to identify associated factors.
  
  
  METHODS
  Members of the general public aged ≥ 16 years residing in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain.
  
  
  RESULTS
  In total, 9344 individuals were interviewed. Most people chose 'improve quality of life for the time they had left', ranging from 57% (95% confidence interval: 55%-60%, Italy) to 81% (95% confidence interval: 79%-83%, Spain). Only 2% (95% confidence interval: 1%-3%, England) to 6% (95% confidence interval: 4%-7%, Flanders) said extending life was most important, and 15% (95% confidence interval: 13%-17%, Spain) to 40% (95% confidence interval: 37%-43%, Italy) said quality and extension were equally important. Prioritising quality of life was associated with higher education in all countries (odds ratio = 1.3 (Flanders) to 7.9 (Italy)), experience of caregiving or bereavement (England, Germany, Portugal), prioritising pain/symptom control over having a positive attitude and preferring death in a hospice/palliative care unit. Those prioritising extending life had the highest home death preference of all groups. Health status did not affect priorities.
  
  
  CONCLUSIONS
  Across all countries, extending life was prioritised by a minority, regardless of health status. Treatment and care needs to be reoriented with patient education and palliative care becoming mainstream for serious conditions such as cancer.
authors.affiliation: 1King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.forename: Barbara
authors.initials: B
authors.lastname: Gomes
authors.forename: Natalia
authors.initials: N
authors.lastname: Calanzani
authors.forename: Wei
authors.initials: W
authors.lastname: Gao
authors.forename: Claudia
authors.initials: C
authors.lastname: Bausewein
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Daveson
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Ferreira
authors.forename: Franco
authors.initials: F
authors.lastname: Toscani
authors.forename: Marjolein
authors.initials: M
authors.lastname: Gysels
authors.forename: Lucas
authors.initials: L
authors.lastname: Ceulemans
authors.forename: Steffen T
authors.initials: ST
authors.lastname: Simon
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
authors.forename: Richard
authors.initials: R
authors.lastname: Harding
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D003431:Cross-Cultural Comparison; D003657:Decision Making; D005060:Europe / Q000453:epidemiology; D005260:Female; D006292:Health Priorities; D006801:Humans; D033181:Information Dissemination; D007407:Interviews as Topic; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000523:psychology*; D016017:Odds Ratio; D010166:Palliative Care; D010353:Patient Education as Topic; D057240:Patient Preference; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013727:Terminal Care; D019452:Terminally Ill / Q000523:psychology*; D055815:Young Adult
keywords: Decision making; cross-cultural comparison; life extension; palliative care; quality of life