title: Decision making about medical interventions in the end-of-life care of people with intellectual disabilities: a national survey of the considerations and beliefs of GPs, ID physicians and care staff.
abstract: OBJECTIVE
  This paper explores the personal beliefs and specific considerations of professionals regarding decisions about potentially burdensome medical interventions in the end-of-life care for people with intellectual disabilities (ID).
  
  
  METHODS
  A survey questionnaire covering decision making about potentially burdensome medical interventions was sent to nationally representative samples of 294 ID care staff-members, 273 ID physicians and 1000 GPs.
  
  
  RESULTS
  Professionals predominantly believed that considerations about quality of life are most important. Quality of life and wellbeing were also frequently considered in both decisions to start/continue an intervention and decisions to forgo/withdraw an intervention. Seventy percent believed that people with ID should always be informed about interventions, and 61% would respect a refusal by the person. The family's wishes were explicitly considered more often than the wishes of the person with ID.
  
  
  CONCLUSIONS
  Although respondents agree that the quality of life is highly important, the wishes of people with ID (especially of those with severe/profound ID) were often not considered in decisions about potentially burdensome medical interventions.
  
  
  CONCLUSIONS
  To enhance the active involvement of people with ID in decision making we recommend that professionals integrate collaborative principles in decision making and make use of pictorial and easy reading resources.
authors.affiliation: NIVEL, Netherlands Institute of Health Services Research, Utrecht, The Netherlands.
authors.forename: Nienke
authors.initials: N
authors.lastname: Bekkema
authors.affiliation: NIVEL, Netherlands Institute of Health Services Research, Utrecht, The Netherlands. Electronic address: a.deveer@nivel.nl.
authors.forename: Anke J E
authors.initials: AJ
authors.lastname: de Veer
authors.affiliation: Koraalgroep, Maasveld, Maastricht, The Netherlands.
authors.forename: Annemieke M A
authors.initials: AM
authors.lastname: Wagemans
authors.affiliation: Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Expertise Center for Palliative Care Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Cees M P M
authors.initials: CM
authors.lastname: Hertogh
authors.affiliation: NIVEL, Netherlands Institute of Health Services Research, Utrecht, The Netherlands; Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Expertise Center for Palliative Care Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Anneke L
authors.initials: AL
authors.lastname: Francke
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003657:Decision Making; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D008607:Intellectual Disability; D008297:Male; D009426:Netherlands; D010820:Physicians; D011368:Professional-Family Relations; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods*
keywords: Decision making; End-of-life care; Intellectual disabilities; Medical interventions