title: Comparing end-of-life practices in different policy contexts: a scoping review.
abstract: OBJECTIVE
  End-of-life policy reforms are being debated in many countries. Research evidence is used to support different assumptions about the effects of public policies on end-of-life practices. It is however unclear whether reliable international practice comparisons can be conducted between different policy contexts. Our aim was to assess the feasibility of comparing similar end-of-life practices in different policy contexts.
  
  
  METHODS
  This is a scoping review of empirical studies on medical end-of-life practices. We developed a descriptive classification of end-of-life practices that distinguishes practices according to their legal status. We focused on the intentional use of lethal drugs by physicians because of international variations in the legal status of this practice. Bibliographic database searches were supplemented by expert consultation and hand searching of reference lists. The sensitivity of the search strategy was tested using a set of 77 articles meeting our inclusion criteria. Two researchers extracted end-of-life practice definitions, study methods and available comparisons across policy contexts. Canadian decision-makers were involved to increase the policy relevance of the review.
  
  
  RESULTS
  In sum, 329 empirical studies on the intentional use of lethal drugs by doctors were identified, including studies from 19 countries. The bibliographic search captured 98.7% of studies initially identified as meeting the inclusion criteria. Studies on the intentional use of lethal drugs were conducted in jurisdictions with permissive (62%) and restrictive policies (43%). The most common study objectives related to the frequency of end-of-life practices, determinants of practices, and doctors' adherence to regulatory standards. Large variations in definitions and research methods were noted across studies. The use of a descriptive classification was useful to translate end-of-life practice definitions across countries. A few studies compared end-of-life practice in countries with different policies, using consistent research methods. We identified no comprehensive review of end-of-life practices across different policy contexts.
  
  
  CONCLUSIONS
  It is feasible to compare end-of-life practices in different policy contexts. A systematic review of international evidence is needed to inform public deliberations on end-of-life policies and practice.
authors.affiliation: Assistant Professor, Department of Family Medicine, Montreal University Hospital Research Center (CRCHUM), Canada antoine.boivin@umontreal.ca.
authors.forename: Antoine
authors.initials: A
authors.lastname: Boivin
authors.affiliation: Assistant Professor, Faculty of Health Science, University of Ottawa, Canada.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Marcoux
authors.affiliation: Researcher, Université de Sherbrooke, Canada.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Garnon
authors.affiliation: Professor, Institut de recherche en santé publique de l'Université de Montréal, Canada.
authors.forename: Pascale
authors.initials: P
authors.lastname: Lehoux
authors.affiliation: Professor of Health Policy, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mays
authors.affiliation: Professor, École nationale d'administration publique, Canada.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Prémont
authors.affiliation: Researcher, Université de Sherbrooke, Canada.
authors.forename: Yi-Sheng
authors.initials: YS
authors.lastname: Chao
authors.affiliation: Professor of Medical Ethics, Scientific Institute for Quality of Healthcare, Radboud University, Netherlands.
authors.forename: Evert
authors.initials: E
authors.lastname: van Leeuwen
authors.affiliation: Research Professor, Institut National de Santé Publique du Québec, Département de santé publique de Montréal, Canada.
authors.forename: Raynald
authors.initials: R
authors.lastname: Pineault
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005060:Europe; D028601:Euthanasia, Active / Q000331:legislation & jurisprudence / Q000379:methods* / Q000523:psychology; D006291:Health Policy; D006801:Humans; D017236:Suicide, Assisted / Q000331:legislation & jurisprudence; D014481:United States
keywords: end-of-life; euthanasia; health policy; physician practice; systematic review