[What influences end-of-life decisions? Results of a representative German survey].
BACKGROUND
Because of demographic changes of an aging society, palliative care is becoming increasingly important. It is therefore necessary to evaluate preferences at the end of life at an early stage to meet the needs and requests of future patients.


OBJECTIVE
The aim of this study was to find out preferences in a theoretical scenario ("If you developed a serious medical condition such as cancer and you had less than a year to live…") regarding the desired involvement in decision-making at the end of life and the preferred place of death.


METHODS
As part of the international PRISMA project, a representative telephone survey was carried out in Germany.


RESULTS
A total of 1,363 Germans took part in the survey (response rate 29.0 %, 47.1 ± 15.7 years, 42 % male). 90.8 % wanted to make their own decisions with regard to end-of-life care, which was most important for people with higher education. 83.3 % wanted to predetermine decisions by means of an advance directive in case they are no longer able to make them at the time. This was again more important for individuals with higher education and for older subjects (≥ 65 years). The preferred place of death was their own home (63.3 %), and the least preferred place for death was in hospital in 48.2 %. In particular, women did not want to die in a hospital.


CONCLUSIONS
These results should be considered when planning health care structures to meet the wishes of people at the end of their life, in particular to strengthen the importance of patient provision and the desire for their own home to be the preferred place to die.
Klinik und Poliklinik für Palliativmedizin, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland. martin.fegg@med.uni-muenchen.de.
Martin
M
Fegg
Klinik und Poliklinik für Palliativmedizin, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
Marc
M
Lehner
Zentrum für Palliativmedizin, Universitätsklinikum Köln, Köln, Deutschland.
Steffen T
ST
Simon
Cicely Saunders Institute, King's College London, Großbritannien, London.
Barbara
B
Gomes
Cicely Saunders Institute, King's College London, Großbritannien, London.
Irene J
IJ
Higginson
Klinik und Poliklinik für Palliativmedizin, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
Claudia
C
Bausewein
D016223:Advance Directives / Q000523:psychology* / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D001294:Attitude to Health; D004522:Educational Status; D005260:Female; D005858:Germany / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology / Q000706:statistics & numerical data*; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data*; D026684:Personal Autonomy; D017678:Sex Distribution; D013727:Terminal Care / Q000523:psychology / Q000706:statistics & numerical data*
End of life; Living will; Palliative care; Place of death; Self-determination