title: Differences in attitudes to end-of-life care among patients, relatives and healthcare professionals.
abstract: BACKGROUND
  This study explored and compared the differences in attitudes toward end-of-life care among patients, relatives and healthcare professionals, including doctors and nurses.
  
  
  METHODS
  We performed a descriptive study on a cross-section of the population of a tertiary hospital in Singapore. Data was collected using a questionnaire survey involving 50 participants from each of the four groups of patients, relatives, doctors and nurses.
  
  
  RESULTS
  Family members were the most commonly nominated surrogate decision-makers by the patient group (76%) and the majority of the relative group (74%) felt comfortable deciding on end-of-life care for their loved ones. However, the patient and relative groups differed significantly in their preferences on end-of-life care options, including cardiopulmonary resuscitation (CPR) (p = 0.001), intubation (p = 0.003), nasogastric tube feeding (p < 0.001) and the use of antibiotics (p = 0.023). Doctors, nurses and relatives demonstrated differences in preference between end-of-life care for themselves and for their loved ones, especially with regard to the use of nasogastric tube feeding. There was also a difference between patients and doctors in their decisions on CPR (p < 0.001) and intubation (p = 0.008).
  
  
  CONCLUSIONS
  This study demonstrated the importance of early planning for end-of-life care. This must be initiated proactively by healthcare professionals to engage patients in a culturally sensitive manner to discuss their preferences, in order to facilitate open communication between the patient and family.
authors.affiliation: Department of Geriatric Medicine, Changi General Hospital, Singapore.
authors.forename: Guat Cheng
authors.initials: GC
authors.lastname: Ang
authors.affiliation: Department of Nursing, Changi General Hospital, Singapore.
authors.forename: Di
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Geriatric Medicine, Changi General Hospital, Singapore.
authors.forename: Kim Hwa Jim
authors.initials: KH
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D016887:Cardiopulmonary Resuscitation / Q000523:psychology*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology*; D055815:Young Adult
keywords: decisions; end-of-life care; options; surrogate
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