title: Surveying End-of-Life Medical Decisions in France: Evaluation of an Innovative Mixed-Mode Data Collection Strategy.
abstract: BACKGROUND
  Monitoring medical decisions at the end of life has become an important issue in many societies. Built on previous European experiences, the survey and project Fin de Vie en France ("End of Life in France," or EOLF) was conducted in 2010 to provide an overview of medical end-of-life decisions in France.
  
  
  OBJECTIVE
  To describe the methodology of EOLF and evaluate the effects of design innovations on data quality.
  
  
  METHODS
  EOLF used a mixed-mode data collection strategy (paper and Internet) along with follow-up campaigns that employed various contact modes (paper and telephone), all of which were gathered from various institutions (research team, hospital, and medical authorities at the regional level). A telephone nonresponse survey was also used. Through descriptive statistics and multivariate logistic regressions, these innovations were assessed in terms of their effects on the response rate, quality of the sample, and differences between Web-based and paper questionnaires.
  
  
  RESULTS
  The participation rate was 40.0% (n=5217). The respondent sample was very close to the sampling frame. The Web-based questionnaires represented only 26.8% of the questionnaires, and the Web-based secured procedure led to limitations in data management. The follow-up campaigns had a strong effect on participation, especially for paper questionnaires. With higher participation rates (63.21% and 63.74%), the telephone follow-up and nonresponse surveys showed that only a very low proportion of physicians refused to participate because of the topic or the absence of financial incentive. A multivariate analysis showed that physicians who answered on the Internet reported less medication to hasten death, and that they more often took no medical decisions in the end-of-life process.
  
  
  CONCLUSIONS
  Varying contact modes is a useful strategy. Using a mixed-mode design is interesting, but selection and measurement effects must be studied further in this sensitive field.
authors.affiliation: Institut National d'études Démographiques, Department of Survey and Sampling, Paris, France. stephane.legleye@ined.fr.
authors.forename: Stephane
authors.identifier: http://orcid.org/0000-0002-1704-2499
authors.initials: S
authors.lastname: Legleye
authors.forename: Sophie
authors.identifier: http://orcid.org/0000-0002-5752-6463
authors.initials: S
authors.lastname: Pennec
authors.forename: Alain
authors.identifier: http://orcid.org/0000-0002-3674-3899
authors.initials: A
authors.lastname: Monnier
authors.forename: Amandine
authors.identifier: http://orcid.org/0000-0003-2965-4924
authors.initials: A
authors.lastname: Stephan
authors.forename: Nicolas
authors.identifier: http://orcid.org/0000-0003-1169-9729
authors.initials: N
authors.lastname: Brouard
authors.forename: Johan
authors.identifier: http://orcid.org/0000-0001-8371-4612
authors.initials: J
authors.lastname: Bilsen
authors.forename: Joachim
authors.identifier: http://orcid.org/0000-0002-7224-9476
authors.initials: J
authors.lastname: Cohen
keywords: France; end-of-life decisions; methodology; mixed-mode survey