title: Medical end-of-life practices among Canadian physicians: a pilot study.
abstract: BACKGROUND
  Medical end-of-life practices are hotly debated in Canada, and data from other countries are used to support arguments. The objective of this pilot study was twofold: to adapt and validate a questionnaire designed to measure the prevalence of these practices in Canada and the underlying decision-making process, and to assess the feasibility of a nationally representative study.
  
  
  METHODS
  In phase 1, questionnaires from previous studies were adapted to the Canadian context through consultations with a multidisciplinary committee and based on a scoping review. The modified questionnaire was validated through cognitive interviews with 14 physicians from medical specialties associated with a higher probability of being involved with dying patients recruited by means of snowball sampling. In phase 2, we selected a stratified random sample of 300 Canadian physicians in active practice from a national medical directory and used the modified tailored method design for mail and Web surveys. There were 4 criteria for success: modified questions are clearly understood; response patterns for sensitive questions are similar to those for other questions; respondents are comparable to the overall sampling frame; and mean questionnaire completion time is less than 20 minutes.
  
  
  RESULTS
  Phase 1: main modifications to the questionnaire were related to documentation of all other medical practices (including practices intended to prolong life) and a question on the proportionality of drugs used. The final questionnaire contained 45 questions in a booklet style. Phase 2: of the 280 physicians with valid addresses, 87 (31.1%) returned the questionnaire; 11 of the 87 declined to participate, for a response rate of 27.1% (n = 76). Most respondents (64 [84%]) completed the mail questionnaire. All the criteria for success were met.
  
  
  CONCLUSIONS
  It is feasible to study medical end-of-life practices, even for practices that are currently illegal, including the intentional use of lethal drugs. Results from this pilot study support conducting a large national study, but additional strategies would be necessary to improve the response rate.
authors.affiliation: Interdisciplinary School of Health Sciences, Faculty of Health Sciences (Marcoux, Mesana) and School of Epidemiology, Public Health & Preventive Medicine, Faculty of Medicine (Graham), University of Ottawa, Ottawa, Ont.; Department of Family Medicine, Faculty of Medicine (Boivin), University of Montreal Hospital Research Centre, Montréal, Que.; Centre de recherche du centre hospitalier de l'Université de Montréal (Hébert), Montréal, Que.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Marcoux
authors.affiliation: Interdisciplinary School of Health Sciences, Faculty of Health Sciences (Marcoux, Mesana) and School of Epidemiology, Public Health & Preventive Medicine, Faculty of Medicine (Graham), University of Ottawa, Ottawa, Ont.; Department of Family Medicine, Faculty of Medicine (Boivin), University of Montreal Hospital Research Centre, Montréal, Que.; Centre de recherche du centre hospitalier de l'Université de Montréal (Hébert), Montréal, Que.
authors.forename: Antoine
authors.initials: A
authors.lastname: Boivin
authors.affiliation: Interdisciplinary School of Health Sciences, Faculty of Health Sciences (Marcoux, Mesana) and School of Epidemiology, Public Health & Preventive Medicine, Faculty of Medicine (Graham), University of Ottawa, Ottawa, Ont.; Department of Family Medicine, Faculty of Medicine (Boivin), University of Montreal Hospital Research Centre, Montréal, Que.; Centre de recherche du centre hospitalier de l'Université de Montréal (Hébert), Montréal, Que.
authors.forename: Laura
authors.initials: L
authors.lastname: Mesana
authors.affiliation: Interdisciplinary School of Health Sciences, Faculty of Health Sciences (Marcoux, Mesana) and School of Epidemiology, Public Health & Preventive Medicine, Faculty of Medicine (Graham), University of Ottawa, Ottawa, Ont.; Department of Family Medicine, Faculty of Medicine (Boivin), University of Montreal Hospital Research Centre, Montréal, Que.; Centre de recherche du centre hospitalier de l'Université de Montréal (Hébert), Montréal, Que.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Graham
authors.affiliation: Interdisciplinary School of Health Sciences, Faculty of Health Sciences (Marcoux, Mesana) and School of Epidemiology, Public Health & Preventive Medicine, Faculty of Medicine (Graham), University of Ottawa, Ottawa, Ont.; Department of Family Medicine, Faculty of Medicine (Boivin), University of Montreal Hospital Research Centre, Montréal, Que.; Centre de recherche du centre hospitalier de l'Université de Montréal (Hébert), Montréal, Que.
authors.forename: Paul
authors.initials: P
authors.lastname: Hébert