End-of-life decisions: a cross-national study of treatment preference discussions and surrogate decision-maker appointments.
<h4>Background</h4>Making treatment decisions in anticipation of possible future incapacity is an important part of patient participation in end-of-life decision-making. This study estimates and compares the prevalence of GP-patient end-of-life treatment discussions and patients' ap...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2013-01-01
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| Series: | PLoS ONE |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23472122/pdf/?tool=EBI |
| _version_ | 1818573850347044864 |
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| author | Natalie Evans H Roeline Pasman Tomás Vega Alonso Lieve Van den Block Guido Miccinesi Viviane Van Casteren Gé Donker Stefano Bertolissi Oscar Zurriaga Luc Deliens Bregje Onwuteaka-Philipsen EUROIMPACT |
| author_facet | Natalie Evans H Roeline Pasman Tomás Vega Alonso Lieve Van den Block Guido Miccinesi Viviane Van Casteren Gé Donker Stefano Bertolissi Oscar Zurriaga Luc Deliens Bregje Onwuteaka-Philipsen EUROIMPACT |
| author_sort | Natalie Evans |
| collection | DOAJ |
| description | <h4>Background</h4>Making treatment decisions in anticipation of possible future incapacity is an important part of patient participation in end-of-life decision-making. This study estimates and compares the prevalence of GP-patient end-of-life treatment discussions and patients' appointment of surrogate decision-makers in Italy, Spain, Belgium and the Netherlands and examines associated factors.<h4>Methods</h4>A cross-sectional, retrospective survey was conducted with representative GP networks in four countries. GPs recorded the health and care characteristics in the last three months of life of 4,396 patients who died non-suddenly. Prevalences were estimated and logistic regressions were used to examine between country differences and country-specific associated patient and care factors.<h4>Results</h4>GP-patient discussion of treatment preferences occurred for 10%, 7%, 25% and 47% of Italian, Spanish, Belgian and of Dutch patients respectively. Furthermore, 6%, 5%, 16% and 29% of Italian, Spanish, Belgian and Dutch patients had a surrogate decision-maker. Despite some country-specific differences, previous GP-patient discussion of primary diagnosis, more frequent GP contact, GP provision of palliative care, the importance of palliative care as a treatment aim and place of death were positively associated with preference discussions or surrogate appointments. A diagnosis of dementia was negatively associated with preference discussions and surrogate appointments.<h4>Conclusions</h4>The study revealed a higher prevalence of treatment preference discussions and surrogate appointments in the two northern compared to the two southern European countries. Factors associated with preference discussions and surrogate appointments suggest that delaying diagnosis discussions impedes anticipatory planning, whereas early preference discussions, particularly for dementia patients, and the provision of palliative care encourage participation. |
| first_indexed | 2024-12-15T00:18:25Z |
| format | Article |
| id | doaj.art-727b7a98ca904083b8f2714e4b831d7e |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-15T00:18:25Z |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-727b7a98ca904083b8f2714e4b831d7e2022-12-21T22:42:24ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-0183e5796510.1371/journal.pone.0057965End-of-life decisions: a cross-national study of treatment preference discussions and surrogate decision-maker appointments.Natalie EvansH Roeline PasmanTomás Vega AlonsoLieve Van den BlockGuido MiccinesiViviane Van CasterenGé DonkerStefano BertolissiOscar ZurriagaLuc DeliensBregje Onwuteaka-PhilipsenEUROIMPACT<h4>Background</h4>Making treatment decisions in anticipation of possible future incapacity is an important part of patient participation in end-of-life decision-making. This study estimates and compares the prevalence of GP-patient end-of-life treatment discussions and patients' appointment of surrogate decision-makers in Italy, Spain, Belgium and the Netherlands and examines associated factors.<h4>Methods</h4>A cross-sectional, retrospective survey was conducted with representative GP networks in four countries. GPs recorded the health and care characteristics in the last three months of life of 4,396 patients who died non-suddenly. Prevalences were estimated and logistic regressions were used to examine between country differences and country-specific associated patient and care factors.<h4>Results</h4>GP-patient discussion of treatment preferences occurred for 10%, 7%, 25% and 47% of Italian, Spanish, Belgian and of Dutch patients respectively. Furthermore, 6%, 5%, 16% and 29% of Italian, Spanish, Belgian and Dutch patients had a surrogate decision-maker. Despite some country-specific differences, previous GP-patient discussion of primary diagnosis, more frequent GP contact, GP provision of palliative care, the importance of palliative care as a treatment aim and place of death were positively associated with preference discussions or surrogate appointments. A diagnosis of dementia was negatively associated with preference discussions and surrogate appointments.<h4>Conclusions</h4>The study revealed a higher prevalence of treatment preference discussions and surrogate appointments in the two northern compared to the two southern European countries. Factors associated with preference discussions and surrogate appointments suggest that delaying diagnosis discussions impedes anticipatory planning, whereas early preference discussions, particularly for dementia patients, and the provision of palliative care encourage participation.https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23472122/pdf/?tool=EBI |
| spellingShingle | Natalie Evans H Roeline Pasman Tomás Vega Alonso Lieve Van den Block Guido Miccinesi Viviane Van Casteren Gé Donker Stefano Bertolissi Oscar Zurriaga Luc Deliens Bregje Onwuteaka-Philipsen EUROIMPACT End-of-life decisions: a cross-national study of treatment preference discussions and surrogate decision-maker appointments. PLoS ONE |
| title | End-of-life decisions: a cross-national study of treatment preference discussions and surrogate decision-maker appointments. |
| title_full | End-of-life decisions: a cross-national study of treatment preference discussions and surrogate decision-maker appointments. |
| title_fullStr | End-of-life decisions: a cross-national study of treatment preference discussions and surrogate decision-maker appointments. |
| title_full_unstemmed | End-of-life decisions: a cross-national study of treatment preference discussions and surrogate decision-maker appointments. |
| title_short | End-of-life decisions: a cross-national study of treatment preference discussions and surrogate decision-maker appointments. |
| title_sort | end of life decisions a cross national study of treatment preference discussions and surrogate decision maker appointments |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23472122/pdf/?tool=EBI |
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