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  • journal.pone.0057965

    Rights statement: Copyright: © 2013 Evans et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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End-of-life decisions: a cross-national study of treatment preference discussions and surrogate decision-maker appointments

Research output: Contribution to journalJournal article

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  • 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
  • Sarah Brearley
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Article numbere57965
<mark>Journal publication date</mark>03/2013
<mark>Journal</mark>PLoS ONE
Issue number3
Volume8
Number of pages12
StatePublished
Original languageEnglish

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Bibliographic note

Copyright: © 2013 Evans et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.