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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/727b7a98ca904083b8f2714e4b831d7e
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spelling	oai:doaj.org-article:727b7a98ca904083b8f2714e4b831d7e2021-11-18T07:54:54ZEnd-of-life decisions: a cross-national study of treatment preference discussions and surrogate decision-maker appointments.1932-620310.1371/journal.pone.0057965https://doaj.org/article/727b7a98ca904083b8f2714e4b831d7e2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23472122/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<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.Natalie EvansH Roeline PasmanTomás Vega AlonsoLieve Van den BlockGuido MiccinesiViviane Van CasterenGé DonkerStefano BertolissiOscar ZurriagaLuc DeliensBregje Onwuteaka-PhilipsenEUROIMPACTPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 3, p e57965 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q 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.
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.
format	article
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
title	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_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_sort	end-of-life decisions: a cross-national study of treatment preference discussions and surrogate decision-maker appointments.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/727b7a98ca904083b8f2714e4b831d7e
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End-of-life decisions: a cross-national study of treatment preference discussions and surrogate decision-maker appointments.

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