END-OF-LIFE MEDICAL TREATMENT PREFERENCE DISCUSSIONS AND SURROGATE DECISION-MAKER APPOINTMENTS: EVIDENCE FROM ITALY, SPAIN, BELGIUM AND THE NETHERLANDS. Issue 2 (1st June 2013)

• Record Type: Journal Article
• Authors: Evans, N; Pasman, H R W; Vega Alonso, T; Van den Block, L; Miccinesi, G; Van Casteren, V; Donker, G; Bertolissi, S; Zurriaga, O; Deliens, L; Onwuteaka-Philipsen, B
• Is Part Of: BMJ supportive & palliative care. Volume 3:Issue 2(2013)
• Page Start: 235
• Page End: 235
• Publication Date: 2013-06-01
• Subjects: Palliative treatment -- Periodicals; Terminal care -- Periodicals; 616.029
• DOI: 10.1136/bmjspcare-2013-000491.28
• Languages: English
• ISSNs: 2045-435X

Abstract

Abstract : Background: Making treatment decisions in anticipation of possible future incapacity is an important part of patient participation in end-of-life decision-making. Aim: To compare the prevalence of GP-patient end-of-life treatment discussions and patient surrogate appointments in Italy, Spain, Belgium and the Netherlands and examine 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 3 months of life of patients who died non-suddenly. Prevalences were estimated and between country differences, and country-specific associated patient and care factors, were examined using logistic regressions. Results: 4396 non-sudden deaths were included. 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 diagnosis discussions, 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. The single most important factor was prior GP-patient diagnosis discussion. Discussion: The study revealed a higher prevalence of treatment preference discussions and surrogate appointments in the two northern European countries. Conclusion: Delaying diagnosis discussions impedes anticipatory planning, whereas early discussions for all patients, particularly those with cognitive decline, and palliative care provision support patients' participation in decision-making.