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Forgoing treatment at the end of life in 6 European countries.

https://arctichealth.org/en/permalink/ahliterature29878
Source
Arch Intern Med. 2005 Feb 28;165(4):401-7
Publication Type
Article
Date
Feb-28-2005
Author
Georg Bosshard
Tore Nilstun
Johan Bilsen
Michael Norup
Guido Miccinesi
Johannes J M van Delden
Karin Faisst
Agnes van der Heide
Author Affiliation
Institute of Legal Medicine, University of Zurich, Zurich, Switzerland. bosh@irm.unizh.ch
Source
Arch Intern Med. 2005 Feb 28;165(4):401-7
Date
Feb-28-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cause of Death - trends
Child
Child, Preschool
Comparative Study
Decision Making
Europe - epidemiology
Female
Health Knowledge, Attitudes, Practice
Humans
Infant
Life Support Care - statistics & numerical data
Male
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Physician-Patient Relations
Questionnaires
Refusal to Treat - statistics & numerical data
Registries - statistics & numerical data
Research Support, Non-U.S. Gov't
Retrospective Studies
Terminally ill
Treatment Refusal - statistics & numerical data
Abstract
BACKGROUND: Modern medicine provides unprecedented opportunities in diagnostics and treatment. However, in some situations at the end of a patient's life, many physicians refrain from using all possible measures to prolong life. We studied the incidence of different types of treatment withheld or withdrawn in 6 European countries and analyzed the main background characteristics. METHODS: Between June 2001 and February 2002, samples were obtained from deaths reported to registries in Belgium, Denmark, Italy, the Netherlands, Sweden, and Switzerland. The reporting physician was then sent a questionnaire about the medical decision-making process that preceded the patient's death. RESULTS: The incidence of nontreatment decisions, whether or not combined with other end-of-life decisions, varied widely from 6% of all deaths studied in Italy to 41% in Switzerland. Most frequently forgone in every country were hydration or nutrition and medication, together representing between 62% (Belgium) and 71% (Italy) of all treatments withheld or withdrawn. Forgoing treatment estimated to prolong life for more than 1 month was more common in the Netherlands (10%), Belgium (9%), and Switzerland (8%) than in Denmark (5%), Italy (3%), and Sweden (2%). Relevant determinants of treatment being withheld rather than withdrawn were older age (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.31-1.79), death outside the hospital (death in hospital: OR, 0.80; 95% CI, 0.68-0.93), and greater life-shortening effect (OR, 1.75; 95% CI, 1.27-2.39). CONCLUSIONS: In all of the participating countries, life-prolonging treatment is withheld or withdrawn at the end of life. Frequencies vary greatly among countries. Low-technology interventions, such as medication or hydration or nutrition, are most frequently forgone. In older patients and outside the hospital, physicians prefer not to initiate life-prolonging treatment at all rather than stop it later.
PubMed ID
15738368 View in PubMed
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Which patients with cancer die at home? A study of six European countries using death certificate data.

https://arctichealth.org/en/permalink/ahliterature97524
Source
J Clin Oncol. 2010 May 1;28(13):2267-73
Publication Type
Article
Date
May-1-2010
Author
Joachim Cohen
Dirk Houttekier
Bregje Onwuteaka-Philipsen
Guido Miccinesi
Julia Addington-Hall
Stein Kaasa
Johan Bilsen
Luc Deliens
Author Affiliation
End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium. Joachim.Cohen@vub.ac.be
Source
J Clin Oncol. 2010 May 1;28(13):2267-73
Date
May-1-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Chi-Square Distribution
Child
Child, Preschool
Death Certificates
Educational Status
Europe - epidemiology
Female
Home Care Services - statistics & numerical data
Humans
Infant
Infant, Newborn
Logistic Models
Male
Marital status
Middle Aged
Neoplasms - mortality
Sex Factors
Terminal Care - statistics & numerical data
Terminally Ill - statistics & numerical data
Urbanization
Young Adult
Abstract
PURPOSE: This study examines the proportion of cancer deaths occurring at home in six European countries in relation to illness and to demographic and health care factors. METHODS: Death certificate data of all cancer-related deaths in 2002 in Italy and 2003 in Belgium, the Netherlands, Norway, England, and Wales (N = 238,216) were linked with regional health care and area statistics. Multivariate binomial logistic regressions were performed to examine factors associated with dying at home. RESULTS: The percentage of all cancer deaths occurring at home was 12.8 in Norway, 22.1 in England, 22.7 in Wales, 27.9 in Belgium, 35.8 in Italy, and 45.4 in the Netherlands. Having solid cancers and being married increased the chances of dying at home in all countries. Being older and being a woman decreased the chances of dying at home, except in Italy where the opposite was the case. A higher educational attainment was associated with better chances of dying at home in Belgium, Italy, and Norway (countries where information on educational attainment was available). Better chances of dying at home were also associated with living in less urbanized areas in all countries but England. The number of hospital and care home beds seemed not to be universally strong predictors of dying at home. CONCLUSION: There are large country differences in the proportion of patients with cancer dying at home, and these seem influenced by country-specific cultural, social, and health care factors. Alongside cross-national differences, country-specific aspects need to be considered in the development of policy strategies facilitating home death.
PubMed ID
20351336 View in PubMed
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