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End-of-life decision-making in six European countries: descriptive study.

https://arctichealth.org/en/permalink/ahliterature30801
Source
Lancet. 2003 Aug 2;362(9381):345-50
Publication Type
Article
Date
Aug-2-2003
Author
Agnes van der Heide
Luc Deliens
Karin Faisst
Tore Nilstun
Michael Norup
Eugenio Paci
Gerrit van der Wal
Paul J van der Maas
Author Affiliation
Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, Netherlands. a.vanderheide@erasmusmc.nl
Source
Lancet. 2003 Aug 2;362(9381):345-50
Date
Aug-2-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Cause of Death
Child
Child, Preschool
Comparative Study
Decision Making
Denmark
Europe
Euthanasia - statistics & numerical data
Female
Humans
Infant
Italy
Male
Middle Aged
Physician's Practice Patterns
Questionnaires
Refusal to Treat - statistics & numerical data
Research Support, Non-U.S. Gov't
Right to Die
Suicide, Assisted - statistics & numerical data
Sweden
Switzerland
Treatment Refusal - statistics & numerical data
Abstract
BACKGROUND: Empirical data about end-of-life decision-making practices are scarce. We aimed to investigate frequency and characteristics of end-of-life decision-making practices in six European countries: Belgium, Denmark, Italy, the Netherlands, Sweden, and Switzerland. METHODS: In all participating countries, deaths reported to death registries were stratified for cause (apart from in Switzerland), and samples were drawn from every stratum. Reporting doctors received a mailed questionnaire about the medical decision-making that had preceded the death of the patient. The data-collection procedure precluded identification of any of the doctors or patients. All deaths arose between June, 2001, and February, 2002. We weighted data to correct for stratification and to make results representative for all deaths: results were presented as weighted percentages. FINDINGS: The questionnaire response rate was 75% for the Netherlands, 67% for Switzerland, 62% for Denmark, 61% for Sweden, 59% for Belgium, and 44% for Italy. Total number of deaths studied was 20480. Death happened suddenly and unexpectedly in about a third of cases in all countries. The proportion of deaths that were preceded by any end-of-life decision ranged between 23% (Italy) and 51% (Switzerland). Administration of drugs with the explicit intention of hastening death varied between countries: about 1% or less in Denmark, Italy, Sweden, and Switzerland, 1.82% in Belgium, and 3.40% in the Netherlands. Large variations were recorded in the extent to which decisions were discussed with patients, relatives, and other caregivers. INTERPRETATION: Medical end-of-life decisions frequently precede dying in all participating countries. Patients and relatives are generally involved in decision-making in countries in which the frequency of making these decisions is high.
Notes
Comment In: Lancet. 2003 Oct 25;362(9393):1419-20; author reply 142014585656
PubMed ID
12907005 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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