End-of-life decision-making in Belgium, Denmark, Sweden and Switzerland: does place of death make a difference?

Abstract

OBJECTIVE:

To examine differences in end-of-life decision-making in patients dying at home, in a hospital or in a care home.

DESIGN:

A death certificate study: certifying physicians from representative samples of death certificates, taken between June 2001 and February 2002, were sent questionnaires on the end-of-life decision-making preceding the patient's death.

SETTING:

Four European countries: Belgium (Flanders), Denmark, Sweden, and Switzerland (German-speaking part).

MAIN OUTCOME MEASURES:

The incidence of and communication in different end-of-life decisions: physician-assisted death, alleviation of pain/symptoms with a possible life-shortening effect, and non-treatment decisions.

RESULTS:

Response rates ranged from 59% in Belgium to 69% in Switzerland. The total number of deaths studied was 12 492. Among all non-sudden deaths the incidence of several end-of-life decisions varied by place of death. Physician-assisted death occurred relatively more often at home (0.3-5.1%); non-treatment decisions generally occurred more often in hospitals (22.4-41.3%), although they were also frequently taken in care homes in Belgium (26.0%) and Switzerland (43.1%). Continuous deep sedation, in particular without the administration of food and fluids, was more likely to occur in hospitals. At home, end-of-life decisions were usually more often discussed with patients. The incidence of discussion with other caregivers was generally relatively low at home compared with in hospitals or care homes.

CONCLUSION:

The results suggest the possibility that end-of-life decision-making is related to the care setting where people die. The study results seem to call for the development of good end-of-life care options and end-of-life communication guidelines in all settings.

• Authors: Joachim Cohen, Johan Bilsen, Susanne Fischer, Rurik Löfmark, Michael Norup, Agnes van der Heide, Guido Miccinesi, Luc Deliens, EURELD Consortium
• Journal: Journal of epidemiology and community health (J Epidemiol Community Health) Vol. 61 Issue 12 Pg. 1062-8 (Dec 2007) ISSN: 0143-005X [Print] England
• PMID: 18000128 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Caregivers
• Decision Making
• Europe
• Euthanasia
• Female
• Home Care Services
• Homes for the Aged
• Hospitalization
• Humans
• Logistic Models
• Male
• Middle Aged
• Pain Management
• Patient Participation
• Terminal Care (methods, standards)