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Decision making in terminal care: a survey of Finnish doctors' treatment decisions in end-of-life scenarios involving a terminal cancer and a terminal dementia patient

Kangasala Health Center, Herttualantie 28, Kangasala and Department of General Practice, Medical School, University of Tampere, Tampere

E Kosunen

U-K Lammi

Department of General Practice, Medical School, University of Tampere, Tampere

R Metsänoja

A Puustelli

School of Public Health, University of Tampere, Tampere

P Kellokumpu-Lehtinen

Department of Oncology, Medical School, University of Tampere, Tampere and Clinic of Oncology, Tampere University Hospital, Tampere

Goals: The physicians' decision-making process in terminal care is complex: medical, ethical, legal and psychological aspects are all involved, particularly in critical situations. Here, a study was made of the association of personal background factors with end-of-life decisions. Methods: A questionnaire was sent to 300 surgeons, 300 internists, 500 health centre practitioners (GPs) and all 82 Finnish oncologists. The response rate was 62%. Two scenarios were presented: one involving a terminal cancer patient, the other a dementia patient. Sociodemographic factors, general life values and attitudes related to end-of-life care were asked. Main Results: In the cancer case (Scenario 1) 17%, and in the dementia case (Scenario 2) 43% of all the respondents chose active treatment. In a logistic regression analysis of treatment decisions in Scenario 1, physician's age, specialty, marital status and attitudes to assisted suicide and withdrawal of life-sustaining treatment (LST) entered the model. In Scenario 2, the variables were physician's age, physician's own experience of severe disease in the family, attitude to withdrawal of LST and opinion of advanced directives. Conclusions: Doctors' end-of-life decisions vary widely according to personal background factors. The findings underline the importance of advance communication, making these decisions in accordance with the patient's wishes.

Key Words: cancer • decision making • dementia • end-of-life • ethics • terminal care

Palliative Medicine, Vol. 16, No. 3, 195-204 (2002)
DOI: 10.1191/0269216302pm510oa


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