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End-of-life decisions: a cross-national study of treatment preference discussions and surrogate decision-maker appointments.

Evans, N., Pasman, H.R.W., Vega Alonso, T., Block, L. van den, Miccinesi, G., Viviane, V.C., Donker, G., Bertolissi, S., Zurriaga, O., Deliens, L. End-of-life decisions: a cross-national study of treatment preference discussions and surrogate decision-maker appointments. European Journal of Palliative Care: 2013, p. 130-131. Abstract. In abstractbook. EAPC 2013. 13th World Congress of the European Association for Palliative Care (EAPC). 30 may - 2 june 2013, Prague.
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Aim: Making decisions in anticipation of possible future incapacity is part of patient participation in end-of-life decision-making. This study estimates and compares the prevalence of GP-patient end-of-life treatment preference discussions and appointments of surrogate decision-makers in Italy, Spain, Belgium and the Netherlands and examines associated patient and care characteristics. 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 three months of life, including the discussion of treatment preferences and appointment of surrogate decision-makers, for all patients who died using a standardised questionnaire. Prevalences were estimated and logistic regressions were used to examine between country differences and country-specific associated factors. Results: 4,396 non-sudden deaths were included. GPpatient discussion of treatment preferences occurred for 10%, 7%, 25% and 47% of Italian, Spanish, Belgian and Dutch patients respectively. Furthermore, 6%, 5%, 16% and 29% of Italian, Spanish, Belgian and Dutch patients had a surrogate decision-maker. Despite some cross-country variation, previous diagnosis discussions, more frequent GP contact, GP provision of palliative care, identification of palliative care as an important treatment aim and place of death were generally positively associated with preference discussions or surrogate appointments. Dementia was negatively associated with preference discussions and surrogate appointments in all countries. Conclusion: The study revealed a higher prevalence of treatment preference discussions and surrogate appointments in Belgium and the Netherlands. The findings suggest that delaying diagnosis discussions impedes anticipatory planning, whereas early preference discussions, particularly for dementia patients, and the provision of palliative care encourage participation.
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