Background
Methods
Participants and mailing procedure
Questionnaire
(1) “Did you or another physician perform or did you make sure that one of the following actions would be performed: a) Withholding of treatment b) Withdrawing of treatment.” |
(2) In case of withholding/withdrawing a treatment: “Did you or another physician assume that this action will probably or certainly hasten the death of the patient?” |
(3) “Was death the consequence of withholding/withdrawing a treatment with the explicit intention to hasten death?” |
Due to the structure of the questionnaire, we were only able to analyse the decision-making for the decisions on treatment limitation that were the limitations mentioned last and, therefore, the most important. |
Analyses
(1) Analysis of the whole sample regarding the frequency of limiting treatment as one aspect of end-of-life practices (n = 403) |
(2) Analysis of the subgroup concerning “Types of limited treatment and expected consequences” (n = 104) |
(3) Analysis of the subgroup “Decision-making and patient involvement” (n = 81) |
(4) Regression analysis on determinants associated with limitation of treatment and expected shortening of life (n = 403) |
Results
Types of limited treatment and expected consequences regarding shortening of life
N = 95 | Percent | |
---|---|---|
Medical specialty | ||
Internal medicine | 25 | 26.3 |
General medicine | 20 | 21.1 |
Anaesthesia | 19 | 20.0 |
Surgery | 17 | 17.9 |
Neurology/Psychiatry | 7 | 7.4 |
Emergency medicine | 2 | 2.1 |
Gynaecology | 2 | 2.1 |
Otolaryngology | 2 | 2.1 |
Urology | 1 | 1.1 |
Missing data | 9 | -- |
Age | ||
< 36 years | 29 | 27.9 |
36–45 years | 29 | 27.9 |
46–55 years | 24 | 23.1 |
56–65 years | 17 | 16.3 |
> 65 years | 5 | 4.8 |
Gender | ||
Male | 64 | 61.5 |
Female | 40 | 38.5 |
Religion | ||
Protestant | 40 | 38.5 |
Catholic | 39 | 37.5 |
No religion | 19 | 18.3 |
Islamic | 2 | 1.9 |
Other | 4 | 3.8 |
Number | Percent | |
---|---|---|
Age | ||
< 75 years | 34 | 32.7 |
≥ 75 years | 70 | 67.3 |
Gender | ||
Male | 54 | 52.4 |
Female | 49 | 47.6 |
Cause of deatha
| ||
Cancer | 36 | 34.6 |
Cardiovascular disease | 27 | 26.0 |
Disease of the nervous system | 16 | 15.4 |
Respiratory disease | 9 | 8.7 |
Other/Unknown | 21 | 20.2 |
Action and consequence: Time of estimated shortening of life | Limiting treatment with intended shortening of life (n = 75) | Limiting treatment with possible shortening of life (n = 29) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Total | Withholding | Withdrawing | Total | Withholding | Withdrawing | |||||||
N
| %a
|
N
| % |
N
| % |
N
| %a
|
N
| % |
N
| % | |
1–6 months | 10 | 13.7 | 6 | 12.5 | 4 | 16.0 | -- | -- | -- | -- | -- | -- |
1–4 weeks | 14 | 19.2 | 8 | 16.7 | 6 | 24.0 | 3 | 10.7 | 2 | 13.3 | 1 | 7.7 |
1–7 days | 32 | 43.8 | 22 | 45.8 | 10 | 40.0 | 9 | 32.1 | 7 | 46.7 | 2 | 15.4 |
<24 h | 9 | 12.3 | 8 | 16.7 | 1 | 4.0 | 4 | 14.3 | -- | -- | 4 | 30.8 |
Not shortened at all | 8 | 11.0 | 4 | 8.3 | 4 | 16.0 | 12 | 42.9 | 6 | 40.0 | 6 | 46.2 |
Missing data | 2 | -- | 2 | -- | -- | -- | 1 | -- | -- | -- | 1 | -- |
Withholding of treatment | Withdrawal of treatment | |||
---|---|---|---|---|
(n = 87) | (n = 60) | |||
N
| % |
N
| % | |
Nutrition | 22 | 25.3 | 13 | 21.7 |
Antibiotics | 19 | 21.8 | 14 | 23.3 |
Catecholamines | 15 | 17.2 | 12 | 20.0 |
Hydration | 15 | 17.2 | 11 | 18.3 |
Dialysis | 14 | 16.1 | 9 | 15.0 |
Respiration | 14 | 16.1 | 5 | 8.3 |
Chemotherapy | 12 | 13.8 | 8 | 13.3 |
Resuscitation | 9 | 10.3 | 7 | 11.7 |
Medicationb
| 8 | 9.2 | 15 | 25.0 |
Intubation | 6 | 6.9 | - | - |
Other | 4 | 4.6 | 2 | 3.3 |
Surgery | 4 | 4.6 | 1 | 1.7 |
Diagnostic tests | 3 | 3.4 | - | - |
Radiotherapy | 2 | 2.3 | 1 | 1.7 |
Hospital admission | 2 | 2.3 | - | - |
Transfusions | 1 | 1.1 | 1 | 1.7 |
Decision-making and patient involvement
Has the possible or intended shortening of life been discussed with the patient? | Number | Percent |
---|---|---|
- Yes, at the time or shortly before this action | 21 | 25.9 |
- Yes, some time before | 23 | 28.4 |
At the time of discussion: Did you consider the patient able to evaluate his/her situation properly and to take a competent decision? | ||
- Yes, the patient was able to do so | 34 | 77.3 |
- No, not entirely able to do so | 8 | 18.2 |
- No, not able at all | 2 | 4.5 |
Determinants associated with limitation of treatment and expected shortening of life
Treatment limitation with possible/intended shortening of life | ||
---|---|---|
Socio-demographic factors | Bivariate logistic regression | Multivariable regression |
Patient age ≥ 75 years |
p = 0.007, OR 1.848, CI [1.183;2.886] |
p = 0.205, OR 1.432, CI [0.822;2.496] |
Patient dying from cancer |
p = 0.000, OR 0.409, CI [0.261;0.64] |
p = 0.01, OR 0.486, CI [0.281;0.84] |
Physician being non-religious |
p = 0.951, OR 0.984, CI [0.581;1.666] |
p = 0.829, OR 1.072, CI [0.572;2.011] |
Physician’s specialisation in palliative medicine |
p = 0.440, OR 0.742, CI [0.348;1.583] |
p = 0.727, OR 0.866, CI [0.386;1.943] |