Similar percentage of physicians (7 %; 16 from 233) and students (6 %; 26 from 427) refused to participate. Respondents’ basic demographics are submitted in Table
1. Physicians were older than students; a similar percentage of males and females and religion preferences in physicians and students were found. The majority of respondents were Catholics.
Table 1
Demographics data of physicians and students
Age years, mean ± SD | 32.3 ± 5.5 | 23.1 ± 2.2 |
0.00001* |
Gender (n) Male/female (%) | 65/152 (31 %/69 %) | 112/289 (28 %/72 %) | 0.595** |
Religion n (%) | Catholic | 163 (75 %) | 288 (72 %) | 0.368** |
Other | 26 (12 %) | 44 (11 %) |
Atheists | 28 (13 %) | 69 (17 %) |
Breaking Bad News
The answers to the question “Is it always right to inform the patient about an incurable disease and unfavourable prognosis?” are shown in Table
2. Over 35 % of physicians and students subjected making the decision to circumstances, i.e. whether the content of the information could adversely influence the patient’s ability to continue the fight with the disease. To a question “Who should be given bad news first?” 53 % of the physicians and 55 % of the students indicated that bad news should be given first to patients; 28 % and 32 %, respectively, stated that bad news should be given to patients’ relatives first. The choice whether to break bad news to patients or relatives first, for 10 % of physicians and 12 % of the students surveyed, depends on many factors, which have to be considered before making the final decision. The age of a patient and his psychological condition were admitted to be the most important.
Table 2
Is it always right to inform patients about incurable disease?
Yes | 52 (24 %) | 113 (28 %) | 0.282 |
No | 83 (38 %) | 120 (30 %) |
0.043
|
It depends on patient’s ability to cope with the disease | 80 (37 %) | 156 (39 %) | 0.625 |
No answer | 2 (1 %) | 12 (3 %) | 0.113 |
For a question “How bad news should be given?” the answers are shown in Table
3. A total of 19 % of the physicians and 11 % of the students subjected making the decision in this matter to the mental condition of the patient. To the question “If you were suffering from an incurable disease would you like to be fully or partly informed about it?” decided majority of the physicians (80 %) and the students (84 %) would like to be fully informed about the unfavourable prognosis (Table
4).
Table 3
How bad news should be given
Fully | 87 (40 %) | 237 (59 %) |
0.00001
|
Partially | 82 (38 %) | 116 (29 %) |
0.022
|
It depends on patient’s mental condition | 41 (19 %) | 44 (11 %) |
0.006
|
No answer | 7 (3 %) | 4 (1 %) | 0.067 |
Table 4
Would you like to be informed in case of an incurable disease?
Fully | 174 (80 %) | 337 (84 %) | 0.211 |
Partially | 30 (14 %) | 56 (14 %) | 1.0 |
No answer | 13 (6 %) | 8 (2 %) |
0.009
|
Euthanasia and the Doctrine of Double Effect
Euthanasia was defined by 36 % of the physicians and 37 % of the students as “a murder or a life termination, acceleration of death of a person suffering from an incurable disease with the patient’s consent (to her/his request or wish)”. Other definitions given by physicians: “the good (dignified) death” (12 %), “painless termination of life of an incurably ill patient” (11 %), “homicide (murder)” (6 %), “assistance in dying” (5 %), “homicide on request” (5 %). Students described euthanasia as “termination of life of an incurable person” (12 %), “good death” (5 %), “a murder” (4 %), without giving compassion for its motive. Most physicians and students would not commit euthanasia or assisted suicide (Table
5). In case of incurable disease, over 70 % of physicians and students chose natural death (Table
6). Majority of physicians and students responded negatively to the possibility of euthanasia legalisation (Table
7).
Table 5
Would you commit an act of euthanasia or assisted suicide?
Yes | 11 (5 %) | 48 (12 %) |
0.005
|
No | 195 (90 %) | 329 (82 %) |
0.008
|
Don’t know | 11 (5 %) | 24 (6 %) | 0.607 |
Table 6
In case of incurable disease would you like to choose
Natural death | 167 (77 %) | 289 (72 %) | 0.177 |
Euthanasia | 26 (12 %) | 76 (19 %) |
0.025
|
Assisted suicide | 9 (4 %) | 20 (5 %) | 0.573 |
Don’t know | 15 (7 %) | 16 (4 %) | 0.104 |
Table 7
Are you in favour of euthanasia legalisation
Yes | 37 (17 %) | 104 (26 %) |
0.011
|
No | 163 (75 %) | 269 (67 %) |
0.039
|
Don’t know | 17 (8 %) | 28 (7 %) | 0.649 |
To the question “Describe the doctrine of double effect” 47 % of the physicians and 88 % of the students did not answer. Physicians described the term as “a death-resulting side effect caused by administering medicine in good faith” (19 %); “causing any unintended side effect by administering medicine” (23 %); “any action causing a good or bad side effect” (5 %); “means causing any side effect by administering medicine or applying medical procedure” (4 %); “means to administer an analgesic accelerating death” (3 %).
Definitions of Suffering, Pain, Palliative Care and Hospice
The most common definition of suffering and pain was “it is a feeling of unease, discomfort” without either the distinction between pain and suffering or the indication of their effect on patient’s life (14 % of the physicians, 22 % of the students). Other more frequent answers included the following: “Pain is a physical experience, whereas suffering is a combination between physical pain and spiritual and mental experience” (13 % and 17 %, respectively); “Pain has a physical nature, suffering is a mental experience” (12 % and 15 % respectively), respectively; “Pain and suffering is an experience occupying patient’s attention completely making it impossible to lead a normal life” (12 % and 16 %, respectively).
For 49 % of the physicians and 51 % of the students, palliative care is “care for incurable patients’ improving their comfort of life”. Other physicians definitions are as follows: “a number of medical and psychological treatments applied to incurable patients” (9 %), “help provided to an incurable patient and his family, with the family’s cooperation, in each aspect of his/her life” (6 %), “a treatment of a cancer patient” (4 %), “care for the chronically ill” (3 %). Students defined the term as “care concentrating on relieving the pain and on psychological support” (9 %), “help with gentle, painless dying” (5 %), “all methods and treatment procedures used in order to relieve pain” (6 %), “care for the terminally ill, based on relief of disease symptoms without causal treatment” (4 %), “care for the patients, the disabled, who cannot function without it” (2 %).
For 35 % of the physicians and 37 % of the students, the word hospice meant “a place where incurably ill patients stay”; other physicians’ opinions are the following: it is “a concrete form of help and care for incurably ill people” (18 %), “dignified death” (6 %), “persons taking care of terminally ill patients” (6 %), “dying patients” (3 %), “death” (3 %), and “home, warmth, hospitality and human goodness” (4 %). The students answers included the following: “a form of help and care for the terminally ill” (9 %), “dignified dying” (9 %), “dying patients” (5 %), “a hospital caring for terminally ill patients” (4 %), “physical and mental preparation for death” (4 %), and “death” (2 %).
Basic Principles of Morphine Administration
To the question of the most proper route of morphine administration, the physicians indicated oral (70 %), oral and subcutaneous (7 %), subcutaneous (5 %), and oral, subcutaneous and intravenous (3 %); 2 % agreed that all routes are correct. Among students 23 % indicated an oral route as the most preferable, an intravenous (33 %), subcutaneous and intramuscular—12 % each. A total of 12 % of the physicians and 51 % of the students responded positively to the question: “Is it always wrong to exceed a certain doses of morphine?” with 74 % and 43 % respectively, who disagreed with this statement.
With regard to morphine adverse effects, most physicians (64 %) and few students (6 %) chose the right answer that morphine is causing constipation. According to 5 % of the physicians and 25 % of the students, morphine causes all listed adverse effects. Remaining answers combined a number of side effects of morphine included in the survey, 17 % of the physicians and 12 % of the students did not return an answer. To a question “Should morphine be prescribed only to the patients who will die soon?” 82 % of the physicians and 85 % of the students gave a negative answer to this question, whereas 3 and 8 %, respectively, replied that morphine should only be administered to dying patients.