Priorities for treatment, care and information if faced with serious illness: a comparative population-based survey in seven European countries.

Abstract

BACKGROUND:

Health-care costs are growing, with little population-based data about people's priorities for end-of-life care, to guide service development and aid discussions.

AIM:

We examined variations in people's priorities for treatment, care and information across seven European countries.

DESIGN:

Telephone survey of a random sample of households; we asked respondents their priorities if 'faced with a serious illness, like cancer, with limited time to live' and used multivariable logistic regressions to identify associated factors.

SETTING/PARTICIPANTS:

Members of the general public aged ≥ 16 years residing in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain.

RESULTS:

In total, 9344 individuals were interviewed. Most people chose 'improve quality of life for the time they had left', ranging from 57% (95% confidence interval: 55%-60%, Italy) to 81% (95% confidence interval: 79%-83%, Spain). Only 2% (95% confidence interval: 1%-3%, England) to 6% (95% confidence interval: 4%-7%, Flanders) said extending life was most important, and 15% (95% confidence interval: 13%-17%, Spain) to 40% (95% confidence interval: 37%-43%, Italy) said quality and extension were equally important. Prioritising quality of life was associated with higher education in all countries (odds ratio = 1.3 (Flanders) to 7.9 (Italy)), experience of caregiving or bereavement (England, Germany, Portugal), prioritising pain/symptom control over having a positive attitude and preferring death in a hospice/palliative care unit. Those prioritising extending life had the highest home death preference of all groups. Health status did not affect priorities.

CONCLUSIONS:

Across all countries, extending life was prioritised by a minority, regardless of health status. Treatment and care needs to be reoriented with patient education and palliative care becoming mainstream for serious conditions such as cancer.

• Authors: Irene J Higginson, Barbara Gomes, Natalia Calanzani, Wei Gao, Claudia Bausewein, Barbara A Daveson, Luc Deliens, Pedro L Ferreira, Franco Toscani, Marjolein Gysels, Lucas Ceulemans, Steffen T Simon, Joachim Cohen, Richard Harding, Project PRISMA
• Journal: Palliative medicine (Palliat Med) Vol. 28 Issue 2 Pg. 101-10 (Feb 2014) ISSN: 1477-030X [Electronic] England
• PMID: 23703237 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Attitude to Death
• Cross-Cultural Comparison
• Decision Making
• Europe (epidemiology)
• Female
• Health Priorities
• Humans
• Information Dissemination
• Interviews as Topic
• Life Expectancy
• Male
• Middle Aged
• Neoplasms (mortality, psychology)
• Odds Ratio
• Palliative Care
• Patient Education as Topic
• Patient Preference
• Quality of Life
• Surveys and Questionnaires
• Terminal Care
• Terminally Ill (psychology)
• Young Adult