Physician discussions with terminally ill patients: a cross-national comparison

Colleen M. Cartwright, Southern Cross University
Bregje D. Onwuteaka-Philipsen, Vrije University
Gail M. Williams, University of Queensland
Karin Faisst, University of Zurich
Freddy Mortier, University of Ghent
Tore Nilstun, University of Lund
Michael Norup, University of Copenhagen
Agnes van der Heide, University Medical Centre Rotterdam
Guido Miccinesi, Centre for Study & Prevention of Cancer, Florence

Abstract

A major issue in the care of terminally ill patients is communication and information provision. This paper reports the extent to which physicians in Australia, Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland discuss topics relevant to end of life care with terminally ill patients and their relatives (without first informing the patient), and possible associations between physician-specific characteristics and such discussions. Response rates to the postal survey ranged from 39% to 68% (n = 10139). Physicians in most of the countries except Italy `in principle, always' discuss issues related to terminal illness with their patients but not with patients' relatives without first informing the patient, unless the relatives ask. Cross-national differences remained strong after controlling for physician characteristics. The majority of physicians appeared to support the principle of patient-centred care to terminally ill patients, consistent with palliative care philosophy and with the law and/or professional guidelines in most of the countries studied.