Med Decis Making - Trends in medical end-of-life decision making in Flanders, Belgium 1998-2001-2007.

Tópicos

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Resumo

In 2002, Belgium saw the enactment of 3 laws concerning euthanasia, palliative care, and patient rights that are likely to affect end-of-life decision making. This report examines trends in the occurrence and decision-making process of end-of-life practices in different patient groups since these legal changes. A large-scale retrospective survey in Flanders, Belgium, previously conducted in 1998 and 2001, was repeated in 2007. Questionnaires regarding end-of-life practices and the preceding decision-making process were mailed to physicians who certified a representative sample (N = 6927) of death certificates. The 2007 response rate was 58.4%. In patient groups in which the prevalence of life-ending drug use without explicit patient request has dropped, performance of euthanasia and assisted suicide has increased. The consistent increase in intensified pain and symptom alleviation was found in all patient groups except cancer patients. In 2007, competent patients were slightly more often involved in the discussion of end-of-life practices than in previous years. Over the years, involvement of the patient in decision making was consistently more likely among younger patients, cancer patients, and those dying at home. Physicians consulted their colleagues more often than in previous years for euthanasia and nontreatment decisions. The euthanasia law and emerging palliative care culture have substantially affected the occurrence and decision making for end-of-life practices in Belgium. Efforts are still needed to encourage shared end-of-life decision making, as some patients would benefit from advance care planning.

Resumo Limpo

belgium saw enact law concern euthanasia palliat care patient right like affect endoflif decis make report examin trend occurr decisionmak process endoflif practic differ patient group sinc legal chang largescal retrospect survey flander belgium previous conduct repeat questionnair regard endoflif practic preced decisionmak process mail physician certifi repres sampl n death certif respons rate patient group preval lifeend drug use without explicit patient request drop perform euthanasia assist suicid increas consist increas intensifi pain symptom allevi found patient group except cancer patient compet patient slight often involv discuss endoflif practic previous year year involv patient decis make consist like among younger patient cancer patient die home physician consult colleagu often previous year euthanasia nontreat decis euthanasia law emerg palliat care cultur substanti affect occurr decis make endoflif practic belgium effort still need encourag share endoflif decis make patient benefit advanc care plan

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