Participation of French general practitioners in end-of-life decisions for their hospitalised patients
- E Ferrand1,
- P Jabre1,
- S Fernandez-Curiel1,
- F Morin1,
- C Vincent-Genod1,
- P Duvaldestin1,
- F Lemaire2,
- C Hervé3,
- J Marty1
- 1Service d’Anesthésie Réanimation-SAMU 94, Hôpital Henri Mondor, AP-HP, Créteil, France
- 2Service de Réanimation Médicale, Hôpital Henri Mondor, AP-HP, Créteil, France
- 3Departement d’Ethique Médicale et de Médecine Légale, Faculté de médecine des Saints-Pères—Paris V, Paris, France
- Correspondence to: Dr Edouard Ferrand Service d’Anesthésie Réanimation SAMU 94, Hôpital Henri-Mondor, AP-HP 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil cedex, France;
- Received 26 August 2005
- Accepted 1 November 2005
- Revised 31 October 2005
Background and objective: Assuming the hypothesis that the general practitioner (GP) can and should be a key player in making end-of-life decisions for hospitalised patients, perceptions of GPs’ role assigned to them by hospital doctors in making withdrawal decisions for such patients were surveyed.
Design: Questionnaire survey.
Setting: Urban (districts located near Paris) and rural (southern France) areas.
Results: The response rate was 32.2% (161/500), and it was observed that 70.8% of respondents believed that their participation in withdrawal decisions for their hospitalised patients was essential, whereas 42.1% believed that the hospital doctors were sufficiently skilled to make withdrawal decisions without input from the GPs. Most respondents were found to believe that they had the necessary skills (91.9%) and enough time (87.6%) to participate in withdrawal decisions. The last case of treatment withdrawal in hospital for one of their patients was described by 40% (65/161) of respondents, of whom only 40.0% (26/65) believed that they had participated actively in the decision process. The major factors in the multivariate analysis were the GP’s strong belief that his or her participation was essential (p = 0.01), information on admission of the patient given to the GP by the hospital department (p = 0.007), rural practice (p = 0.03), visit to the patient dying in hospital (p = 0.02) and a request by the family to be kept informed about the patient (p = 0.003).
Conclusion: Strong interest was evinced among GPs regarding end-of-life issues, as well as considerable experience of patients dying at home. As GPs are more closely corrected to patients’ families, they may be a good choice for third-party intervention in making end-of-life decisions for hospitalised patients.
Competing interests: None.
Contributors: EF: conception and design, analysis and interpretation of the data, drafting of the article; PJ: analysis and interpretation of the data, statistical expertise; CH, SF-C, FM, CV-G: conception and design; FL, PD, JM: drafting of the article, critical revision of the article for important intellectual content.