Attitudes of cancer patients, family caregivers, oncologists and members of the general public toward critical interventions at the end of life of terminally ill patients

• Published in: Canadian Medical Association journal (CMAJ) 2011-07, Vol.183 (10), p.E673-E679
• Main Authors: Yun, Young Ho, Han, Kyung Hee, Park, Sohee, Park, Byeong Woo, Cho, Chi-Heum, Kim, Sung, Lee, Dae Ho, Lee, Soon Nam, Lee, Eun Sook, Kang, Jung Hun, Kim, Si-Young, Lee, Jung Lim, Heo, Dae Seog, Lee, Chang Geol, Lim, Yeun Keun, Kim, Sam Yong, Choi, Jong Soo, Jeong, Hyun Sik, Chun, Mison
• Format: Article
• Language: English
• Subjects: Adult; Aged; Assisted suicide; Attitude of Health Personnel; Attitude to Death; Beliefs, opinions and attitudes; Cancer; Cancer patients; Care and treatment; Caregivers - psychology; Euthanasia; Euthanasia, Active - psychology; Female; Humans; Logistic Models; Male; Medical Futility - psychology; Middle Aged; Neoplasms - psychology; Pain - psychology; Palliative care; Physicians - psychology; Public Opinion; Republic of Korea; Social aspects; Studies; Suicide, Assisted - psychology; Surveys and Questionnaires; Terminal care; Terminal illnesses; Terminally Ill - psychology; Withholding Treatment
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.110020

Whereas most studies have focused on euthanasia and physician-assisted suicide, few have dealt comprehensively with other critical interventions administered at the end of life. We surveyed cancer patients, family caregivers, oncologists and members of the general public to determine their attitudes toward such interventions. We administered a questionnaire to four groups about their attitudes toward five end-of-life interventions--withdrawal of futile life-sustaining treatment, active pain control, withholding of life-sustaining measures, active euthanasia and physician-assisted suicide. We performed multivariable analyses to compare attitudes and to identify sociodemographic characteristics associated with the attitudes. A total of 3840 individuals--1242 cancer patients, 1289 family caregivers and 303 oncologists from 17 hospitals, as well as 1006 members of the general Korean population--participated in the survey. A large majority in each of the groups supported withdrawal of futile life-sustaining treatment (87.1%-94.0%) and use of active pain control (89.0%-98.4%). A smaller majority (60.8%-76.0%) supported withholding of life-sustaining treatment. About 50% of those in the patient and general population groups supported active euthanasia or physician-assisted suicide, as compared with less than 40% of the family caregivers and less than 10% of the oncologists. Higher income was significantly associated with approval of the withdrawal of futile life-sustaining treatment and the practice of active pain control. Older age, male sex and having no religion were significantly associated with approval of withholding of life-sustaining measures. Older age, male sex, having no religion and lower education level were significantly associated with approval of active euthanasia and physician-assisted suicide. Although the various participant groups shared the same attitude toward futile and ameliorative end-of-life care (the withdrawal of futile life-sustaining treatment and the use of active pain control), oncologists had a more negative attitude than those in the other groups toward the active ending of life (euthanasia and physician-assisted suicide).