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Abstract
Objectives To study changes in the peer consultation practice of assessing assisted dying requests and its quality among trained ‘Life End Information Forum’ (LEIF) consultants in Belgium between 2008 and 2019.
Methods Cross-sectional surveys conducted in 2008 (N=132) and 2019 (N=527) among all registered LEIF consultants.
Results The response rate was 75% in 2008 and 57% in 2019. In 2019 compared with 2008, more LEIF consultants were significantly less than 40 years old (25%/10%, p=0.006) and at least 60 years old (34%/20%, p=0.006). In their activities regarding assessments of assisted dying requests over 12 months, we found a significant increase in the number of patients who did not meet the substantive requirements for assisted dying in 2019 compared with 2008 (1–4 patients: 41.1 %/58.8%, p=0.020). In their most recent assessments of an assisted dying request, LEIF consultants in 2019 made significantly more assessments of patients aged 80 years or older than in 2008 (31%/9%, p<0.001), and significantly fewer assessments for patients with cancer (53%/70%, p=0.034). Regarding adherence to quality criteria for consultation, LEIF consultants discussed unbearable suffering (87%/65%, p=0.003) and alternative treatments (palliative: 48 %/13%, p<0.001; curative: 28%/5%, p=0.002) significantly more often with the attending physician.
Conclusions Changes in peer consultation practice and its quality among LEIF consultants likely reflect changes in assisted dying practice in general, as well as changes in LEIF consultations on more complex cases for which LEIF consultants’ expertise is required.
- Terminal care
- Service evaluation
- End of life care
- Ethics
- Education and training
- Clinical decisions
Data availability statement
Data are available on reasonable request. Data will be stored in the archive of Vrije Universiteit Brussel and will be shared with third parties only on reasonable request and upon signing a data user agreement, as these data are covered by the GDPR (restricted access).
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Data availability statement
Data are available on reasonable request. Data will be stored in the archive of Vrije Universiteit Brussel and will be shared with third parties only on reasonable request and upon signing a data user agreement, as these data are covered by the GDPR (restricted access).
Footnotes
SV and SD are joint first authors.
Contributors SD, KC, LD and JC were responsible for the study’s conception and design. SV and SD were responsible for data collection and analysis and drafted the manuscript. All authors contributed to the interpretation of the data, critically revised the manuscript for important intellectual content, and gave final approval for submission. SV, SD and JC act as guarantors of the work. SV and SD contributed equally as first author.
Funding This study was supported by funding from the Vrije Universiteit Brussel Funds ‘Wetenschappelijk Steunfonds’ and ‘Zorg aan het Levenseinde’ and the Federal Public Service for Public Health, Food Chain Safety and Environment of Belgium. SD is a Postdoctoral Fellow of the Research Foundation—Flanders (FWO).
Disclaimer The funding sources had no role in the design and conduct of the study, in the collection, management, analysis and interpretation of the data, or in the preparation, review, or approval of the manuscript.
Competing interests FM teaches in the LEIF training. Stijn Vissers, Sigrid Dierickx, Luc Deliens, Kenneth Chambaere, and Joachim Cohen declare no conflict of interest.
Provenance and peer review Not commissioned; externally peer reviewed.