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Has there been a change in the end-of-life decision-making over the past 16 years?
  1. Reetta P Piili1,2,
  2. Juho T Lehto1,2,
  3. Riina Metsänoja3,
  4. Heikki Hinkka4 and
  5. Pirkko-Liisa I Kellokumpu-Lehtinen1,5
  1. 1 Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
  2. 2 Department of Oncology, Palliative Unit, Tampere University Hospital, Tampere, Finland
  3. 3 Faculty of Social Sciences, Tampere University, Tampere, Finland
  4. 4 Rehabilitation Center Apila, ret, Kangasala, Finland
  5. 5 Department of Oncology, Tampere University Hospital, Tampere, Finland
  1. Correspondence to Dr Reetta P Piili, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland; reetta.piili{at}


Objectives Physicians’ decision-making in end-of-life (EOL) care includes many medical, ethical and juridical aspects. We studied the changes of these decisions over time and factors influencing them.

Methods A postal survey including two hypothetical patient scenarios was sent to 1258 Finnish physicians in 2015 and to 1182 in 1999. The attitudes, values and background factors of the physicians were also enquired.

Results The response rate was 56%. The physicians’ decisions to choose palliative approaches over active or intensive care increased from 1999 to 2015 when a terminally ill prostate cancer patient had probable iatrogenic gastrointestinal bleeding (53% vs 59%, p=0.014) and waited to meet his son (46% vs 60%, p<0.001) or a minister (53% vs 71%, p<0.001). Training in EOL care independently increased palliative approaches. Patient’s benefit (96% vs 99%, p=0.001), ethical values (83% vs 93%, p<0.001) and patient’s (68% vs 86%, p<0.001) or physician’s (44% vs 63%, p<0.001) legal protection were considered more influential to the decisions in 2015, while the family’s benefit was regarded as less influential to the decisions than it was in 1999 (37% vs 25%, p<0.001). Physicians were more willing to give a hospice voucher for an advanced breast cancer patient in 2015 (34% vs 58%, p<0.001).

Conclusions Our findings may reflect the transition to a stronger emphasis on patient-centred care and a stronger tendency to avoid futile therapies that have only short-term goals. The results highlight that education in all aspects of EOL care should be incorporated into the post-graduate training of medical specialties that take care of dying patients.

  • end-of-life
  • clinical ethics
  • decision-making

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors RPP, JTL, HH and P-LIK-L designed the study outline and the questionnaire. RPP, JTL and P-LIK-L collected the data. RPP, JTL, P-LIK-L and RM analysed the data. RPP and RM performed the final statistical analysis. All the authors contributed to the writing and reviewing of the manuscript and approved the final manuscript.

  • Funding This study was funded by the Seppo Nieminen Legacy Fund, the Signe and Ane Gyllenberg Foundation, the Finnish Medical Association and the Cancer Society of Pirkanmaa.

  • Disclaimer The funders did not have any role in the design of the study; in the collection, analysis or interpretation of the data; or in the writing of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.