End-of-life care and medical decision-making in the last phase of life

Student thesis: Doctoral Thesis

Abstract

The general research question guiding this thesis is:
How and in what circumstances do people die in Belgium?

This general question is further subdivided into two research areas: one specially focused on end-of-life care in terms of place and type of care and one focused on end-of-life decision-making and how this varies in Belgium according to several patient and care characteristics.

Where are patients cared for in the final three months of life and what type of end-of-life care is provided in Belgium?
1. Where are patients cared for in the final three months of life in Belgium, how often and when are they transferred between which settings, and where do they die?
2. How many patients are hospitalised during the last three months of life, how often and for how many days?
3. To what extent are specialist multidisciplinary palliative care services, GPs and other carers involved in patient care in the last three months of life? What are the main goals of medical treatment across these last months of life? What is the importance of physical, psychosocial, and spiritual care at the end of life?
These questions will be studied in PART II of this dissertation.

How does end-of-life decision-making vary according to cause of death, language community, and care delivered at the end of life in Belgium?
4. Are there differences in the prevalence of euthanasia, physician-assisted suicide, life-ending drug use without explicit patient request, intensification of symptom alleviation, or non-treatment decisions, between cancer and non-cancer patients?
5. Are there differences in the prevalence of euthanasia, physician-assisted suicide, life-ending drug use without explicit patient request, intensification of symptom alleviation, non-treatment decisions, or continuous deep sedation until death, between the Dutch-speaking and French-speaking communities of Belgium?
6. How are euthanasia, physician-assisted suicide, life-ending drug use without explicit patient request, intensification of symptom alleviation, non-treatment decisions, or continuous deep sedation until death related to the characteristics of the care provided in the final three months of life?
These questions will be studied in PART III of this dissertation.

To answer the epidemiological research questions of this dissertation, two different research methods are used, both with a quantitative mortality follow-back design. The SENTI-MELC study investigates the end of life in Belgium via the Sentinel Network of General Practitioners, who register weekly all deaths within their practice. The death certificate study investigates end-of-life decisions with possible life-shortening effect in Flanders on the basis of a representative sample of official death certificates. The certifying physician is asked to fill in a questionnaire.
Date of Award5 May 2008
Original languageEnglish
Awarding Institution
  • Vrije Universiteit Brussel
SupervisorLuc Deliens (Promotor) & Reginald Deschepper (Co-promotor)

Keywords

  • end-of-life care
  • end-of-life decisions
  • palliative care
  • sentinel network
  • terminally ill

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