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Factors considered in end-of-life decision-making of healthcare professionals

Background The factors considered in decision making at the end of life is largely unknown. Aim To explore the importance of factors influencing end-of-life decision-making of healthcare professionals (HCP). Methods This short survey reviewed the significance of regularly reported factors and scenarios involving the patient, family and HCPs themselves in discerning end of life decision making and was carried out among physicians and nurses from the Oncology and Palliative Medicine department at the Singapore General Hospital and the National Cancer Centre between 1 and 31 March 2011. A response rate of 78.6% was acquired from the 187 questionnaires distributed. The ages of participants ranged from 19 to 68 years (mean 32.1, median 29) and their experience in oncology or palliative care ranged from 0 to 40 years (mean 5.87 years, median 4). Results First, respondents rated patient's wishes (96.6%), their clinical symptoms (93.9%) and the patient's beliefs (91.1%) as the pivotal factors determining their decision making process. Least important were the HCP's own beliefs (54.79%). Second, 94.6% of HCPs reported that they would respect the wishes of a competent patient over the family's wishes should there be a conflict of goals, but 59.9% would switch to the family's wishes when the patient loses capacity even if it ran against the patient's previously stated wishes. Third, of the 57.1% of respondents who had read the hospital's end of life care policy, most felt it useful in guiding their decisions and rarely required for them to be overruled. Conclusion End-of-life care decision making in Singapore appears to be largely patient-centred with patients' wishes and objective factors such as clinical symptoms taking precedence over HCP-related factors. However, familial determination remains influential especially when the patient is incapacitated. A better understanding of the factors can help inform future decision-making framework or guidelines.