Abstract
Background: Although general practitioners (GPs) are among the preferred contact persons for discussing end-of-life issues including advance directives (ADs), there is little data on how GPs manage such consultations.Objectives: This postal survey asked German GPs about their counselling for end-of-life decisions.Methods: In 2015, a two-sided questionnaire was mailed to 959 GPs. GPs were asked for details of their consultations on ADs: frequency, duration, template use, and whether they have own ADs. Statistical analysis evaluated physician characteristics associated with an above-average number of consultations on AD.Results: The participation rate was 50.3% (n = 482), 70.5% of the GPs were male; the average age was 54 years. GPs had an average of 18 years of professional experience, and 61.4% serve more than 900 patients per three months. Most (96.9%) GPs perform consultations on living wills (LW) and/or powers of attorney (PA), mainly in selected patients (72.3%). More than 20 consultations each on LWs and PAs are performed by 60% and 50% of GPs, respectively. The estimated mean duration of consultations was 21 min for LWs and 16 min for PAs. Predefined templates were used in 72% of the GPs, 50% of GPs had their ADs. A statistical model showed that GPs with ADs and/or a qualification in palliative medicine were more likely to counsel ≥20 patients per year for each document.Conclusion: The study confirmed that nearly all German GPs surveyed provide counselling on ADs. Physicians with ADs counsel more frequently than those without such documents.
Highlights
Patient autonomy is recognized as one of the most fundamental principles in medical ethics, and a particular area of concern is how autonomy can be maintained for patients with a severely impaired decisionmaking capacity [1]
Study design In April and May 2015, a two-page questionnaire was mailed to 959 general practitioners (GPs) in academic teaching practices from eight universities in North-Rhine Westphalia (NRW) together with a pre-stamped return envelope
The GPs were recruited by the university institutes for general practice of these universities (Aachen, Bochum, Bonn, Cologne, Du€sseldorf, Essen, Mu€nster, Witten-Herdecke), which collaborate in the regional family medicine competence network (Kompetenzverbund Allgemeinmedizin NRW)
Summary
Patient autonomy is recognized as one of the most fundamental principles in medical ethics, and a particular area of concern is how autonomy can be maintained for patients with a severely impaired decisionmaking capacity [1]. Within the scope of country-specific societal discussions, legal regulations in many countries support the documentation of patients’ advance directives (AD) in the form of living wills (LWs) and/or. General practitioners (GPs) are among the preferred contact persons for discussing end-of-life issues including advance directives (ADs), there is little data on how GPs manage such consultations. Most (96.9%) GPs perform consultations on living wills (LW) and/or powers of attorney (PA), mainly in selected patients (72.3%). The estimated mean duration of consultations was 21 min for LWs and 16 min for PAs. Predefined templates were used in 72% of the GPs, 50% of GPs had their ADs. A statistical model showed that GPs with ADs and/or a qualification in palliative medicine were more likely to counsel 20 patients per year for each document. Physicians with ADs counsel more frequently than those without such documents
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