Physicians' interpretation of the prognostic term “terminal”: A survey among Norwegian physicians

Abstract

Optimal clinical practice depends upon a precise language with common understanding of core terms. The aim of the present study was to examine how Norwegian physicians understand the commonly used but poorly defined term "terminal". A questionnaire was mailed to 1605 Norwegian physicians, representative of the Norwegian medical community. Nine hundred and sixty-eight responded and defined "terminal" in expected weeks left to live. The effects of gender, age, specialty, and experience with prognostication toward end of life on the estimation of "terminal" were investigated. Norwegian physicians on average expect a "terminal" patient to have 3.6 (+/- 3.5 SD) weeks to live with expectation ranging from 0 to 26 weeks. The majority (83.5%) defined "terminal" as less than 5 weeks' survival; 15.0% as 5 to 12 weeks' survival and 1.5% as more than 12 weeks' survival. No difference between genders was observed, whereas the youngest physicians (27-39 years) held shorter definitions than the other age groups. Physicians in internal medicine, surgery, and anaesthesiology held significantly shorter estimations of "terminal" than did physicians in general practice, public health, and psychiatry. Our study shows that the majority of Norwegian physicians restrict "terminal" to the last 2-4 weeks of patients' lives. A life expectancy of a few days compared to several weeks should lead to different clinical actions. Efforts should therefore be made to come to a common definition of the term. In our opinion the use of "terminal" should be limited to when death is expected within a few days.