Issues and needs in end-of-life decision making: An international modified Delphi study

Natasja J H Raijmakers, Lia Van Zuylen, Massimo Costantini, Augusto Caraceni, Jean B. Clark, Gustavo De Simone, Gunilla Lundquist, Raymond Voltz, John E. Ellershaw, Agnes Van Der Heide

Research output: Contribution to journalArticlepeer-review


Background: end-of-life decision making is an important aspect of end-of-life care that can have a significant impact on the process of dying and patients' comfort in the last days of life. Aim: the aim of our study was to identify issues and considerations in end-of-life decision making, and needs for more evidence among palliative care experts, across countries and professions. Participants: 90 palliative care experts from nine countries participated in a modified Delphi study. Participants were asked to identify important issues and considerations in end-of-life decision making and to rate the need for more evidence. Results: experts mentioned 219 issues in end-of-life decision making related to the medical domain, 122 issues related to the patient wishes and 92 related to relatives' wishes, regardless of profession or country (p > 0.05). In accordance, more than 90% of the experts rated the comfort and wishes of the patient and the potential futility of treatment as important considerations in end-of-life decision making, although some variation was present. When asked about issues that are in need of more evidence, 87% mentioned appropriate indications for using sedatives and effects of artificial hydration at the end of life. A total of 83% mentioned adequate communication approaches. Conclusions: palliative care experts from different professions in different countries encounter similar issues in end-of-life decision making. Adequate communication about these issues is universally experienced as a challenge, which might benefit from increased knowledge. This shared experience enables and emphasizes the need for more international research.

Original languageEnglish
Pages (from-to)947-953
Number of pages7
JournalPalliative Medicine
Issue number7
Publication statusPublished - Oct 2012


  • decision making
  • expert opinion
  • palliative care
  • research priorities
  • terminal care

ASJC Scopus subject areas

  • Medicine(all)
  • Anesthesiology and Pain Medicine


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