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

Published online by Cambridge University Press:  27 September 2006

LOTTE ROGG ,
PETER KJÆR GRAUGAARD  and
JON HÅVARD LOGE
LOTTE ROGG
Affiliation:
Department of Oncology, Ulleval University Hospital, Oslo, Norway
PETER KJÆR GRAUGAARD
Affiliation:
Department of Behavioral Sciences in Medicine, University of Oslo, Oslo, Norway
JON HÅVARD LOGE
Affiliation:
Department of Oncology, Ulleval University Hospital, Oslo, Norway
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Abstract

Objective: 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.”

Methods: 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.

Results: 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.

Significance of results: 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.

Keywords

Conceptual researchTerminologyTerminalEnd-of-life
Type
Research Article
Information
Palliative & Supportive Care , Volume 4 , Issue 3 , September 2006 , pp. 273 - 278
Copyright
© 2006 Cambridge University Press

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References

REFERENCES

Aasland, O.G., Olff, M., Falkum, E., et al. (1997). Health complaints and job stress in Norwegian physicians: The use of an overlapping questionnaire design. Social Science and Medicine, 45, 1615–1629.Google Scholar
Adam, J. (1997). ABC of palliative care. The last 48 hours. British Medical Journal, 315, 1600–1603.Google Scholar
Bailey, F.A., Burgio, K.L., Woodby, L.L., et al. (2005). Improving processes of hospital care during the last hours of life. Archives of Internal Medicine, 165, 1722–1727.Google Scholar
Brandt, H.E., Deliens, L., Ooms, M.E., et al. (2005). Symptoms, signs, problems, and diseases of terminally ill nursing home patients: A nationwide observational study in the Netherlands. Archives of Internal Medicine, 165, 314–320.Google Scholar
Christakis, N.A. & Iwashyna, T.J. (1998). Attitude and self-reported practice regarding prognostication in a national sample of internists. Archives of Internal Medicine, 158, 2389–2395.Google Scholar
Clayton, J.M., Butow, P.N., Arnold, R.M., et al. (2005). Discussing end-of-life issues with terminally ill cancer patients and their carers: A qualitative study. Supportive Care in Cancer, 13, 589–599.Google Scholar
Ellershaw, J. (2002). Clinical pathways for care of the dying: An innovation to disseminate clinical excellence. Journal of Palliative Medicine, 5, 617–621.Google Scholar
Ellershaw, J. & Ward, C. (2003). Care of the dying patient: The last hours or days of life. British Medical Journal, 326, 30–34.Google Scholar
Emanuel, E.J., Fairclough, D.L., & Emanuel, L.L. (2000). Attitudes and desires related to euthanasia and physician-assisted suicide among terminally ill patients and their caregivers. JAMA, 284, 2460–2468.Google Scholar
Furst, C. & Doyle, D. (2004). The terminal phase. In Oxford Textbook of Palliative Medicine, Doyle, D., Hanks, G., Cherny, N., et al. (eds.), pp. 1119–1133. Oxford: Oxford University Press.
Higginson, I., Wade, A., & McCarthy, M. (1990). Palliative care: Views of patients and their families. British Medical Journal, 301, 277–281.Google Scholar
Hugel, H., Ellershaw, J.E., Cook, L., et al. (2004). The prevalence, key causes and management of insomnia in palliative care patients. Journal of Pain and Symptom Management, 27, 316–321.Google Scholar
Kutner, J.S., Steiner, J.F., Corbett, K.K., et al. (1999). Information needs in terminal illness. Social Science and Medicine, 48, 1341–1352.Google Scholar
Lecouturier, J., Jacoby, A., Bradshaw, C., et al. (1999). Lay carers' satisfaction with community palliative care: Results of a postal survey. South Tyneside MAAG Palliative Care Study Group. Palliative Medicine, 13, 275–283.Google Scholar
Levorato, A., Stiefel, F., Mazzocato, C., et al. (2001). Communication with terminal cancer patients in palliative care: Are there differences between nurses and physicians? Supportive Care in Cancer, 9, 420–427.Google Scholar
Llobera, J., Esteva, M., Rifa, J., et al. (2000). Terminal cancer: Duration and prediction of survival time. European Journal of Cancer, 36, 2036–2043.Google Scholar
Lynn, J. & Forlini, J.H. (2001). “Serious and complex illness” in quality improvement and policy reform for end-of-life care. Journal of General Internal Medicine, 16, 315–319.Google Scholar
Lynn, J., Harrell, F.E., Cohn, F., et al. (1996). Defining the “terminally ill”: Insights from SUPPORT. Duquesne Law Review, 35, 311–336.Google Scholar
Okie, S. (2005). Physician-assisted suicide—Oregon and beyond. New England Journal of Medicine, 352, 1627–1630.Google Scholar
Saunders, C. (1961). Euthanasia. Lancet, 278, 548–549.Google Scholar
Simpson, J.A., & Weiner, E.S.C., Eds. (2006). Oxford English Dictionary. Oxford: Oxford University Press. Available at: http://dictionary.oed.com/cgi/entry/50249364?single=1&query_type=word&queryword=terminal&first=1&max_to_show=10.
The SUPPORT Principal Investigators. (1995). A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). JAMA, 274, 1591–1598.Google Scholar
Twycross, R. & Lichter, I. (1998). The terminal phase. In Oxford Textbook of Palliative Medicine, Doyle, D., Hanks, G. & MacDonald, N. (eds.), pp. 977–992. Oxford: Oxford University Press.
Vig, E.K. & Pearlman, R.A. (2004). Good and bad dying from the perspective of terminally ill men. Archives of Internal Medicine, 164, 977–981.Google Scholar
Weeks, J.C., Cook, E.F., O'Day, S.J., et al. (1998). Relationship between cancer patients' predictions of prognosis and their treatment preferences. JAMA, 279, 1709–1714.Google Scholar