End-of-life decision-making : a descriptive study on the decisional attitudes of Italian physicians

The research on medical decision-making is growing in three main directions: emergency treatment, treatment of chronic disorders, palliative care. The increasing occurrence of chronic diseases, in particular, cancer, has generated a new interest in decision-making procedures in this medical domain. Furthermore, the role of physicians working in different and complex settings and the role of patients and informal caregivers, who are supposed to play an active part in the treatment flow, are now important subjects of research in all parts of the world. In this framework, we conducted a survey on Italian physicians concerned with end of life care. The aim of this study was to describe which factors might influence the decision-making style in this context. Our data clearly showed that the medical decision-making process in incurable illnesses represents a complex and delicate context. Several modulating factors are present in order: medical, ethical, social, and cultural. Physicians, in formulating their own therapeutic decisions, seem to be influenced by three key elements: the patients' need for information and treatment involvement; the interaction between survival time and qualityof life, and the role of the informal caregiver (the family). Future research will be required to better understand both patients' and physicians' needs in this critical domain.