Supporting GPs around euthanasia requests from people with dementia: a qualitative analysis of Dutch nominal group meetings

Abstract

BackgroundEuthanasia has been regulated by law under strict conditions in the Netherlands since 2002. Since then the number of euthanasia cases has constantly increased, and increased exponentially for patients with dementia (PWD). The number of euthanasia requests by such patients is even higher. Recently, an interview study showed that physicians who are confronted with a PWD’s euthanasia request experience problems with communication, pressure from relatives, patients, and society, workload, interpretation of the law, and ethical considerations. Moreover, if honoured, the physician and patient may interpret the right moment for euthanasia differently.AimTo identify ways of supporting GPs confronted with a PWD’s euthanasia request.Design and settingTwo expert nominal group meetings were organised with Dutch care physicians for older people, GPs, legal experts, a healthcare chaplain, a palliative care consultant, and a psychologist.MethodA total of 15 experts participated in the meetings. Both meetings were audio-recorded, transcribed verbatim, and analysed using thematic analysis.ResultsFour themes emerged from the meetings: support provided by healthcare professionals, influencing public opinion, educational activities, and managing time and work pressure. The need for support was considered highest for GPs for all of these themes.ConclusionConsensus was reached with the help of experts on support needs for GPs confronted with euthanasia requests from PWD. A concise and clear explanation of the law is strongly desired. Changing public opinion seems the most challenging and a long-term aim. Communication training for finding the right balance between the physician’s professional responsibility and the patient’s autonomy should be made available, as a short-term aim.

Dutch GPs’ experience of burden by euthanasia requests from people with dementia: a quantitative survey

“… 6 , 28 The high percentages of GPs that would like to be supported by a SCEN physician, a geriatric consultation team, a palliative care expert, or the expert centre for euthanasia, is in accordance with the recommendations resulting from two nominal group meetings with all kind of experts in this field. 18 Strikingly, moral deliberation or spiritual counselling was hardly mentioned by the responders. Perhaps, GPs mistakenly may associate those kinds of support with religion.…”

“…Since no validated questionnaire to answer the research question was available, and no comparable study had been performed before, a survey was developed (Supplementary Appendix 1). Based on a literature search, a qualitative interview study, 6 and two expert meetings, 18 a concept survey was composed. Expert validity of the survey was achieved through pilot testing by six GPs, an ethicist, a journalist, a geriatrician, and an older persons' psychiatrist, and adapted where necessary.…”

Practitioners’ perceptions of acceptability of a question prompt list about palliative care for advance care planning with people living with dementia and their family caregivers: a mixed-methods evaluation study

“…The physicians, although associated with an academic centre and probably with an interest in the topic, may not feel comfortable to discuss some topics included in the QPL, perhaps also including around hastening death. 24 Strengths and limitations of this study The mixed-methods design allowed for a richer understanding of the quantitative survey data, in particular regarding barriers and concerns, and also provided an efficient iterative approach of analysing the quantitative data based on a question that emerged prominently from the qualitative interviews, additional to interviewing about completed surveys. The response to the survey was low but within the range of responses commonly observed for physician surveys, while trends point to declining response rates.…”

Title Euthanasia in advanced Dementia; the view of the GPs in the Netherlands on a vignette case along the juridical and ethical dispute . A survey among Dutch general practitioners

“…Since no validated questionnaire to answer our research question was available, and no comparable study had been performed before, a survey was developed (Appendix 2). Based on a literature search, a qualitative interview study [11] and two expert meetings [22], a concept survey was composed. Expert validity of the survey was achieved through pilot testing by six GPs, an ethicist, a journalist, a geriatrician and an elderly psychiatrist, and adapted where necessary.…”