End-of-life decisions and opinions: Results of E.L.D.Y.-CA.RE study carried out at Veneto Institute of Oncology, Italy

Background: Issues related to end-of-life decisions (ELDs) generate impassioned debates in society. Our study aimed at investigating attitudes in care of cancer patients at the end-of-life (EOL); ascertaining the opinion of healthcare professionals (HCPs), patients, and caregivers. Methods: An anonymous and self-administered questionnaire was delivered to HCPs (physicians, nurses, psychologists, and social workers), patients and family caregivers at Veneto Institute of Oncology, Italy, and 425 questionnaires were collected (136 HCPs, 171 patients, 118 caregivers). Results: Withholding life-sustaining treatment (LST) was declared by 11.3% of physicians and nurses and withdrawing by 19.4%, whereas 46.8% declared starting LST, and 48.4% did not discontinue LST. Most HCPs (75.7%) were in favor of patient's right to anticipate EOL, and 86.4% of withholding/withdrawing LST upon patient's request, with 62.4% HCPs agreeing on lethal drug doses to be allowed upon request of the patient. The majority (80.1%) disagreed that “ life is an unavailable asset and there is no right to die ”. For patients and caregivers, in ELDs greater value was given to self-determination first, with family members and trustees’ subsequent involvement. A considerable number of HCPs reported feeling inadequate to communicate bad news. Conclusion: Despite the limitations imposed by the cross-sectional nature, this study adds information with regard to EOL in oncology setting in Italy. Our study shows that an attitude to prolonging patient's life in ELDs is still prevalent among HCPs in an Italian oncological setting, although there are signs of change. Communicating bad news emerges as an issue, along with HCPs’ awareness that they need more education and training.