Self-determination in terminal care. A comparison of GP and community members' responses

To examine health practitioner and community concerns, priorities and preferred options regarding patient self-determination in terminal care.

A postal questionnaire was sent to 229 general practitioners in two areas of Queensland (Brisbane and Wide Bay) and to 1100 community members throughout Queensland. Questions covered a range of end of life decision making issues, including where people wish to die, the use of advance directives and proxy decision makers, and possible barriers to such options.

GPs and community members held very different opinions on most issues: community members were divided between home, hospital and hospice as a preferred place to die, while GPs strongly favoured home as their preferred place to die. Both groups supported the use of advance directives and proxies, but differed significantly with respect to barriers preventing the use of such options.

Clarifying differences in perceptions and preferred options between the two groups on end of life decision making should not only improve communication and interactions between GPs and their patients but also allow both groups to become full participants in current policy and practice debates on end of life decisions.