Palliative care has many benefits in easing suffering and improving the quality of life of end-of-life patients, yet its availability in Israel is limited. This study examines the attitudes of both community physicians and the general public to treatment of end-of-life patients and to palliative care, and the barriers and challenges to its provision. Two surveys were conducted; one, among 227 family physicians interviewed in a self-completion questionnaire and, the other, among 721 members of the general population, interviewed by telephone.
Among the main findings:
Some 70% of the physicians said that they had the skill to treat patients according to palliative principles but the rate of those actually using these principles is much lower. For example only 24% reported that they clarify the treatment preferences of patients with a serious illness.
The physicians cited the following obstacles to referring patients to palliative care: a shortage of palliative services, a lack of guidelines on the suitable timing for referral, and the fact that the available services are virtually exclusive to cancer patients.
46% of the general public had never heard of palliative care or treatment to ease end-of-life suffering and improve the quality of life in the end-of-life period.
Public attitudes toward end-of-life care are complex and not always consistent. Some 80%-90% said that quality of life is more important than length of life, and that they would like to choose their type of care and have their preferences taken seriously. However, a significant proportion, 60%, said that in the case of an incurable illness, they would want everything done to save their lives; and 53% believe that advance care planning is unnecessary.
The findings indicate the importance of a number of programmatic directions: broadening the training of family physicians in the principles of palliative care and expanding their involvement in treating end-of-life patients. This can be done by strengthening their connection with the palliative consultation staff and suitable support services, that also need expansion. There is also a need to improve the access of non-cancer patients to palliative services. Public knowledge of palliative care and its services would benefit from information activities.
The study findings have been presented to health-plan and Ministry of Health directors and are already being used to construct a National Program for People in End-of-Life Situations and for Palliative Care, which is a cooperative undertaking of the ministry, Eshel and the Myers-JDC-Brookdale Institute.
The study was financed with the assistance of a research grant from the Israel National Institute for Health Policy Research.