• Susan Catt, Martin Blanchard, Julia Addington-Hall, Maria Zis, Robert Blizard, and Michael King.
• Department of Mental Health Sciences, Royal Free and University College Medical School (UCL), London, UK. m.blanchard@medsch.ucl.ac.uk
• Palliat Med. 2005 Jul 1;19(5):402-10.

BackgroundCancer patients who receive care from specialist palliative care services in the UK are younger than those who do not receive this care. This may be explained by age-related differences in attitudes to end-of-life care.ObjectiveTo determine the relationship between age and i) attitudes to death and preparation for death; and ii) knowledge about, and attitudes to, cancer and palliative care.DesignInterviews with older people, using a novel questionnaire developed using nominal groups. Main comparisons were made between people aged 55-74 with those aged 75 years and over.SettingGeneral practices in London.Subjects129 people aged 55-74 and 127 people aged 75 years or over on the lists of general practitioners.MethodsA cross-sectional survey to determine knowledge and experience of hospice care; preparation for end-of-life; and attitudes to end-of-life issues.ResultsParticipants were knowledgeable about specialist palliative care and almost half had some indirect contact with a hospice. People aged >74 were less likely than younger participants to want their doctor to end their life in a terminal illness. Although they believed death was easier to face for older people, they did not believe that younger people deserved more consideration than older people when dying, or that they should have priority for hospice care. Education, social class, hospice knowledge and anxiety about death had little influence on overall attitudes.ConclusionsThe relative under-utilization of hospice and specialist palliative care services by older people with cancer in the UK cannot be explained by their attitudes to end-of-life issues and palliative care.

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