• Irene J Higginson, Barbara Gomes, Natalia Calanzani, Wei Gao, Claudia Bausewein, Barbara A Daveson, Luc Deliens, Pedro L Ferreira, Franco Toscani, Marjolein Gysels, Lucas Ceulemans, Steffen T Simon, Joachim Cohen, Richard Harding, and Project PRISMA.
• 1King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK.
• Palliat Med. 2014 Feb 1;28(2):101-10.

BackgroundHealth-care costs are growing, with little population-based data about people's priorities for end-of-life care, to guide service development and aid discussions.AimWe examined variations in people's priorities for treatment, care and information across seven European countries.DesignTelephone survey of a random sample of households; we asked respondents their priorities if 'faced with a serious illness, like cancer, with limited time to live' and used multivariable logistic regressions to identify associated factors.Setting/ParticipantsMembers of the general public aged ≥ 16 years residing in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain.ResultsIn total, 9344 individuals were interviewed. Most people chose 'improve quality of life for the time they had left', ranging from 57% (95% confidence interval: 55%-60%, Italy) to 81% (95% confidence interval: 79%-83%, Spain). Only 2% (95% confidence interval: 1%-3%, England) to 6% (95% confidence interval: 4%-7%, Flanders) said extending life was most important, and 15% (95% confidence interval: 13%-17%, Spain) to 40% (95% confidence interval: 37%-43%, Italy) said quality and extension were equally important. Prioritising quality of life was associated with higher education in all countries (odds ratio = 1.3 (Flanders) to 7.9 (Italy)), experience of caregiving or bereavement (England, Germany, Portugal), prioritising pain/symptom control over having a positive attitude and preferring death in a hospice/palliative care unit. Those prioritising extending life had the highest home death preference of all groups. Health status did not affect priorities.ConclusionsAcross all countries, extending life was prioritised by a minority, regardless of health status. Treatment and care needs to be reoriented with patient education and palliative care becoming mainstream for serious conditions such as cancer.

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