Physicians' Beliefs and Attitudes About End-of-Life Care: A Comparison of Selected Regions in Hungary and the United States

Context. Unlike primary care physicians in the U.S., it is only recently that Hungarian primary care physicians have had the educational resources for providing end-of-life care and the availability of hospice services as part of the Hungarian health care system. Objectives. The aim of this study was to assess, compare, and contrast beliefs and practices of end-of-life care held by primary care physicians practicing in selected regions of the United States and Hungary. Methods. A 22-item questionnaire, written in English, translated to Hungarian, and pilot tested in both countries, was mailed to 339 Hungarian and 330 U.S. physicians, with response rates of 54% and 48%, respectively. Descriptive and bivariate analyses were conducted to compare the samples. Results. Over half of U.S. physicians indicated they were quite knowledgeable about hospice care and rated currently available services for the terminally ill as exceptionally good, compared to less than 10% of Hungarian physicians. The physicians' differing beliefs that discussing a terminal prognosis fosters a sense of hopelessness is consistent with disclosure beliefs and practices. The majority of U.S. physicians believe it is the patients' right to know and always tell them when the diagnosis is terminal. Hungarian physicians (44%) believe that the patient's right to know is balanced by the physician's judgment of the patient's best interest, and an additional 40% disclose only if asked. Conclusion. These results illustrate some of the important differences in physicians' beliefs about the care of terminally ill patients between the two countries and can be used to guide medical education and practice. J Pain Symptom Manage 2010;39:76-87. (C) 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.