Table 4 Characteristics associated with difficult consultations as perceived by SCEN physicians, 2016–2017
Difficult (N = 203) | Not difficult (N = 735) | Univariable Odds ratio (95% CI) | Multivariable Odds ratio (95% CI) | |
|---|---|---|---|---|
N (%) | N (%) | |||
SCEN physician | ||||
Number of consultations per year | ||||
< 5 | 11 (5.5) | 52 (7.1) | 1 | ¶ |
5–9 | 53 (26.5) | 190 (25.9) | 1.32 (0.64–2.7) | |
10–14 | 52 (26) | 212 (28.9) | 1.16 (0.57–2.38) | |
≥ 15 | 84 (42) | 280 (38.1) | 1.42 (0.71–2.84) | |
Attending physician | ||||
Profession | ||||
General practitioner | 151 (81.2) | 665 (92.7) | 1 | 1 |
Medical specialist | 17 (9.1) | 23 (3.2) | 3.26 (1.7–6.24) | 1.23 (0.48–3.17) |
Elderly care physician | 18 (9.7) | 29 (4) | 2.73 (1.48–5.05) | 0.73 (0.31–1.69) |
Works at End of life clinic | 46 (22.8) | 49 (6.7) | 4.13 (2.66–6.4) | 1.44 (0.71–2.94) |
Certainty of decision before consultation | ||||
Already promised to grant the request | 29 (14.3) | 186 (25.4) | 1 | 1 |
Decided to grant the request | 78 (38.4) | 353 (48.2) | 1.42 (0.89–2.25) | 0.76 (0.43–1.33) |
Probably wants to grant the request | 75 (36.9) | 177 (24.1) | 2.72 (1.69–4.37) | 1.58 (0.88–2.82) |
Doubts about/doesn’t want to grant the request | 21 (10.3) | 17 (2.3) | 7.92 (3.74–16.77) | 4.48 (1.73–11.58) |
Patient | ||||
Age | ||||
< 70 years | 78 (39) | 260 (35.6) | 1 | 1 |
70–79 years | 36 (18) | 240 (32.9) | 0.5 (0.33–0.77) | 0.38 (0.21–0.68) |
≥ 80 years | 86 (43) | 230 (31.5) | 1.25 (0.88–1.78) | 0.53 (0.31–0.93) |
Sex (female) | 104 (51.7) | 339 (46.2) | 1.25 (0.91–1.71) | ¶ |
Residency | ||||
Home | 136 (67.7) | 615 (84) | 1 | 1 |
Care/nursing home | 33 (16.4) | 57 (7.8) | 2.62 (1.64–4.18) | 1.31 (0.7–2.47) |
Hospital | 17 (8.5) | 20 (2.7) | 3.84 (1.96–7.53) | 3.01 (1.15–7.85) |
Hospice | 15 (7.5) | 40 (5.5) | 1.7 (0.91–3.16) | 2.01 (0.9–4.49) |
Main diagnosis | ||||
Cancer | 73 (36.1) | 551 (75.1) | 1 | 1 |
Heart failure/CVA | 23 (11.4) | 35 (4.8) | 4.96 (2.78–8.86) | 4.43 (2.08–9.42) |
MS/ALS | 7 (3.5) | 22 (3) | 2.4 (0.99–5.82) | 0.85 (0.25–2.87) |
COPD | 7 (3.5) | 33 (4.5) | 1.6 (0.68–3.75) | 0.7 (0.2–2.46) |
Accumulation of age-related health problems/dementia/psychiatric disorder | 64 (31.7) | 40 (5.4) | 12.08 (7.59–19.21) | 6.94 (3.58–13.46) |
Other | 28 (13.9) | 53 (7.2) | 3.99 (2.37–6.7) | 3.42 (1.77–6.6) |
Besides main diagnosis alsoa | ||||
Physical illness | 94 (50.5) | 299 (49.9) | 1.03 (0.74–1.43) | ¶ |
Psychiatric disorder | 29 (15.6) | 53 (8.8) | 5.17 (2.28–11.71) | 3.91 (1.41–10.83) |
Accumulation of age-related health problems | 29 (15.6) | 53 (8.8) | 1.9 (1.17–3.1) | 1.58 (0.77–3.24) |
Dementia | 6 (3.2) | 9 (1.5) | 2.19 (0.77–6.22) | ¶ |
Psychosocial or existential problems | 34 (18.3) | 31 (5.2) | 4.1 (2.44–6.88) | 2.25 (1.13–4.5) |
Reasons to request EAS | ||||
Loss of dignity | 90 (44.3) | 364 (49.6) | 0.81 (0.59–1.11) | ¶ |
Overall weakness | 86 (42.4) | 457 (62.3) | 0.45 (0.33–0.61) | 0.78 (0.51–1.2) |
Being tired with life | 17 (8.4) | 20 (2.7) | 3.26 (1.68–6.35) | 0.95 (0.37–2.43) |
Pointless suffering | 45 (22.2) | 156 (21.3) | 1.06 (0.73–1.54) | ¶ |
Knowing that suffering will not get better | 93 (45.8) | 382 (52) | 0.78 (0.57–1.06) | ¶ |
Fear of suffocation | 15 (7.4) | 89 (12.1) | 0.58 (0.33–1.02) | 0.73 (0.32–1.67) |
Invalidity | 42 (20.7) | 115 (15.7) | 1.4 (0.95–2.08) | ¶ |
Depressionb | 12 (5.9) | 1 (0.1) | – | – |
Dependency | 92 (45.3) | 353 (48.1) | 0.9 (0.66–1.22) | ¶ |
Not wanting to be a burden for family | 22 (10.8) | 32 (4.4) | 2.67 (1.51–4.7) | 1.32 (0.58–2.99) |
Physical sufferingc | 72 (35.5) | 405 (55.2) | 0.45 (0.32–0.62) | 0.62 (0.4–0.96) |