Questions on the patient's clinical and care characteristics during the last phase of life, assessing: |
   patient's main diagnosis [28] |
   other diseases for which the patient received treatment during the last three months of life [25–27] |
   patient's level of consciousness during the last week of life (not unconscious; unconscious one or more hours before death; unconscious one or more days before death; unconscious during whole week) [25–27] |
   time before death patient had started feeling ill and time before death patient was diagnosed [25–27] |
   number of GP contacts with the patient or with family regarding the patient during the last 3 months of life |
   the involvement of informal caregivers and/or clinical specialist in providing care for this patient during the last 3 months of life |
   symptom burden in the last week of life using an adapted version of the Memorial Symptom Assessment Scale Global Distress Index (MSAS-GDI) [23] |
   functional status during the last three months of life using the Eastern Cooperative Oncology Group Performance Status Scale (ECOG) [24] |
   whether or not multidisciplinary palliative care services were involved |
   whether or not curative, life-prolonging or alternative palliative treatments could be considered that were not applied, and what the reasons were for not applying them [46] |
   to what extent the patient's suffering was persistent and unbearable and how GPs came to their judgment [46] |
   to what extent physical and/or psychological suffering was present that could not be alleviated [46] |
   to what extent the patient's medical situation was without prospect of improvement [46] |
Questions on the process of the decision-making, assessing [1, 3, 4, 6, 25–27, 47]: |
   The content and timing of the decision-making process: |
   whether or not the hastening of death was discussed with the patient (and reason for not discussing) |
   whether or not the patient was competent to make decisions (and reasons for incompetence) |
   wishes expressed by the patient concerning the termination of life, prior to the decision-making |
   involvement in the decision-making of patient's relatives, and other caregivers |
   time before death the decision was made and |
   GP's main considerations for doing so |
   Whether or not three other types of medical end-of-life decisions were made at the end of the patient's life and their sequence in time in relation to the decision to end life without explicit patient request: |
   (1) non-treatment decisions taking into account a possible hastening of death or with the explicit intent to hasten death |
   (2) intensifying alleviation of pain or other symptoms taking into account or co-intending the hastening of death |
   (3) using drugs to continuously sedate the patient until death |
Questions on the performance of the practice, assessing [3, 4]: |
   moment of drug administration and the circumstances surrounding death |
   drugs used to end life, time between administration of life-ending drugs and coma, and death |
   persons involved in the drug administration and GP's presence during the period until death |
   estimated life shortening effect of the drugs |