Attitudes of physicians, nurses, and the general public toward End‑of‑Life (EoL) decisions in European countries: an umbrella review

aspects of healthcare. Understanding the attitudes of physicians, nurses, and the public toward EoL decisions is crucial\r\nfor aligning care provided with the personal values and preferences of patients.\r\nAim To explore the attitudes of physicians, nurses, and the general public toward EoL decisions, including the withdrawal\r\nor withholding of life-sustaining treatments, euthanasia, physician-assisted suicide (PAS), palliative sedation,\r\nand advance care planning (ACP) within European countries.\r\nDesign An umbrella review was conducted, covering the period from January 2010 to June 2024. The search strategy\r\nincluded Medline, CINAHL, and PsycINFO, supplemented by manual searches of reference lists of all included studies\r\nto identify additional relevant studies.\r\nResults The search identified 587 papers, 11 of which were included in the synthesis. Of these, six addressed euthanasia\r\nand PAS, three focused on ACP, one on the withdrawal of life-sustaining treatments, and one on palliative\r\nsedation.\r\nIn Europe, the general public expressed the highest level of support for EoL practices such as euthanasia and PAS,\r\nfollowed by nurses, while physicians often held a more cautious perspective. For withdrawal of treatment, palliative\r\nsedation, and ACP, a critical recurring theme was the need to improve communication between patients and healthcare\r\nprofessionals.\r\nConclusions The divergence underscores the intricate complexity of navigating ethical, cultural, and professional\r\nconsiderations in EoL care. Effective communication serves as a cornerstone for respecting patient autonomy\r\nand ensuring that healthcare decisions align with individual values, goals and preferences.\r\nKeywords Attitude, End-of-life (EoL) decision, Euthanasia, Physician-assisted suicide (PAS), Withdrawal of treatment,\r\nPalliative sedation, Advance care planning (ACP)