Table 5 HCPs’ reflections on main theme 3: Making end-of-life choices

3.1 Acceleration & alleviation of death

HCPs mentioned that patients’ request on acceleration and alleviation of death was a consequence of patients’ fears of “the big unknown”. However, they experienced that older patients’ ideas about the end-of-life are usually more veiled as the patient interviews also suggested, or too simplistic; for example, patients talk about “being put to sleep.” With respect to euthanasia requests, HCPs notice a lack of knowledge about its proper realization. HCPs noted that a shared exploration of a patient’s fears, previous experiences with cancer, motives, expectations of the disease trajectory and social situation, and potential scenarios, including special forms of treatment, such as palliative sedation, should at least precede its actualization. Euthanasia and other end-of-life decisions ideally are slow decision-processes in which proxies and healthcare professionals have an opportunity to accompany the patient and prepare for it themselves. Proactively providing clear information about future scenarios, alternatives and end-of-life requests is important in such a process. HCPs, though, stated advance care planning is not a common practice yet.

3.2 Place of death

To provide the best patient-centered care, some HCPs believe that a diverse but select group of HCPs should be involved in care. Also, the informational “gap” between the hospital and general practitioner (GP) should be decreased. Sometimes a GP is not informed about a patient situation and neither in touch with a patient as this latter is still in hospital treatment. However, according to HCPs, patients tend to ask questions to their caregivers related to his/her specialism, e.g. asking an oncologist for cure. A GP, however, could have a “coaching” and preparatory role in making decisions related to, e.g. a home-situation and dying at home, and thus, should be involved in care.