Evidence map›Paper›PMID 40346520›Full record

SynthesisBMC medical ethics2025

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

Pietro Refolo, Costanza Raimondi, Salvatore Simone Masilla, Antonina Argo, Emma Capulli, Silvia Ceruti, Silvia Gonella, Francesca Ingravallo, Guido Miccinesi, Mario Picozzi and 2 more

Registry-linked trialAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC medical ethics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07554209 (Perceptions Among Healthcare Professionals of Key Domains of Home-Based Palliative Care), which is not on this map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07554209 enrolling by invitationnot on this mapstarted 2026, after this paper: background citation

Perceptions Among Healthcare Professionals of Key Domains of Home-Based Palliative Care: A Multicriteria Comparative Cross-Sectional Survey (MULTIPAL)

TypeobservationalSponsorInstituto de Investigacion Sanitaria La FeRan2026 to 2026Enrolled580ConditionsHome Care, Hospital-Based, Palliative Care, Health Services Research, Decision Making
3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Japanese Version of the Quality of Dying and Death in the PICU Instrument: Development and Validation in Eight Centers in Japan.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2026
    Article
  2. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Pietro RefoloResearch Center for Clinical Bioethics and Medical Humanities, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy. pietro.refolo@unicatt.it.
Costanza RaimondiResearch Center for Clinical Bioethics and Medical Humanities, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
Salvatore Simone MasillaResearch Center for Clinical Bioethics and Medical Humanities, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
Antonina ArgoDepartment of Health Promotion, Mother and Childcare, Internal Medicine and Medical Specialties (PROMISE), Piazzale delle Cliniche 2, 90127, Palermo, Italy.
Emma CapulliDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy.
Silvia CerutiDepartment of Biotechnology and Life Science, Research Center for Clinical Ethics, University of Insubria, Padiglione Antonini, Via O. Rossi 9, 21100, Varese, Italy.
Silvia GonellaDepartment of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, Turin, 10126, Italy.
Francesca IngravalloDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy.
Guido MiccinesiDepartment of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, Turin, 10126, Italy.
Mario PicozziDepartment of Biotechnology and Life Science, Research Center for Clinical Ethics, University of Insubria, Padiglione Antonini, Via O. Rossi 9, 21100, Varese, Italy.
Pietro RedaelliDepartment of Biotechnology and Life Science, Research Center for Clinical Ethics, University of Insubria, Padiglione Antonini, Via O. Rossi 9, 21100, Varese, Italy.
Antonio Gioacchino SpagnoloResearch Center for Clinical Bioethics and Medical Humanities, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.

Funding

This research was funded by the ELISI (Attitudes towards End-of-Life Issues in Italy) project (https://www.elisiproject.it/), supported by the European Union (NextGenerationEU) and the Italian Ministry of University and Research 2022XSS48C
6 · The paper itself

Abstract

backgroundEnd-of-life (EoL) decisions represent some of the most ethically complex and emotionally charged aspects of healthcare. Understanding the attitudes of physicians, nurses, and the public toward EoL decisions is crucial for aligning care provided with the personal values and preferences of patients.

aimTo explore the attitudes of physicians, nurses, and the general public toward EoL decisions, including the withdrawal or withholding of life-sustaining treatments, euthanasia, physician-assisted suicide (PAS), palliative sedation, and advance care planning (ACP) within European countries.

designAn umbrella review was conducted, covering the period from January 2010 to June 2024. The search strategy included Medline, CINAHL, and PsycINFO, supplemented by manual searches of reference lists of all included studies to identify additional relevant studies.

resultsThe search identified 587 papers, 11 of which were included in the synthesis. Of these, six addressed euthanasia and PAS, three focused on ACP, one on the withdrawal of life-sustaining treatments, and one on palliative sedation. In Europe, the general public expressed the highest level of support for EoL practices such as euthanasia and PAS, followed by nurses, while physicians often held a more cautious perspective. For withdrawal of treatment, palliative sedation, and ACP, a critical recurring theme was the need to improve communication between patients and healthcare professionals.

conclusionsThe divergence underscores the intricate complexity of navigating ethical, cultural, and professional considerations in EoL care. Effective communication serves as a cornerstone for respecting patient autonomy and ensuring that healthcare decisions align with individual values, goals and preferences.

Indexed as

Attitude of Health PersonnelDecision MakingNursesPhysiciansPublic OpinionTerminal CareAdvance Care PlanningEuropeEuthanasiaHumansPalliative CareSuicide, AssistedWithholding TreatmentAdvance care planning (ACP)AttitudeEnd-of-life (EoL) decisionEuthanasiaPalliative sedationPhysician-assisted suicide (PAS)Withdrawal of treatment

Identifiers

PMID40346520
PMCPMC12063369

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.