US and Russian physician perspectives regarding end of life care

Purpose: To compare US and Russian primary care physicians’ attitudes, comfort and experiences providing palliative care. Design: Cross sectional survey. Settings: Iowa, USA and Leningrad Oblast, Russia Participants: Family medicine physicians at University of Iowa and Northwestern State Medical University, St Petersburg, Russia, community practicing family physicians. Methods: Chi-squared testing for dichotomous variables and t-tests for mean scores. Results: Sixty-six US and 81 Russian physicians completed the survey. More US physicians preferred the home setting for care (83% vs 56%) p<.001 and Russian physicians community hospice (47% vs 18%) p<.001 weeks to months before patient’s death. Ninety-four percent of US physicians reported that patients should make end of life decisions, 57% of Russian sample reported that family physicians should make those decisions p<.001. Patient should be informed (US vs Russia) of terminal illness Always (74% vs 31%) p<.001 and If Asked (9% vs 64%) p<.001. US physicians reported higher comfort rates with managing symptoms except for pain management (88% vs 100%) p=0.001. Drug prescribing comfort favored US physicians. In the last 6 months Russian physicians made more home visits “Often or Always” 73% vs 6%, p<.001 and US physicians disclosed poor prognosis “Often or Always” 83% vs 56%, p<.001 and were more satisfied with provided care “Often or Always” 63% vs 36%, p=0.002. Conclusions: US sample was more concerned with patient autonomy and had more comfort and satisfaction in providing end of life care.