Table 1.

Interview topics assessed in this study

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