US, Russian and Indian physician perspectives regarding end of life care

Aim. To compare US, Russian and Indian primary care physicians’ attitudes, comfort and experiences providing palliative care. Design. Cross sectional survey. Settings. Iowa, USA; Leningrad Oblast, Russia; Mangalore, India. Participants. Primary care physicians. Methods. Chi-squared testing for dichotomous variables and t-tests for mean scores. Results. 66 US, 81 Russian and 95 Indian physicians completed the survey. More US physicians preferred end of life care at home (83% v 56% Russian and 29% Indian) p < 0.001 and Indian physicians preferring hospitals (36% v 0% US and 1% Russian) p < 0.001. 94% percent of US physicians preferred patient make their own decisions, 57% of Russian sample preferred physicians as decision makers, and Indian physicians preferred family members to patients themselves (44%) p < 0.001. Patient should be informed (US vs Russia vs India) of terminal illness “Always” (74% vs 31% vs 33%) p < 0.001, “If Asked” (9% vs 64% vs 12%) p < 0.001 or “Physician’s Judgement” (15%, 5%, 54%) p < 0.001. US physicians reported higher comfort rates with managing symptoms at the end of life. In the last 6 months US physicians were more satisfied with provided care “Often or Always” (63% vs 36% Russian v 21% Indian) p < 0.001. Conclusions. US sample was more concerned with patient autonomy and had more comfort and satisfaction in providing end of life care compared to Russian and Indian samples.