Three follow-up letters were sent and a follow-up phone call was made. We also conducted a telephone survey on a sample of 620 non-responding physicians to
ensure that the results were representative. We recorded their socio-demographic profiles and their reasons for non-response. Questions and variables The questionnaire was based on the Eureld survey questionnaire  but was adapted to take account of the French legal context and of the results of preliminary tests. It comprised 113 questions (see Additional file 1). End-of-life medical decisions and the decision-making process were explored in the middle part of the questionnaire after questions Inhibitors,research,lifescience,medical about the end-of-life context (characteristics of the deceased person, physician, place of death, whether palliative care had been BMS-754807 molecular weight provided). Another section comprised questions on the physician’s feelings about the death. The last section asked the physicians whether they Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical habitually respond
to surveys and what made them decide to respond to this particular survey if such was the case. The key questions about end-of-life medical decisions were (see Additional file 2) (1) whether first of all everything was done to prolong the patient’s life (2) whether a treatment of any kind was withheld; (3) whether a treatment of any kind Inhibitors,research,lifescience,medical was withdrawn; (4) whether a treatment to alleviate the symptoms was intensified (opioids, benzodiazepines and/or any other treatment) and (5) whether a medication was administered to the patient to deliberately end his/her life. For questions (2) to (4), three sub-questions investigated the physician’s intention: (a) did he/she know that his/her decisions could hasten the death (b) did he/she take the decision with the explicit intention of hastening the death and (c) did he/she consider
the decision to have hastened the death. We classified the answers to these questions to ensure maximum similarity Inhibitors,research,lifescience,medical with the EURELD classification of medical end-of-life decisions (as published in Van den Heide ): when one of questions (2) (3) and one of their sub-questions (a) (b) were answered yes, the case was classified as “non treatment decision”; when question (4) and one of its sub-questions (a) (b) were answered yes, Ketanserin the case was classified as “intensification of alleviation of symptoms with possible life shortening effect”; when question (5) was answered yes, we classified the case as “using a medication to deliberately hasten death”, differentiating between treatment at the patient’s explicit request, administration by the patient him/herself in “physicianassisted suicide” or administration by a nurse or a physician.