The Survey on End-of-Life in France

Two main changes concerning death arise during the last decades. Firstly death affects old and very old people due to the decline of mortality and the ageing of the population. Secondly, death occurs nowadays mainly in institutions while just after WWII, they mainly took place at home. Besides, the legal context of medical decisions, rights of patients and end of life has changed in many countries. In France, a law was passed in 2005 and another change is under discussion at parliament. To monitor medical decisions at the end of life has become important.

INED run a survey in 2010 on end of life in France, based on a nationally representative sample of 14080 deaths. Physicians who signed a death certificate where invited to describe the conditions in which these deaths occurred, the medical decisions if any, the use of palliative care… by answering to a self-administered questionnaire. They could answer on a paper questionnaire or online.

This survey was challenging as it was the first survey on this topic at nationwide level in France; physicians are a “hard to reach” population resulting in high nonresponding rates. Due to the highly sensitivity of the topic because we were questioning some illegal practices, we had to ensure the anonymity of the respondents for both ways of response (filled-in questionnaires and online).

This presentation will focus on the rationale of the research, the methodological issues we went through and how there were resolved in particular to encourage the participation and ensure the anonymity of respondents.