General practitioners' attitudes and ethical decisions in end-of-life care after a year of interactive Internet-based training

Background. Personal characteristics affect physicians' end-of-life decisions. Education in palliative care (PC) faces a challenge in influencing doctors' attitudes and decision making in PC. A one-year Internet-mediated education project was arranged for general practitioners in Finland to provide postgraduate education in PC. Methods. A questionnaire was sent before and after the project to the education group (EG, n = 79) and a control group (CG, n = 100). Treatment decisions for presented scenarios and attitudes toward PC were elicited. Results. EG doctors had previously participated in postgraduate training in PC more often than had CO doctors (93% vs 29%). For a young terminal cancer patient, EG doctors chose CPR less often than did CC doctors (7% vs 33%, p = 0.004); 30% of EG doctors would have continued antibiotic treatment in the case of a terminal cancer patient, vs 55% of CG doctors (p = 0.023). EG doctors more often agreed with the statement "Terminal care is satisfying" (p < 0.001). Treatment decisions or attitudes did not change significantly in either group during the year, the EG doctors were more satisfied with their work after the project. Conclusion. There are substantial differences in decision making between those who have experience and special interest in the subject and those who do not. To achieve the goals of education in PC, the most difficult target group, the "silent majority" of doctors, should be reached.