@article {MarcouxE222, author = {Isabelle Marcoux and Antoine Boivin and Laura Mesana and Ian D. Graham and Paul H{\'e}bert}, title = {Medical end-of-life practices among Canadian physicians: a pilot study}, volume = {4}, number = {2}, pages = {E222--E229}, year = {2016}, doi = {10.9778/cmajo.20150084}, publisher = {Canadian Medical Association Open Access Journal}, abstract = {Background: Medical end-of-life practices are hotly debated in Canada, and data from other countries are used to support arguments. The objective of this pilot study was twofold: to adapt and validate a questionnaire designed to measure the prevalence of these practices in Canada and the underlying decision-making process, and to assess the feasibility of a nationally representative study.Methods: In phase 1, questionnaires from previous studies were adapted to the Canadian context through consultations with a multidisciplinary committee and based on a scoping review. The modified questionnaire was validated through cognitive interviews with 14 physicians from medical specialties associated with a higher probability of being involved with dying patients recruited by means of snowball sampling. In phase 2, we selected a stratified random sample of 300 Canadian physicians in active practice from a national medical directory and used the modified tailored method design for mail and Web surveys. There were 4 criteria for success: modified questions are clearly understood; response patterns for sensitive questions are similar to those for other questions; respondents are comparable to the overall sampling frame; and mean questionnaire completion time is less than 20 minutes.Results: Phase 1: main modifications to the questionnaire were related to documentation of all other medical practices (including practices intended to prolong life) and a question on the proportionality of drugs used. The final questionnaire contained 45 questions in a booklet style. Phase 2: of the 280 physicians with valid addresses, 87 (31.1\%) returned the questionnaire; 11 of the 87 declined to participate, for a response rate of 27.1\% (n = 76). Most respondents (64 [84\%]) completed the mail questionnaire. All the criteria for success were met.Interpretation: It is feasible to study medical end-of-life practices, even for practices that are currently illegal, including the intentional use of lethal drugs. Results from this pilot study support conducting a large national study, but additional strategies would be necessary to improve the response rate.}, URL = {https://www.cmajopen.ca/content/4/2/E222}, eprint = {https://www.cmajopen.ca/content/4/2/E222.full.pdf}, journal = {Canadian Medical Association Open Access Journal} }