{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T11:58:44Z","timestamp":1781179124172,"version":"3.54.1"},"reference-count":65,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Palliat Care"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The benefits of palliative care (PC) education are recognized, but the effects of physicians\u2019 attitudes, values and growing experience on end-of-life (EOL) decision-making remain unclear. This study aimed to evaluate whether graduating medical students\u2019 EOL decision-making regarding an advanced dementia patient with critical gastrointestinal (GI) bleeding has changed after 6 years\u2019 working experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A questionnaire presenting a case scenario of a patient with advanced dementia and critical GI bleeding, together with additional questions on attitudes and background factors, was offered to all Finnish final-year medical students in 2015 (n\u2009=\u2009639). Respondents were asked to choose between PC and active life-prolonging procedures. The same questionnaire was sent to the previous respondents (n\u2009=\u2009402) at the end of 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The proportion of the respondents (n\u2009=\u2009227) choosing PC for a dementia patient increased from 37% (n\u2009=\u200984) in 2015 to 50% (n\u2009=\u2009114) in 2021 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.002). During the study, 60 respondents changed their option from active care (AC) to PC and 30 from PC to AC. However, attitudes behind the decisions remained largely unchanged. The respondents choosing PC prioritized patient benefit and ethics, while those choosing AC regarded physician's legal protection as more influential.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Physicians were more likely to choose PC for an advanced dementia patient after 6 years of clinical experience, though decision-making still varied. The attitudes influencing these decisions may primarily have developed during medical school. The findings underscore the importance of education on PC and ethical aspects of the EOL decision-making in dementia in all levels of medical training.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08258597261455964","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T12:59:51Z","timestamp":1780923591000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Physicians\u2019 Tendency to Choose Palliative Care for an Advanced Dementia Patient Increases Concomitantly With Clinical Experience"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0907-8990","authenticated-orcid":false,"given":"Saila","family":"Haapasalmi","sequence":"first","affiliation":[{"name":"Tampere University"},{"name":"Tampere University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6727-3773","authenticated-orcid":false,"given":"Reetta P.","family":"Piili","sequence":"additional","affiliation":[{"name":"Tampere University"},{"name":"Tampere University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4432-8247","authenticated-orcid":false,"given":"Riina","family":"Mets\u00e4noja","sequence":"additional","affiliation":[{"name":"Tampere University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilari","family":"Lehtinen","sequence":"additional","affiliation":[{"name":"Tampere University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8519-7372","authenticated-orcid":false,"given":"Juho T.","family":"Lehto","sequence":"additional","affiliation":[{"name":"Tampere University"},{"name":"Tampere University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3356-1675","authenticated-orcid":false,"given":"Pirkko-Liisa I.","family":"Kellokumpu-Lehtinen","sequence":"additional","affiliation":[{"name":"Tampere University"},{"name":"Tampere University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.2147\/AMEP.S94550"},{"key":"e_1_3_3_3_2","unstructured":"World Health Organization. Global Status Report on the Public Health Response to Dementia. 2021:1\u2013251. Accessed August 4 2024. http:\/\/apps.who.int\/"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/nejmcp1412652"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/02692163211025457"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-015-0053-8"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.0677"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afz052"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269216317726443"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-023-04449-1"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-018-0332-2"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.111.097030"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/1178224219826579"},{"issue":"4","key":"e_1_3_3_14_2","first-page":"330","article-title":"End-of-life issues in advanced dementia Part 1: goals of care, decision-making process, and family education","volume":"61","author":"Arcand M","year":"2015","unstructured":"Arcand M. End-of-life issues in advanced dementia Part 1: goals of care, decision-making process, and family education. Can Fam Physician. 2015;61(4):330-334.","journal-title":"Can Fam Physician"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0203960"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-018-0349-6"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.21873\/anticanres.16543"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/AAS.13842"},{"key":"e_1_3_3_19_2","volume-title":"End-of-life decision-making in cancer patients: attitudes, ethics and background factors among Finnish physicians and medical students","author":"Piili R","year":"2019","unstructured":"Piili R. End-of-life decision-making in cancer patients: attitudes, ethics and background factors among Finnish physicians and medical students. Tampere University; 2019. Accessed May 7, 2023. http:\/\/urn.fi\/URN:ISBN:978-952-03-1268-8%0Ahttp:\/\/urn.fi\/URN:ISBN:978-952-03-1268-8"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1111\/AAS.13549"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.21037\/apm-20-948"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-016-0819-6"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1089\/JPM.2008.0058"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-018-5196-7\u00ef"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/J.JCRC.2020.08.030"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1186\/S13054-021-03750-Y"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-023-01189-8"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1055\/S-0040-1710571\/ID\/JR01583-22\/BIB"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/2055102915622928"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0300-9572(00)00367-1"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1136\/jme.28.2.109"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2019-001802"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.21873\/INVIVO.11557"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0902234"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-008-0713-y"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-020-02253-8"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-016-0182-8"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.3390\/IJERPH18095031"},{"issue":"4","key":"e_1_3_3_39_2","first-page":"757","article-title":"Dying well-informed: the need for better clinical education surrounding facilitating end-of-life conversations","volume":"92","author":"Sutherland R","year":"2019","unstructured":"Sutherland R. Dying well-informed: the need for better clinical education surrounding facilitating end-of-life conversations. Yale J Biol Med. 2019;92(4):757-764.","journal-title":"Yale J Biol Med"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1186\/S12904-019-0458-X"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1007\/S13187-014-0712-0\/METRICS"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1186\/S12904-021-00811-5"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckaf044"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1177\/1403494820944073"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18510"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.2174\/1567205020666221221145259"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1177\/14713012221077533"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.3978\/j.issn.2224-5820.2015.09.03"},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.13-1351"},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph191610236"},{"key":"e_1_3_3_51_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9020402"},{"key":"e_1_3_3_52_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2017.0470"},{"key":"e_1_3_3_53_2","doi-asserted-by":"publisher","DOI":"10.21037\/apm-20-2046"},{"key":"e_1_3_3_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/J.JSURG.2023.06.005"},{"key":"e_1_3_3_55_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2017.0050"},{"key":"e_1_3_3_56_2","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-230692"},{"key":"e_1_3_3_57_2","doi-asserted-by":"publisher","DOI":"10.21037\/apm.2017.06.13"},{"key":"e_1_3_3_58_2","doi-asserted-by":"publisher","DOI":"10.1016\/J.ANNEMERGMED.2019.01.003"},{"key":"e_1_3_3_59_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1145142"},{"key":"e_1_3_3_60_2","doi-asserted-by":"publisher","DOI":"10.1080\/10872981.2019.1603525"},{"key":"e_1_3_3_61_2","doi-asserted-by":"publisher","DOI":"10.1111\/J.1365-2923.2010.03627.X"},{"issue":"3","key":"e_1_3_3_62_2","first-page":"1","article-title":"Establishment of medical education upon internalization of virtue ethics: bridging the gap between theory and practice","volume":"10","author":"Madani M","year":"2017","unstructured":"Madani M, Larijani B, Madani E, Ghasemzadeh N. Establishment of medical education upon internalization of virtue ethics: bridging the gap between theory and practice. J Med Ethics Hist Med. 2017;10(3):1-12.","journal-title":"J Med Ethics Hist Med"},{"key":"e_1_3_3_63_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2013.0233"},{"key":"e_1_3_3_64_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12660"},{"key":"e_1_3_3_65_2","unstructured":"FINLEX. Laki potilaan asemasta ja oikeuksista 785\/1992 \u2013 Ajantasainen lains\u00e4\u00e4d\u00e4nt\u00f6 - FINLEX \u00ae. Accessed May 24 2020. https:\/\/finlex.fi\/fi\/laki\/ajantasa\/1992\/19920785"},{"key":"e_1_3_3_66_2","doi-asserted-by":"publisher","DOI":"10.1038\/S41598-024-79803-3"}],"container-title":["Journal of Palliative Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08258597261455964","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08258597261455964","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08258597261455964","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T11:16:35Z","timestamp":1781176595000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08258597261455964"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,8]]},"references-count":65,"alternative-id":["10.1177\/08258597261455964"],"URL":"https:\/\/doi.org\/10.1177\/08258597261455964","relation":{},"ISSN":["0825-8597","2369-5293"],"issn-type":[{"value":"0825-8597","type":"print"},{"value":"2369-5293","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,8]]},"article-number":"08258597261455964"}}