Advance Directives and End-of-Life Wishes: Perspectives of Patients and Physicians in OECD countries
Abstract
Background: Discussions about end-of-life treatment preferences and advance directives are key elements of patient-centred care. Comparing perspectives of patients and primary care physicians can help identify gaps and inform policy.
Methods: Data from the Commonwealth Fund’s International Health Policy Survey for adults aged 65 and older (2024) and primary care physicians (2025) were analysed for 10 EU/OECD countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the UK and the US).
Results: Germany shows comparatively high levels of end-of-life care planning. In 2024, 83% of older adults reported having discussed end-of-life wishes with someone close or a doctor. 66% had a written advance directive. Much lower levels were observed in France (38% and 12%) and Sweden (31%, 6%), while the United States showed intermediate values (74%, 54%). Physician engagement also varies. In Germany, 88% of physicians reported discussing end-of-life wishes with patients, compared to higher levels in the Netherlands (99%) and the United Kingdom (96%), and lower levels in the United States (73%), Sweden (80%), and France (81%). Over time, Germany has seen a steady increase in advance care planning, with discussions of end-of-life wishes rising from 72% (2014) to 83% (2024) and existing advance directives from 57% to 66%.
Conclusions: Country variations point to the key role of national policies and health system organisation in end-of-life care planning. Greater involvement of both patients and primary care physicians could lead to higher levels of end-of-life care planning. Comparatively high and increasing levels of end-of-life care planning can be observed in Germany, both from patient and physician perspective. However, whereas end-of-life wishes have been discussed widely, this has only partly resulted in advance directives.International comparisons provide valuable insights to strengthen patient-centred end-of-life care.
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BibTeX
@article{wengler2026advance,
title = {{Advance Directives and End-of-Life Wishes: Perspectives of Patients and Physicians in OECD countries}},
author = {A Wengler and LM Foaleng Gamgne and F Prütz and J Allen and H Lachenmaier and A Meier and A Rommel},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.561},
url = {https://doi.org/10.1093/eurpub/ckag169.561},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Advance Directives and End-of-Life Wishes: Perspectives of Patients and Physicians in OECD countries
AU - A Wengler
AU - LM Foaleng Gamgne
AU - F Prütz
AU - J Allen
AU - H Lachenmaier
AU - A Meier
AU - A Rommel
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.561
UR - https://doi.org/10.1093/eurpub/ckag169.561
AB - Background: Discussions about end-of-life treatment preferences and advance directives are key elements of patient-centred care. Comparing perspectives of patients and primary care physicians can help identify gaps and inform policy. Methods: Data from the Commonwealth Fund’s International Health Policy Survey for adults aged 65 and older (2024) and primary care physicians (2025) were analysed for 10 EU/OECD countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the UK and the US). Results: Germany shows comparatively high levels of end-of-life care planning. In 2024, 83% of older adults reported having discussed end-of-life wishes with someone close or a doctor. 66% had a written advance directive. Much lower levels were observed in France (38% and 12%) and Sweden (31%, 6%), while the United States showed intermediate values (74%, 54%). Physician engagement also varies. In Germany, 88% of physicians reported discussing end-of-life wishes with patients, compared to higher levels in the Netherlands (99%) and the United Kingdom (96%), and lower levels in the United States (73%), Sweden (80%), and France (81%). Over time, Germany has seen a steady increase in advance care planning, with discussions of end-of-life wishes rising from 72% (2014) to 83% (2024) and existing advance directives from 57% to 66%. Conclusions: Country variations point to the key role of national policies and health system organisation in end-of-life care planning. Greater involvement of both patients and primary care physicians could lead to higher levels of end-of-life care planning. Comparatively high and increasing levels of end-of-life care planning can be observed in Germany, both from patient and physician perspective. However, whereas end-of-life wishes have been discussed widely, this has only partly resulted in advance directives.International comparisons provide valuable insights to strengthen patient-centred end-of-life care.
SN - 1101-1262
SN - 1464-360X
ER -