Objective: Optimal clinical practice depends upon a precise
language with common understanding of core terms. The aim of the present
study was to examine how Norwegian physicians understand the commonly used
but poorly defined term “terminal.”
Methods: A questionnaire was mailed to 1605 Norwegian
physicians, representative of the Norwegian medical community. Nine
hundred and sixty-eight responded and defined “terminal” in
expected weeks left to live. The effects of gender, age, specialty, and
experience with prognostication toward end of life on the estimation of
“terminal” were investigated.
Results: Norwegian physicians on average expect a
“terminal” patient to have 3.6 (± 3.5 SD)
weeks to live with expectation ranging from 0 to 26 weeks. The majority
(83.5%) defined “terminal” as less than 5 weeks'
survival; 15.0% as 5 to 12 weeks' survival and 1.5% as more than 12
weeks' survival. No difference between genders was observed, whereas
the youngest physicians (27–39 years) held shorter definitions than
the other age groups. Physicians in internal medicine, surgery, and
anaesthesiology held significantly shorter estimations of
“terminal” than did physicians in general practice, public
health, and psychiatry.
Significance of results: Our study shows that the majority of
Norwegian physicians restrict “terminal” to the last 2–4
weeks of patients' lives. A life expectancy of a few days compared to
several weeks should lead to different clinical actions. Efforts should
therefore be made to come to a common definition of the term. In our
opinion the use of “terminal” should be limited to when death
is expected within a few days.