Advance Directives and End-of-Life Wishes: Perspectives of Patients and Physicians in OECD countries
A Wengler, LM Foaleng Gamgne, F Prütz, J Allen, H Lachenmaier, A Meier, A RommelAbstract
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.