BACKGROUND In the Netherlands, euthanasia or physician-assisted suicide (EAS) is allowed if due care criteria are met. One criterion is consultation of a second independent physician, often SCEN physicians. The public debate about EAS focuses on patients with psychiatric disorders, dementia, and tired of living, as complex cases. What complexities SCEN physicians perceive during consultation is unknown. This study aims to assess the frequency of EAS consultations that are perceived difficult by SCEN physicians, to explore what complexities are perceived by SCEN physicians during consultation, and to assess what characteristics are associated with difficult consultations. METHODS Data from 2015 to 2017 from an annual cross-sectional survey among SCEN physicians was used. In 2015, the survey focused on the most difficult consultation that year and in 2016/2017 on the most recent consultation. Frequencies of coded answers to an open-ended question were done to explore what complexities SCEN physicians perceived during their most difficult consultation. Univariable and multivariable logistic regression analyses were used to assess what characteristics were associated with difficult consultations. RESULTS 21.6% of cases consulted by SCEN physicians is perceived difficult. Complexities that SCEN physicians perceive were mainly in contact with patients (79.7%) and in the assessment of due care criteria (41.0%). Characteristics that were associated with a higher likelihood of a consultation being difficult are the attending physician being less certain to perform the EAS, patients staying in the hospital, main diagnosis heart failure/CVA, and accumulation of age-related health problems/psychiatry/dementia, and the presence of a psychiatric disorder, or psychosocial or existential problems besides the main diagnosis. Characteristics that were associated with a lower likelihood of a consultation being difficult are high patient's age and physical suffering as reason to request EAS. CONCLUSION Complexities perceived by SCEN physicians in EAS consultations are not limited to the 'complex' cases present in the current public debate about EAS, e.g. patients with psychiatric disorders, dementia, and tired of living. Attention for these complexities in intervision could indicate if there is a need among SCEN physicians to enhance knowledge and skills in training and to receive specific support in intervision on these complexities.

中文翻译：

---

安乐死或医生协助自杀时的咨询复杂性：SCEN医生之间的一项调查。

背景技术在荷兰，如果符合适当的护理标准，则允许安乐死或医生协助的自杀（EAS）。一个标准是咨询第二位独立的医师，通常是SCEN医师。关于EAS的公开辩论集中在患有精神疾病，痴呆和厌倦生活的患者（作为复杂病例）。SCEN医师在会诊期间所感知的复杂程度尚不清楚。这项研究旨在评估SCEN医师认为困难的EAS咨询的频率，探讨SCEN医师在咨询过程中察觉到的复杂性，以及评估与困难咨询相关的特征。方法使用2015年至2017年来自SCEN医师的年度横断面调查数据。在2015年，该调查的重点是当年最困难的咨询，而2016/2017年则是最近的咨询。解答了一个开放式问题的编码答案的频率，以探索SCEN医师在最困难的咨询过程中发现的复杂性。单变量和多变量逻辑回归分析用于评估哪些特征与困难的咨询相关。结果SCEN医师咨询的病例中有21.6％被认为是困难的。SCEN医生认为的复杂性主要是与患者接触（79.7％）和评估适当护理标准（41.0％）。与会诊的可能性较高相关的特征是主治医师不太确定执行EAS，住院病人，主要诊断心力衰竭/ CVA，以及与年龄相关的健康问题/精神病学/痴呆症的积累，除主要诊断外还存在精神疾病，心理社会问题或存在问题。与较低的会诊困难度相关的特征是患者的高年龄和身体痛苦，这是要求接受EAS的原因。结论SCEN医师在EAS咨询中发现的复杂性不仅限于当前有关EAS的公开辩论中出现的“复杂”病例，例如精神病患者，痴呆症患者和厌倦了生活的患者。注意这些复杂的相处可能表明SCEN医师是否需要增强培训方面的知识和技能，并在有关这些复杂相处的相处中获得具体支持。以及与年龄相关的健康问题/精神病学/痴呆症的积累，以及除了主要诊断外还存在精神病，心理社会问题或存在问题。与较低的会诊困难度相关的特征是患者的高年龄和身体痛苦，这是要求接受EAS的原因。结论SCEN医师在EAS咨询中发现的复杂性不仅限于当前有关EAS的公开辩论中出现的“复杂”病例，例如精神病患者，痴呆症患者和厌倦了生活的患者。注意这些复杂的相处可能表明SCEN医师是否需要增强培训方面的知识和技能，并在有关这些复杂相处的相处中获得具体支持。以及与年龄相关的健康问题/精神病学/痴呆症的积累，以及除了主要诊断外还存在精神病，心理社会问题或存在问题。与较低的会诊困难度相关的特征是患者的高年龄和身体痛苦，这是要求接受EAS的原因。结论SCEN医师在EAS咨询中发现的复杂性不仅限于当前有关EAS的公开辩论中出现的“复杂”病例，例如精神病患者，痴呆症患者和厌倦了生活的患者。注意这些复杂的相处可能表明SCEN医师是否需要增强培训方面的知识和技能，并在有关这些复杂相处的相处中获得具体支持。