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End-of-life healthcare skills - Thesis by Clément Meier

On Wednesday 13 December 2023, Clément Meier defended his thesis and was awarded a doctorate in the human and social sciences of medicine and health from the University of Lausanne. The entire LIVES Centre team congratulates him on this great achievement! In his thesis, Dr Meier observes that in Switzerland, around one in three older adults has a low level of health competence and has difficulty managing health-related issues. This can lead them to make poor health decisions at the end of their lives. It also highlights the need for Switzerland to create new public health policies aimed at strengthening the end-of-life care skills of older people to enable them to make more informed choices.

His thesis, supervised by Prof. Jürgen Maurer, is entitled "A public health perspective on end-of-life health skills among older people in Switzerland". Dr Meier looks at the approach to healthcare, which has shifted from a paternalistic model to one that is patient-centred and emphasises the importance of individual decision-making, particularly in the face of end-of-life challenges that are accentuated by an ageing population and advances in medical technology. 

This change emphasizes the need to explore individuals' health literacy skills that empower them to make complex end-of-life healthcare decisions. Despite its importance, research on end-of-life health literacy is limited. Recent studies, especially in Switzerland, suggest that many older adults lack an understanding of critical end-of-life healthcare options they or their loved ones might have to choose at some point in their lives. This PhD thesis presents a comprehensive synthesis of recent research findings exploring end-of-life health literacy among older adults in Switzerland using data from the Survey of Health, Ageing, and Retirement in Europe (SHARE). It also aims to introduce and validate a unique instrument tailored to measure individuals' subjective end-of-life literacy (S-EOL-HLS), i.e., their abilities to navigate end-of-life medical situations and enhance communication and decision-making in these contexts.

The results from the different studies included in this PhD thesis show that in Switzerland, approximately one older adult out of three has low health literacy levels and experiences difficulties in managing health-related matters. Subgroups in the population at risk of having lower health literacy levels varied depending on important factors such as sex, education, financial difficulties, and self-rated health. In addition, significant misunderstandings persist about various end-of-life medical situations, with many overestimating the effectiveness of some treatments and underestimating others. Factors such as sex, financial difficulties, age, and differences between the linguistic regions were associated with these inaccurate perceptions. For instance, only 9.3% accurately understood the survival rates of cardiopulmonary resuscitation performed on a 70-year-old outside a hospital, with those who understood the cardiopulmonary resuscitation survival rates being significantly more inclined to prefer not to be resuscitated.

Moreover, the introduced S-EOL-HLS tool appears to measure end-of-life health literacy among older adults effectively. Higher end-of-life health literacy scores are associated with better end-of-life knowledge and more proactive engagement in advance care planning. In conclusion, the highlighted studies collectively emphasize Switzerland's need to derive new and/or enhance existing public health policies that bolster older adults’ end-of-life health literacy skills to enable them to make better-informed choices, potentially leading to improved end-of-life healthcare quality for individuals, their loved ones, and healthcare providers.