To study Finnish physicians’ attitudes and opinions toward euthanasia and physician-assisted suicide (PAS).

A nationwide cross-sectional study.

An online survey was conducted via the Finnish Medical Association in the autumn of 2023 covering all Finnish physicians.

8857 Finnish physicians answered the survey, yielding a response rate of 31%.

Finnish physicians’ attitudes towards euthanasia and PAS and background factors influencing these attitudes and opinions.

Of the responders, 29% fully agreed and 29% fully disagreed with the statement ‘Euthanasia should be legalised in Finland’, respectively. Fewer responders (18%) fully agreed that physicians should be able to assist a patient in suicide. Factors such as being female and having experience in end-of-life care were associated with disagreement about legalising euthanasia and assistance in suicide. Conversely, having faced a request for euthanasia or PAS was associated with agreeing on legalising euthanasia and assistance in suicide. One out of seven respondents fully agreed that they could practise euthanasia, and one out of six fully agreed that they could assist a patient in suicide if these practices were legal in Finland.

Finnish physicians’ attitudes and opinions towards assistance in dying are highly divided, emphasising the controversy of this challenging subject.

Approximately 53 million family caregivers (FCGs) support and provide home-based care for patients with chronic and life-limiting conditions. Caregiving at the end of life is an emotionally, cognitively and physically demanding role, and FCGs are often unpaid and receive little training. FCGs in remote, rural areas experience adverse social determinants of health (SDOHs), such as limited access to healthcare services and are often financially vulnerable, affecting their healthcare coverage, placing them at higher risk for poor emotional health. Adequate health literacy, a key SDOH, may be a protective factor. The purpose is to present the protocol of an explanatory sequential mixed-method study aiming to examine rural-dwelling FCGs’ emotional health, relationships among FCG characteristics (demographics, co-morbidities) and SDOH and health literacy as a potential mediator.

With 80% power to detect a mediation effect of at least 0.11 when the two-sided alpha is 0.05, an anticipated 108 adult rural FCGs who are providing palliative end-of-life care (PEOLC) will be recruited. Rigorous remote, digital- and community-based recruitment strategies will be employed to increase access to FCGs from under-represented rural communities. Self-report surveys include demographic and health characteristics, SDOH (health literacy, education level, employment status, annual income level, healthcare access and insurance) and anxiety/depressive symptoms. Descriptive statistics will be used to characterise the sample. Correlation analysis and one-way Analysis of variance (ANOVA) will be used to study the relationships between FCG characteristics, SDOH and anxiety/depressive symptoms. Hayes’ PROCESS Macro for IBM SPSS Statistics will be used to test mediation effects of health literacy between FCG characteristics/SDOH and anxiety/depressive symptoms. Indirect effects will be tested using bootstrapped CIs. Semistructured interviews will be conducted with a representative sample to elicit FCG perceptions relative to how SDOH affect their care provision and emotional health, then analysed using content analysis. Quantitative and qualitative strands will be examined and compared for convergence and divergence, then integrated for final interpretations.

Michigan State University’s Institutional Review Board has reviewed and approved the study. Written informed consent will be obtained from each participant. Study findings will be disseminated through publications in peer-reviewed journals and presentations at academic conferences.

Study outcomes will inform the role of SDOHs, particularly health literacy, for the development of interventions to emotionally support rural FCGs.

Timely diagnosis of breast cancer plays a vital role in improving treatment outcomes and increasing patient survival. However, contextual factors such as cultural beliefs, healthcare system structural limitations, and socioeconomic challenges can contribute to diagnostic delays. The qualitative study explores the barriers to timely diagnosis from the perspectives of Iranian women diagnosed with advanced breast cancer.

A qualitative study was conducted using in-depth, semistructured interviews to explore perceived barriers to timely diagnosis among Iranian women with advanced breast cancer. Data analysis were performed using MAXQDA software, V.20.

15 Iranian women [mean age 50.6±9.4 (range 38–72)] years with breast cancer diagnosed at an advanced stage.

Seven participants reported diagnostic delays that exceeded 7 months. Key factors contributing to perceived delays included poorly managed appointments and medical care, care not meeting patient expectations, deceptive marketing practices, cost of diagnostic procedures, lack of knowledge, fears, transcendent beliefs, competing priorities, insufficient support and diagnostic errors.

Understanding perceived barriers to timely diagnosis in women with advanced breast cancer is key to creating effective strategies that reduce preventable negative outcomes. Study findings have implications for patient education, healthcare quality, and enhancement of communication between providers and patients for delayed diagnosis prevention in respective treatment settings.