Decision-making in the end-of-life phase of high-grade glioma patients. 
During the disease course of high-grade glioma (HGG) patients, the goal of therapy eventually shifts from primarily life-prolongation to primarily sustaining the quality of life as good as possible.  End-of-life care is aimed at prolongation of life with good quality, but inevitably also may require medical decisions for prevention and relief of suffering with a potential life shortening effect.  Few data are available on this end-of-life decision (ELD) making process in HGG patients, with decreased consciousness, confusion or cognitive deficits preventing them to participate.  In this study the ELD-making process in HGG patients is described.  Physicians and relatives of a cohort of 155 deceased HGG patients were identified to fill in a questionnaire regarding the end-of-life conditions (patients' ELD preferences, patients' competence) and ELD-making (forgoing treatment and the administration of drugs with a potential life-shortening effect) for their patient or relative.  Data were analysed with descriptive statistics.  Of 101 patients, physicians completed surveys including questions about ELDs (62% response rate).  More than half of the patients relatively early became incompetent to make decisions due to delirium, cognitive deficits and/or decreasing consciousness.  In 40% of patients the physician did not discuss ELD preferences with his/her patient.  At least one ELD was made in 72% of patients, most often this comprised the withdrawal of dexamethasone.  Palliative sedation was performed in 30% of patients and physician assisted death in 7%.  ELDs are common practises amongst HGG patients, although their preferences towards ELDs are frequently unknown to the physician.  Because the majority of patients become incompetent towards death, participation in ELD-making is only possible with advanced care planning.  Hence, timely discussion of ELD preferences is encouraged.