Beyond Support or Opposition: Multidimensional Structure and Social Patterning of End-of-Life Attitudes in a Cross-Sectional Survey of Adults in Greece

Background/Objectives: End-of-life (EoL) decisions in critical and chronic illness are often negotiated among patients, families and healthcare professionals, yet attitudes are commonly reduced to support or opposition. This study examined the higher-order organization and social patterning of EoL attitudes using the PEACE-Q, with attention to family-centered communication. Methods: A nationwide online cross-sectional survey with non-probability snowball sampling was conducted among 1752 adults in Greece. The composition of the sample does not support national representativeness. Eight validated PEACE-Q subscales were examined using descriptive statistics, intercorrelations, principal component analysis, multivariable regression and person-centered cluster analysis. Sensitivity analyses repeated the clustering after removal of the dominant general component. Results: A strong but non-exclusive general axis accounted for 43.4% of the variance of the eight subscales, and three components for 71.0%. An exploratory third component captured whether treatment withdrawal, withholding and do-not-resuscitate orders are judged equivalent to euthanasia and to one another. Religiosity was the strongest correlate of the general axis (β = −0.515), but associations differed across dimensions. Higher education and healthcare-professional status were associated with less equating of these practices with euthanasia, and older age with more. Cluster profiles overlapped and largely reproduced the general component. Conclusions: In this non-probability sample, EoL attitudes formed a structured multidimensional field. Recognizing whether disagreement reflects preferences, conceptual classification or religious/moral framing may support advance care planning, shared decision-making and family-centered communication, a possibility that requires prospective evaluation.