Hospitalist here - I do a lot of End of Life care. The authors here seem to have developed a theoretical model to describe presupposed behavior but this isn't presenting evidence regarding the percentage of patients who are pushed to prolong life and for what reasons.

In my experience (in the US) there are some conditions (i.e. advanced metastatic cancer) where it's pretty clear if a patient is nearing the end of their life, and more often than not the oncologist is on board with not offering any further cancer-directed therapy at that point. I'm seeing patients admitted to the hospital so it's a good time to discuss goals and maybe reframe their options and lots of times we send folks home with hospice or approaching that course.

But a lot of times both patients and families want to try as much treatment as they can. I give my honest assessment but as long as the patient is making informed decisions and is getting the care they want I don't feel too bad about it. The issues come in when a patient is unable to make decisions for themselves and family is pushing for a lot of treatment that the patient might not want. That is when you really need to have tough discussions, but honestly that doesn't happen all the time.