Schildmann J, Vollmann J
Institut für Medizinische Ethik und Geschichte der Medizin, Ruhr-Universität Bochum, Bochum, Germany.
Dtsch Med Wochenschr. 2010 Nov;135(45):2230-4. doi: 10.1055/s-0030-1267505. Epub 2010 Nov 2.
Physicians' decisions regarding the indication of medical treatment are central to the application or limitation of medical measures in advanced cancer. This qualitative study explores criteria and procedural aspects of treatment decisions with patients with cancer near the end of life from the perspective of oncologists.
In this qualitative interview study physicians working in the field of oncology were asked about their decisional criteria and procedural aspects of treatment decision making in cases of patients with advanced cancer. All interviews were audiotaped and transcribed. Qualitative data analysis was conducted in accordance with principles of "Grounded Theory".
17 research interviews had been analysed. Next to medical criteria the life-circumstances of the patients with respect to age and social situation as well as the perceived quality of the physician-patient-relationship were named as foundation for decisions about the application or limitation of medical treatment at the end of life. In addition situational factors such as time pressure or the available technical equipment were cited as relevant factors for the decisions. "Silent acquiescence" as the predominant decision making model which has been reconstructed on the basis of the narratives means that decisions about the limitation of medical treatment are not communicated explicitly within the physician-patient-relationship. This approach was justified by the interviewees in light of the long standing relationship between physicians and patients.
The decisional criteria and procedural aspects of decision making in patients with advanced cancer which have been elicited in this qualitative study inform the current scientific and societal debate on ethically relevant aspects of end-of-life decision making in medicine.
医生对于医疗治疗指征的决策是晚期癌症医疗措施应用或限制的核心。这项定性研究从肿瘤学家的角度探讨了临终癌症患者治疗决策的标准和程序方面。
在这项定性访谈研究中，询问了肿瘤学领域的医生关于晚期癌症患者治疗决策的决策标准和程序方面。所有访谈都进行了录音和转录。定性数据分析按照“扎根理论”的原则进行。
对17次研究访谈进行了分析。除了医学标准外，患者在年龄和社会状况方面的生活情况以及医患关系的感知质量被列为临终时医疗治疗应用或限制决策的基础。此外，时间压力或可用技术设备等情境因素被引述为决策的相关因素。基于叙述重构的主要决策模型“沉默默许”意味着在医患关系中关于医疗治疗限制的决策不会明确传达。鉴于医生与患者之间的长期关系，受访者认为这种方法是合理的。
这项定性研究中得出的晚期癌症患者决策标准和决策程序方面，为当前关于医学临终决策伦理相关方面的科学和社会辩论提供了信息。
