Foo Wei Ting, Zheng Yiliang, Kwee Ann K, Yang Grace M, Krishna Lalit
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Am J Hosp Palliat Care. 2013 Jun;30(4):354-8. doi: 10.1177/1049909112453193. Epub 2012 Jul 16.
To explore the importance of factors influencing the end-of-life care decision making of health care professionals (HCPs) in Singapore.
This cross-sectional survey encompassed facets of patient, family, and HCP-related care considerations. In total, 187 questionnaires were distributed to physicians and nurses and had a response rate of 78.6%.
The respondents rated patients' wishes (96.6%), their clinical symptoms (93.9%), and patients' beliefs (91.1%) very high. In all, 94.6% of the HCPs would respect a competent patient's wishes over the family's wishes when goals conflict. However, 59.9% of HCPs would abide by the family's wishes when the patient loses capacity even if the patient's previously expressed wishes are known.
End-of-life care decision making by HCPs appears largely patient centered, although familial determination still wields significant influence with implications for advance care planning.
探讨影响新加坡医护人员临终关怀决策的因素的重要性。
这项横断面调查涵盖了患者、家庭以及与医护人员相关的护理考量方面。总共向医生和护士发放了187份问卷，回复率为78.6%。
受访者对患者的意愿（96.6%）、临床症状（93.9%）和患者的信念（91.1%）给予了很高的评价。总体而言，当目标冲突时，94.6%的医护人员会尊重有行为能力患者的意愿而非家属的意愿。然而，59.9%的医护人员在患者失去行为能力时会遵循家属的意愿，即使患者之前表达过意愿。
医护人员的临终关怀决策在很大程度上似乎以患者为中心，尽管家属的决定仍具有重大影响，这对预先护理计划有一定启示。
