Malpas Phillipa Jean, Mitchell Kay
1 Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Am J Hosp Palliat Care. 2017 May;34(4):301-307. doi: 10.1177/1049909115619906. Epub 2015 Dec 3.
Rapidly aging populations and increased prevalence of chronic rather than acute illnesses have seen growing public and professional interest in medical decision making at the end of life and greater attention being paid to the factors that influence how individuals make such decisions. This study comprised 2 components: The first, a postal survey, based on the Remmelink questionnaire was sent in May 2013 to 3420 general practitioners (GPs) in New Zealand. Results from this component are reported elsewhere. The second component (reported here) sought information by inviting GPs to ring a free-phone number to be interviewed about their experiences caring for their dying patients. Interviews were recorded then transcribed with identifying information deleted to preserve anonymity. With an aging population, the provision of end-of-life care will increase in general practice. There is no doubt that hospice and specialist palliative care have transformed the quality of care for the dying and their families in New Zealand. However, while respondents in this study seemed realistic about what palliative care can and cannot achieve, patients and their families may have unrealistic expectations of both hospice and palliative medicine. Many GPs appear confused over the legality of the assistance they provide to the terminally ill, concerned that actions such as increasing medication to address refractory symptoms, or stopping food and fluids may put them at risk of legal censure when they foresee that their actions may hasten death.
人口迅速老龄化以及慢性病而非急性病的患病率上升，使得公众和专业人士对临终医疗决策的兴趣日益浓厚，人们也更加关注影响个人做出此类决策的因素。本研究包括两个部分：第一部分是2013年5月基于雷姆林克问卷进行的邮寄调查，调查对象为新西兰的3420名全科医生（GP）。该部分结果已在其他地方报告。第二部分（本文所报告的）通过邀请全科医生拨打一个免费电话号码来获取信息，以便就他们照顾临终患者的经历接受访谈。访谈进行了录音，随后在删除识别信息以保护匿名性的情况下进行了转录。随着人口老龄化，全科医疗中临终关怀的提供将会增加。毫无疑问，临终关怀和专科姑息治疗已经改变了新西兰临终患者及其家人的护理质量。然而，尽管本研究中的受访者似乎对姑息治疗所能达到和无法达到的目标很现实，但患者及其家人可能对临终关怀和姑息医学都抱有不切实际的期望。许多全科医生似乎对他们为绝症患者提供的帮助的合法性感到困惑，担心诸如增加药物剂量以缓解难治性症状，或停止提供食物和液体等行为，在他们预见到这些行为可能加速死亡时，会使他们面临法律责难的风险。
