Department of Pulmonary and Critical Care Medicine, Kyung Hee University Medical Center, Seoul, Korea.
Division of Respiratory and Critical Care Medicine, Department of Medicine, University Medicine Cluster, National University Hospital, National University Health System, Singapore, Singapore.
Crit Care Med. 2018 Jul;46(7):1114-1124. doi: 10.1097/CCM.0000000000003138.
To compare physicians' perceptions and practice of end-of-life care in the ICU in three East Asian countries cultures similarly rooted in Confucianism.
A structured and scenario-based survey of physicians who managed ICU patients from May 2012 to December 2012.
ICUs in China, Korea, and Japan.
Specialists who are either intensivists or nonintensivist primary attending physicians in charge of patients (195 in China, 186 in Korea, 224 in Japan).
None.
Country was independently associated with differences in the practice of limiting multiple forms of life-sustaining treatments on multivariable generalized linear model analysis. Chinese respondents were least likely to apply do-not-resuscitate orders, even if they existed (p < 0.001). Japanese respondents were most likely to practice do not resuscitate for terminally ill patients during cardiac arrest, even when no such prior order existed (p < 0.001). Korean respondents' attitudes were in between those of Chinese and Japanese respondents as far as withdrawing total parenteral nutrition, antibiotics, dialysis, and suctioning was concerned. Chinese respondents were most uncomfortable discussing end-of-life care issues with patients, while Japanese respondents were least uncomfortable (p < 0.001). Chinese respondents were more likely to consider financial burden when deciding on limiting life-sustaining treatment (p < 0.001). Japanese respondents felt least exposed to personal legal risks when limiting life-sustaining treatment (p < 0.001), and the Korean respondents most wanted legislation to guide this issue (p < 0.001). The respondents' gender, religion, clinical experience, and primary specialty were also independently associated with the different perceptions of end-of-life care.
Despite similarities in cultures and a common emphasis on the role of family, differences exist in physician perceptions and practices of end-of-life ICU care in China, Korea, and Japan. These findings may be due to differences in the degree of Westernization, national healthcare systems, economic status, and legal climate.
比较三个同样深受儒家思想影响的东亚国家的 ICU 中医生对终末期患者的关怀的认知和实践。
2012 年 5 月至 12 月对管理 ICU 患者的医生进行基于结构和场景的问卷调查。
中国、韩国和日本的 ICU。
负责患者的专家，要么是重症监护专家，要么是非重症监护主治医生（中国 195 名，韩国 186 名，日本 224 名）。
无。
多变量广义线性模型分析显示，国家与限制多种形式的维持生命治疗的实践差异独立相关。即使存在不复苏医嘱，中国的受访者也最不可能应用（p<0.001）。日本的受访者最有可能在终末期患者心脏骤停时不进行复苏，即使没有事先的此类医嘱（p<0.001）。就停止全胃肠外营养、抗生素、透析和吸痰而言，韩国受访者的态度介于中国和日本受访者之间。中国受访者最不愿意与患者讨论临终关怀问题，而日本受访者最不感到不适（p<0.001）。中国受访者在决定限制维持生命的治疗时更倾向于考虑经济负担（p<0.001）。日本受访者在限制维持生命的治疗时感到个人法律风险最小（p<0.001），而韩国受访者最希望立法来指导这个问题（p<0.001）。受访者的性别、宗教、临床经验和主要专业也与对终末期关怀的不同看法独立相关。
尽管文化存在相似之处，并且都非常重视家庭的作用，但中国、韩国和日本的医生在 ICU 临终关怀的认知和实践方面存在差异。这些发现可能是由于西方化程度、国家医疗保健系统、经济状况和法律环境的差异造成的。
