即将毕业的医学生和经验丰富的医生在临终关怀决策上是否存在差异？
Does Decision-making in End-of-life Care Differ Between Graduating Medical Students and Experienced Physicians?
作者信息
Alminoja Aleksi, Piili Reetta P, Hinkka Heikki, Metsänoja Riina, Hirvonen Outi, Tyynelä-Korhonen Kristiina, Kaleva-Kerola Jaana, Saarto Tiina, Kellokumpu-Lehtinen Pirkko-Liisa I, Lehto Juho T
机构信息
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
出版信息
In Vivo. 2019 May-Jun;33(3):903-909. doi: 10.21873/invivo.11557.
BACKGROUND/AIM: Appropriate decision-making in end-of-life (EOL) care is essential for both junior and senior physicians. The aim of this study was to compare the decision-making and attitudes of medical students with those of experienced general practitioners (GP) regarding EOL-care.
MATERIALS AND METHODS
A questionnaire presenting three cancer patient scenarios concerning decisions and ethical aspects of EOL-care was offered to 500 Finnish GPs and 639 graduating medical students in 2015-2016.
RESULTS
Responses were received from 222 (47%) GPs and 402 (63%) students. The GPs withdrew antibiotics (p<0.001) and nasogastric tubes (p=0.007) and withheld resuscitation (p<0.001), blood transfusions (p=0.002) and pleural drainage (p<0.001) more often than did the students. The students considered euthanasia and assisted suicide less reprehensible (p<0.001 in both) than did the GPs.
CONCLUSION
Medical students were more unwilling to withhold and withdraw therapies in EOL-care than were the GPs, but the students considered euthanasia less reprehensible. Medical education should include aspects of decision-making in EOL-care.
背景/目的：临终关怀中的恰当决策对初级和高级医生而言都至关重要。本研究旨在比较医学生与经验丰富的全科医生（GP）在临终关怀方面的决策制定和态度。
材料与方法
2015 - 2016年，向500名芬兰全科医生和639名即将毕业的医学生发放了一份问卷，该问卷呈现了三个关于临终关怀决策和伦理方面的癌症患者案例。
结果
共收到222名（47%）全科医生和402名（63%）学生的回复。与学生相比，全科医生更常停止使用抗生素（p<0.001）和鼻胃管（p = 0.007），并更常拒绝进行复苏（p<0.001）、输血（p = 0.002）和胸腔引流（p<0.001）。学生认为安乐死和协助自杀的可责难性低于全科医生（两者均为p<0.001）。
结论
在临终关怀中，医学生比全科医生更不愿意拒绝和停止治疗，但学生认为安乐死的可责难性较低。医学教育应纳入临终关怀决策制定方面的内容。
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