Department of Medicine, Christian Medical College & Hospital, Vellore, Tamil Nadu, India.
Department of Biostatistics, Christian Medical College & Hospital, Vellore, Tamil Nadu, India.
Indian J Med Res. 2019 Dec;150(6):598-605. doi: 10.4103/ijmr.IJMR_1409_17.
BACKGROUND & OBJECTIVES: In developing countries like India, there is a lack of clarity regarding the factors that influence decisions pertaining to life supports at the end-of-life (EOL). The objectives of this study were to assess the factors associated with EOL-care decisions in the Indian context and to raise awareness in this area of healthcare.
This retrospectively study included all patients admitted to the medical unit of a tertiary care hospital in southern India, over one year and died. The baseline demographics, economic, physiological, sociological, prognostic and medical treatment-related factors were retrieved from the patient's medical records and analysed.
Of the 122 decedents included in the study whose characteristics were analyzed, 41 (33.6%) received full life support and 81 (66.4%) had withdrawal or withholding of some life support measure. Amongst those who had withdrawal or withholding of life support, 62 (76.5%) had some support withheld and in 19 (23.5%), it was withdrawn. The documentation of the disease process, prognosis and the mention of imminent death in the medical records was the single most important factor that was associated with the EOL decision (odds ratio - 0.08; 95% confidence interval, 0.01-0.74; P=0.03).
INTERPRETATION & CONCLUSIONS: The documentation of poor prognosis was the only factor found to be associated with EOL care decisions in our study. Prospective, multicentric studies need to be done to evaluate the influence of various other factors on the EOL care.
在印度等发展中国家，对于影响生命末期（EOL）支持决策的因素，尚缺乏明确性。本研究的目的是评估与印度 EOL 护理决策相关的因素，并提高在这一医疗保健领域的意识。
本回顾性研究纳入了在印度南部一家三级护理医院的医疗病房住院一年以上并死亡的所有患者。从患者的病历中检索并分析了基线人口统计学、经济、生理、社会学、预后和医疗治疗相关因素。
在所分析的 122 名死者的特征中，41 名（33.6%）接受了全面生命支持，81 名（66.4%）撤回或停止了一些生命支持措施。在撤回或停止生命支持的患者中，62 名（76.5%）停止了一些支持，19 名（23.5%）完全停止。在病历中记录疾病过程、预后和提及即将死亡，是与 EOL 决策最相关的单一最重要因素（优势比 0.08；95%置信区间，0.01-0.74；P=0.03）。
在我们的研究中，只有记录不良预后这一因素被发现与 EOL 护理决策相关。需要进行前瞻性、多中心研究，以评估各种其他因素对 EOL 护理的影响。
