Division of Critical Care, Department of Anesthesiology, School of Medicine, Kocaeli University, Kocaeli, Turkey.
Division of Critical Care, Department of Anesthesiology, School of Medicine, Yeditepe University, İstanbul, Turkey.
PLoS One. 2020 May 20;15(5):e0232743. doi: 10.1371/journal.pone.0232743. eCollection 2020.
Turkey is constitutionally secular with a Muslim majority. There is no legal basis for limiting life-support at the end-of-life (EOL) in Turkey. We aimed to investigate the opinions and attitudes of intensive care unit (ICU) physicians regarding EOL decisions, for both their patients and themselves, and to evaluate if the physicians' demographic and professional variables predicted the attitudes of physicians toward EOL decisions.
An online survey was distributed to national critical care societies' members. Physicians' opinions were sought concerning legalization of EOL decisions for terminally ill patients or by patient-request regardless of prognosis. Participants physicians' views on who should make EOL decisions and when they should occur were determined. Participants were also asked if they would prefer cardiopulmonary resuscitation (CPR) and/or intubation/mechanical ventilation (MV) personally if they had terminal cancer.
A total of 613 physicians responded. Religious beliefs had no effect on the physicians' acceptance of do-not-resuscitate (DNR) / do-not-intubate (DNI) orders for terminally ill patients, but atheism, was found to be an independent predictor of approval of DNR/DNI in cases of patient request (p<0.05). While medical experience (≥6 years in the ICU) was the independent predictor for the physicians' approval of DNI decisions on patient demand, the volume of terminal patients in ICUs (between 10-50% per year) where they worked was an independent predictor of physicians' approval of DNI for terminal patients. When asked to choose personal options in an EOL scenario (including full code, only DNR, only DNI, both DNR and DNI, and undecided), younger physicians (30-39 years) were more likely to prefer the "only DNR" option compared with physicians aged 40-49 years (p<0.05) for themselves and age 30-39 was an independent predictor of individual preference for "only DNR" at the hypothetical EOL. Physicians from an ICU with <10% terminally ill patients were less likely to prefer "DNR" or "DNR and DNI" options for themselves at EOL compared with physicians who worked in ICUs with a higher (>50%) terminally ill patient ratio (p<0.05).
Most ICU physicians did not want legalization of DNR and DNI orders, based solely on patient request. Even if EOL decision-making were legal in Turkey, this attitude may conflict with patient autonomy. The proportion of terminally ill patients in the ICU appears to affect physicians' attitudes to EOL decisions, both for their patients and by personal preference, an association which has not been previously reported.
土耳其在宪法上是世俗的，穆斯林占多数。在土耳其，没有法律依据来限制生命支持在生命末期（EOL）的使用。我们旨在调查重症监护病房（ICU）医生对 EOL 决策的意见和态度，包括他们自己的患者和自己的患者，并评估医生的人口统计学和专业变量是否预测了医生对 EOL 决策的态度。
向全国重症监护学会的成员分发了在线调查。征求医生关于为绝症患者或根据患者要求（无论预后如何）合法化 EOL 决策的意见。确定了参与者医生对谁应该做出 EOL 决策以及何时做出决策的看法。还询问了如果他们患有晚期癌症，他们是否个人愿意接受心肺复苏（CPR）和/或插管/机械通气（MV）。
共有 613 名医生做出了回应。宗教信仰对医生接受绝症患者的不复苏（DNR）/不插管（DNI）命令没有影响，但发现无神论是患者要求时批准 DNR/DNI 的独立预测因素（p<0.05）。虽然医疗经验（在 ICU 工作≥6 年）是医生批准根据患者需求进行 DNI 决策的独立预测因素，但他们所在 ICU 中每年终末期患者的数量（10-50%）是医生批准终末期患者 DNI 的独立预测因素。当被要求在 EOL 场景中选择个人选择（包括全面代码、仅 DNR、仅 DNI、DNR 和 DNI 两者都有、未决定）时，年轻医生（30-39 岁）比 40-49 岁的医生更有可能更喜欢“仅 DNR”选项（p<0.05），而 30-39 岁是个人对假想 EOL 中“仅 DNR”的偏好的独立预测因素。来自终末期患者<10%的 ICU 的医生不太可能在 EOL 时为自己选择“DNR”或“DNR 和 DNI”选项，而在终末期患者比例较高（>50%）的 ICU 工作的医生（p<0.05）。
大多数 ICU 医生不希望仅根据患者的要求来合法化 DNR 和 DNI 命令。即使在土耳其 EOL 决策合法，如果这种态度与患者的自主权相冲突，这种态度可能会与患者的自主权相冲突。在 ICU 中终末期患者的比例似乎会影响医生对 EOL 决策的态度，无论是对他们的患者还是个人偏好，这种关联以前没有报道过。
