Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Medicine, Yonsei University Graduate School, Seoul, Korea.
J Korean Med Sci. 2020 Dec 7;35(47):e401. doi: 10.3346/jkms.2020.35.e401.
Although international guidelines recommend palliative care approaches for many serious illnesses, the palliative needs of patients with serious illnesses other than cancer are often unmet, mainly due to insufficient prognosis-related discussion. We investigated physicians' and the general public's respective attitudes toward prognostic disclosure for several serious illnesses.
We conducted a cross-sectional survey of 928 physicians, sourced from 12 hospitals and the Korean Medical Association, and 1,005 members of the general public, sourced from all 17 administrative divisions in Korea.
For most illnesses, most physicians (adjusted proportions - end-organ failure, 99.0%; incurable genetic or neurologic disease, 98.5%; acquired immune deficiency syndrome [AIDS], 98.4%; stroke or Parkinson's disease, 96.0%; and dementia, 89.6%) and members of the general public (end-organ failure, 92.0%; incurable genetic or neurologic disease, 92.5%; AIDS, 91.5%; stroke or Parkinson's disease, 92.1%; and dementia, 86.9%) wanted to be informed if they had a terminal prognosis. For physicians and the general public, the primary factor to consider when disclosing terminal status was "the patient's right to know his/her condition" (31.0%). Yet, the general public was less likely to prefer prognostic disclosure than physicians. Particularly, when their family members were patients, more than 10% of the general public did not want patients to be informed of their terminal prognosis. For the general public, the main reason for not disclosing prognosis was "psychological burden such as anxiety and depression" (35.8%), while for the physicians it was "disclosure would have no beneficial effect" (42.4%).
Most Physicians and the general public agreed that disclosure of a terminal prognosis respects patient autonomy for several serious illnesses. The low response rate of physicians might limit the generalizability of the results.
尽管国际指南建议对许多严重疾病采用姑息治疗方法，但除癌症以外的严重疾病患者的姑息治疗需求往往得不到满足，主要原因是预后相关讨论不足。我们调查了医生和普通公众对几种严重疾病进行预后告知的态度。
我们对来自 12 家医院和韩国医师协会的 928 名医生以及来自韩国所有 17 个行政区域的 1005 名普通公众进行了横断面调查。
对于大多数疾病，大多数医生（调整后的比例-终末期器官衰竭，99.0%；无法治愈的遗传或神经疾病，98.5%；获得性免疫缺陷综合征[艾滋病]，98.4%；中风或帕金森病，96.0%；痴呆，89.6%）和普通公众（终末期器官衰竭，92.0%；无法治愈的遗传或神经疾病，92.5%；艾滋病，91.5%；中风或帕金森病，92.1%；痴呆，86.9%）如果他们有终末期预后，希望得到通知。对于医生和普通公众来说，告知终末期状态时要考虑的主要因素是“患者了解自己病情的权利”（31.0%）。然而，普通公众不太愿意像医生那样倾向于预后告知。特别是当他们的家人是患者时，超过 10%的普通公众不希望患者被告知他们的终末期预后。对于普通公众来说，不透露预后的主要原因是“焦虑和抑郁等心理负担”（35.8%），而对于医生来说，是“告知不会产生有益效果”（42.4%）。
大多数医生和普通公众都认为，对于几种严重疾病，告知终末期预后尊重了患者的自主权。医生的低反应率可能限制了结果的普遍性。
