Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Anesthesiology and Intensive Care, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
Acta Anaesthesiol Scand. 2021 Sep;65(8):1102-1108. doi: 10.1111/aas.13842. Epub 2021 May 21.
There is increasing evidence that the individual physician is the main factor influencing variability in end-of-life decision-making in intensive care units. End-of-life decisions are complex and should be adapted to each patient. Physician-related variability is problematic as it may result in unequal assessments that affect patient outcomes. The primary aim of this study was to investigate factors contributing to physician-related variability in end-of-life decision-making.
This is a qualitative substudy of a previously conducted study. In-depth thematic analysis of semistructured interviews with 19 critical care specialists from five different Swedish intensive care units was performed. Interviews took place between 1 February 2017 and 31 May 2017.
Factors influencing physician-related variability consisted of different assessment of patient preferences, as well as intensivists' personality and values. Personality was expressed mainly through pace and determination in the decision-making process. Personal prejudices appeared in decisions, but few respondents had personally witnessed this. Avoidance of criticism and conflicts as well as individual strategies for emotional coping were other factors that influenced physician-related variability. Many respondents feared criticism for making their assessments, and the challenging nature of end-of-life decision-making lead to avoidance as well as emotional stress.
Variability in end-of-life decision-making is an important topic that needs further investigation. It is imperative that such variability be acknowledged and addressed in a more formal and transparent manner. The ethical issues faced by intensivists have recently been compounded by the devastating impact of the COVID-19 pandemic, demonstrating in profound terms the importance of the topic.
越来越多的证据表明，医生个体是影响重症监护病房临终决策变异性的主要因素。临终决策是复杂的，应该适应每个患者的情况。与医生相关的变异性是有问题的，因为它可能导致不平等的评估，从而影响患者的结局。本研究的主要目的是调查导致医生在临终决策方面变异性的因素。
这是之前进行的一项研究的定性子研究。对来自瑞典五家不同重症监护病房的 19 名重症监护专家进行了半结构化访谈的深入主题分析。访谈于 2017 年 2 月 1 日至 2017 年 5 月 31 日进行。
影响医生相关变异性的因素包括对患者偏好的不同评估，以及重症监护医师的个性和价值观。个性主要通过决策过程中的节奏和决心来表现。个人偏见出现在决策中，但很少有受访者亲眼目睹过。避免批评和冲突以及个人应对情绪的策略也是影响医生相关变异性的因素。许多受访者担心因做出评估而受到批评，而临终决策的挑战性性质导致了回避和情绪压力。
临终决策的变异性是一个需要进一步调查的重要课题。至关重要的是，应更加正式和透明地承认和处理这种变异性。最近，COVID-19 大流行的毁灭性影响使重症监护医师面临的伦理问题更加复杂，深刻地说明了这个话题的重要性。
