Qureshi Alamgir Ahmed, Mohammad Jassim, Mohammed Elkandow Ali Elhaj, Hanumanthappa Jagannath, Ariboyina Ashok Kumar, Türkmen Süha
Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
Turk J Emerg Med. 2022 Jan 20;22(1):1-7. doi: 10.4103/2452-2473.336105. eCollection 2022 Jan-Mar.
Patients who are affected with severe chronic illness or in need for end-of-life care ((EOLC), they are mainly treated in the emergency departments (EDs) to provide the utmost amount of care for their condition. The major aspects which impact the accessibility of care in the ED include the clinical, social, and economic factors in different regions of countries. In recent years as the EOLC has been provided, it has been observed that patients experiencing EOL and dealing with a dying process do not always achieve the experience what resonates with a good death. The main cause of concern for these patients is the problem that in the ED they do not have access to palliative care options, mainly the ones who are suffering from noncancer ailments. These patients are provided palliative care at a very later stage in the ED when they could have been provided with palliative management at home in an earlier manner. EOLC plays a very critical role in ensuring that terminally ill patients are given a proper and adequate amount of care. The present article aims to highlight the EOLC in the ED in the Middle-Eastern regions. We aim to present a broader view that has impacted the current situation of EOLC in the Middle East regions and demonstrate a description of the EOLC in an ED setting between the Middle Eastern regions and western culture focusing on the following five important factors: Situation acceptance in the ED, cultural compatibility of bioethics, treatment perspective, skills among clinical providers and physician's attitude. In this literature review, we present the evidence associated with the EOLC in the ED setting with respect to the Middle East countries and bring out their differences in the religious, clinical, social, ethical, and economic aspects in comparison with the Western countries. We also tried to determine the differences between the two regions in terms of the principle of explaining the fatal diagnosis or poor prognosis, family relations, and do-not-resuscitate decision. This comparative analysis will help to bring out the gaps in the quality of care in the ED in the Middle East countries and promote the development of well-assessed policies and strategies to improve EOLC. The findings of this study and the future interventions that can be implemented to improve the structure and design of the EOLC that will act as a guiding force to execute evidence-based quality improvement program.
患有严重慢性疾病或需要临终关怀（EOLC）的患者，主要在急诊科（EDs）接受治疗，以针对其病情提供最大限度的护理。影响急诊科医疗可及性的主要方面包括不同国家地区的临床、社会和经济因素。近年来，随着临终关怀的提供，人们观察到经历临终并处于死亡过程中的患者并不总能获得与“善终”相符的体验。这些患者主要关注的问题是，在急诊科他们无法获得姑息治疗选择，尤其是那些患有非癌症疾病的患者。这些患者在急诊科很晚才得到姑息治疗，而他们本可以更早地在家中接受姑息治疗管理。临终关怀在确保为绝症患者提供适当和充分护理方面起着非常关键的作用。本文旨在强调中东地区急诊科的临终关怀。我们旨在呈现一个更广泛的观点，该观点影响了中东地区临终关怀的现状，并描述中东地区与西方文化在急诊科环境下临终关怀的情况，重点关注以下五个重要因素：急诊科的情况接受度、生物伦理学的文化兼容性、治疗观点、临床提供者的技能以及医生的态度。在这篇文献综述中，我们展示了与中东国家急诊科临终关怀相关的证据，并指出其与西方国家在宗教、临床、社会、伦理和经济方面的差异。我们还试图确定两个地区在解释致命诊断或不良预后的原则、家庭关系以及不进行心肺复苏决策方面的差异。这种比较分析将有助于找出中东国家急诊科护理质量方面的差距，并促进制定经过充分评估的政策和策略以改善临终关怀。本研究的结果以及为改善临终关怀的结构和设计可实施的未来干预措施，将成为实施循证质量改进计划的指导力量。
