Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland;
Home Care Services of the Elderly, Pihlajalinna Etälääketiede, Espoo, Finland.
Anticancer Res. 2023 Aug;43(8):3631-3638. doi: 10.21873/anticanres.16543.
BACKGROUND/AIM: Appropriate decision-making is essential for end-of-life (EOL) care without futile therapies. However, these decisions might vary in cases of cancer and other advanced diseases according to physicians' experience, education, and values. This study aimed to compare the decisions in EOL care of advanced cancer and dementia and the factors that influence them in medical students, general practitioners (GPs), and physicians with special competence in palliative medicine (cPM).
A questionnaire presenting patient scenarios concerning different decisions and ethical aspects of EOL care with additional questions on attitudes and background factors was delivered to 500 Finnish GPs, all Finnish physicians with cPM (n=82), and all graduating medical students (n=639) in 2015-2016. Altogether 601 responses were obtained (53%).
Palliative care was chosen more often for a patient with advanced prostate cancer (83%) than for a patient with advanced dementia (41%) (both patients males, same age). A suspicion of iatrogenic bleeding in the prostate cancer patient decreased the willingness to choose palliative care, especially among the students. Patient benefit was regarded as an important background factor in decision making by all respondent groups, but physicians' legal protection was not considered as important among the physicians with cPM as it was among the other respondent groups.
Finnish doctors and students were more likely to choose palliative care options for an advanced prostate cancer patient than for an advanced dementia patient. Decision-making was influenced by respondents' background factors and attitudes. Education on EOL care for different types of advanced and incurable diseases is highly needed.
背景/目的：适当的决策对于避免无效治疗的临终关怀至关重要。然而，这些决策可能因医生的经验、教育和价值观而异，尤其是在癌症和其他晚期疾病的情况下。本研究旨在比较晚期癌症和痴呆症临终关怀决策，以及影响医学生、全科医生（GP）和具有姑息治疗专业能力的医生（cPM）的因素。
2015-2016 年，向 500 名芬兰全科医生、所有芬兰具有 cPM 的医生（n=82）和所有毕业医学生（n=639）分发了一份问卷，其中包含有关不同决策和临终关怀伦理方面的患者情况，并附有关于态度和背景因素的附加问题。共收到 601 份回复（53%）。
与晚期痴呆症患者（41%）相比，晚期前列腺癌患者（均为男性，年龄相同）更倾向于选择姑息治疗（83%）。前列腺癌患者疑似医源性出血会降低选择姑息治疗的意愿，尤其是在学生中。所有受访者群体都认为患者获益是决策的重要背景因素，但与其他受访者群体相比，cPM 医生认为医生的法律保护并不那么重要。
芬兰医生和学生更倾向于为晚期前列腺癌患者选择姑息治疗方案，而不是为晚期痴呆症患者选择。决策受到受访者背景因素和态度的影响。需要对不同类型的晚期和不治之症进行临终关怀教育。
