Kim Semi, Ham Eun Hye, Kim Dong Yeon, Jang Seung Nam, Kim Min Kyeong, Choi Hyun Ah, Cho Yun A, Lee Seung A, Yun Min Jeong
Department of Nursing, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.
J Hosp Palliat Care. 2022 Mar 1;25(1):12-24. doi: 10.14475/jhpc.2022.25.1.12.
This descriptive study compared the perceptions, determinants, and needs of patients, family members, nurses, and physicians regarding life-sustaining treatment decisions for patients with hematologic malignancies in the hematology-oncology department of a tertiary hospital in Seoul, Korea.
In total, 147 subjects were recruited, gave written consent, and provided data by completing a structured questionnaire. Data were analyzed using analysis of variance, the chi-square test, and the Fisher exact test.
Nurses (F=3.35) and physicians (F=3.57) showed significantly greater familiarity with the Act on Decisions on Life-Sustaining Treatment than patients (F=2.69) and family members (F=2.59); (F=19.58, P<0.001). Many respondents, including 19 (51.4%) family members, 16 (43.2%) physicians, and 11 (29.7%) nurses, agreed that the patient's opinion had the greatest effect when making life-sustaining treatment decisions. Twelve (33.3%) patients answered that mental, physical, and financial burdens were the most important factors in life-sustaining treatment decisions, and there was a significant difference among the four groups (P<0.001). Twenty-four patients (66.7%), 27 (73.0%) family members, and 21(56.8%) nurses answered that physicians were the most appropriate people to provide information regarding life-sustaining treatment decisions. Unexpectedly, 19 (51.4%) physicians answered that hospice nurse practitioners were the most appropriate people to talk to about life-sustaining treatment (P<0.001).
It is of utmost importance that the patient and physician determine when life-sustaining treatment should be withdrawn, with the patient making the ultimate decision. Doctors and nurses have the responsibility to provide detailed information. The goal of end-of-life planning is to ensure patients' dignity and respect their values.
本描述性研究比较了韩国首尔一家三级医院血液肿瘤科患者、家属、护士和医生对血液系统恶性肿瘤患者维持生命治疗决策的认知、决定因素和需求。
共招募了147名受试者，他们签署了书面同意书，并通过填写结构化问卷提供数据。使用方差分析、卡方检验和Fisher精确检验对数据进行分析。
护士（F = 3.35）和医生（F = 3.57）对《维持生命治疗决策法》的熟悉程度明显高于患者（F = 2.69）和家属（F = 2.59）；（F = 19.58，P < 0.001）。许多受访者，包括19名（51.4%）家属、16名（43.2%）医生和11名（29.7%）护士，都认为患者的意见在做出维持生命治疗决策时影响最大。12名（33.3%）患者回答说，精神、身体和经济负担是维持生命治疗决策中最重要的因素，四组之间存在显著差异（P < 0.001）。24名患者（66.7%）、27名家属（73.0%）和21名护士（56.8%）回答说，医生是提供维持生命治疗决策信息的最合适人选。出乎意料的是，19名（51.4%）医生回答说，临终关怀护士从业者是谈论维持生命治疗的最合适人选（P < 0.001）。
患者和医生决定何时停止维持生命治疗至关重要，最终决定权在患者手中。医生和护士有责任提供详细信息。临终规划的目标是确保患者的尊严并尊重他们的价值观。
