在自愿停止进食和饮水期间照顾患者（VSED）：德国一个姑息治疗团队的经验。

Caring for patients during voluntarily stopping of eating and drinking (VSED): experiences of a palliative care team in Germany.

机构信息

Interdisciplinary Centre for Palliative Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.

Department of Anaesthesiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.

出版信息

BMC Palliat Care. 2023 Nov 21;22(1):185. doi: 10.1186/s12904-023-01308-z.

DOI:10.1186/s12904-023-01308-z

PMID:37986161

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10662259/

Abstract

BACKGROUND

Health-care professionals are confronted with patients who wish to end their lives through voluntarily stopping eating and drinking (VSED). During VSED, symptoms such as agitation, thirst or psychological distress may arise, thus making close medical accompaniment necessary. Dealing with these symptoms can put a high burden on palliative care teams. Furthermore, divergent perceptions of the ethical classification of VSED may lead to moral distress. The aim of this study was to assess the influence of experience gained over time on the burden of palliative care professionals while accompanying patients during VSED and to assess the perceptions of coping strategies.

METHODS

This is a prospective single-centre study conducted at the Interdisciplinary Centre for Palliative Care at University Hospital Duesseldorf, Germany. At two points in time (T1, T2) one year apart, team members of all professions who were actively involved in the accompaniment were eligible to complete a pretested questionnaire.

RESULTS

Team members perceived the symptom complex of psychological distress, anxiety, and agitation to be the most burdensome symptoms for the patients (T1: 28/49, 57.1%; T2: 33/59, 55.9%). Thirst was the second most observed symptom (T1: 17/49, 34.7%, T2: 19/59, 32.2%). These were also the most burdensome symptoms for individual team members. Most team members found there were no general moral concerns. There was a decrease in the perceived importance of support strategies such as ethical counselling (85.7% versus 63.6%).

CONCLUSIONS

Accompanying patients during VSED is a challenge for health-care professionals. When comparing T2 to T1, less emphasis lies on the importance of ethical counselling or psychiatric assessment to build a foundation for the accompaniment. Moral and ethical concerns seem to play a minor role. More in-depth studies covering a bigger sample size as well as qualitative studies are needed.

摘要

背景

医疗保健专业人员面临着希望通过自愿停止进食和饮水（VSED）结束生命的患者。在 VSED 期间，可能会出现躁动、口渴或心理困扰等症状，因此需要进行密切的医疗陪伴。处理这些症状可能会给姑息治疗团队带来很大的负担。此外，对 VSED 的伦理分类的不同看法可能导致道德困境。本研究旨在评估随着时间的推移获得的经验对姑息治疗专业人员在 VSED 期间陪伴患者时的负担的影响，并评估应对策略的看法。

方法

这是一项在德国杜塞尔多夫大学医院姑息治疗跨学科中心进行的前瞻性单中心研究。在相隔一年的两个时间点（T1、T2），所有积极参与陪伴的专业团队成员都有资格完成一份预先测试的问卷。

结果

团队成员认为心理困扰、焦虑和躁动的症状群是患者最痛苦的症状（T1：28/49，57.1%；T2：33/59，55.9%）。口渴是观察到的第二大症状（T1：17/49，34.7%，T2：19/59，32.2%）。这些也是对个别团队成员最痛苦的症状。大多数团队成员认为没有普遍的道德问题。对支持策略的重要性的感知有所下降，例如伦理咨询（85.7%对 63.6%）。