泰国清迈大学医院医生对终止和撤回生命支持治疗的经验和看法：一项横断面研究。

Physicians' experiences and perceptions about withholding and withdrawal life-sustaining treatment in Chiang Mai University Hospital: a cross-sectional study.

机构信息

Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd. Si Phum, Muang, Chiang Mai, Chiang Mai, 50200, Thailand.

Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand.

出版信息

BMC Palliat Care. 2024 Aug 13;23(1):206. doi: 10.1186/s12904-024-01511-6.

DOI:10.1186/s12904-024-01511-6

PMID:39138443

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11320918/

Abstract

BACKGROUND

Withholding or withdrawing life-sustaining treatment in end-of-life patients is a challenging ethical issue faced by physicians. Understanding physicians' experiences and factors influencing their decisions can lead to improvement in end-of-life care.

OBJECTIVES

To investigate the experiences of Thai physicians when making decisions regarding the withholding or withdrawal of life-sustaining treatments in end-of-life situations. Additionally, the study aims to assess the consensus among physicians regarding the factors that influence these decisions and to explore the influence of families or surrogates on the decision-making process of physicians, utilizing case-based surveys.

METHODS

A web-based survey was conducted among physicians practicing in Chiang Mai University Hospital (June - October 2022).

RESULTS

Among 251 physicians (response rate 38.3%), most of the respondents (60.6%) reported that they experienced withholding or withdrawal treatment in end-of-life patients. Factors that influence their decision-making include patient's preferences (100%), prognosis (93.4%), patients' quality of life (92.8%), treatment burden (89.5%), and families' request (87.5%). For a chronic disease with comatose condition, the majority of the physicians (47%) chose to continue treatments, including cardiopulmonary resuscitation (CPR). In contrast, only 2 physicians (0.8%) would do everything, in cases when families or surrogates insisted on stopping the treatment. This increased to 78.1% if the families insisted on continuing treatment.

CONCLUSION

Withholding and withdrawal of life-sustaining treatments are common in Thailand. The key factors influencing their decision-making process included patient's preferences and medical conditions and families' requests. Effective communication and early engagement in advanced care planning between physicians, patients, and families empower them to align treatment choices with personal values.

摘要

背景

在终末期患者中，是否停止或终止生命支持治疗是医生面临的一个具有挑战性的伦理问题。了解医生的经验和影响他们决策的因素可以改善终末期护理。

目的

调查泰国医生在终末期情况下决定停止或终止生命支持治疗时的经验。此外，本研究旨在评估医生对影响这些决策的因素的共识，并通过案例调查探讨家庭或代理人对医生决策过程的影响。

方法

对在清迈大学医院工作的医生进行了一项基于网络的调查（2022 年 6 月至 10 月）。

结果

在 251 名医生中（回应率为 38.3%），大多数医生（60.6%）报告在终末期患者中经历过停止或终止治疗。影响他们决策的因素包括患者的偏好（100%）、预后（93.4%）、患者的生活质量（92.8%）、治疗负担（89.5%）和家属的要求（87.5%）。对于患有昏迷合并慢性病的患者，大多数医生（47%）选择继续治疗，包括心肺复苏（CPR）。相比之下，如果家属或代理人坚持停止治疗，只有 2 名医生（0.8%）会尽一切努力。如果家属坚持继续治疗，这一比例上升至 78.1%。