评估奥地利医生对协助自杀和姑息性镇静治疗的了解：一项探索性调查研究。

Evaluating physicians' knowledge of assisted suicide and palliative sedation therapy in Austria : An exploratory survey study.

作者信息

Fischer Lukas, Le Nguyen-Son, Kirchner Stefanie, Feichtner Angelika, Falkner Angelina, Masel Eva Katharina, Gärtner Jan, Weixler Dietmar, Kreye Gudrun

机构信息

Karl Landsteiner University of Health Sciences, Krems, Austria.

Division of Palliative Care, Department of Internal Medicine 2, University Hospital Krems, Mitterweg 10, 3500, Krems an der Donau, Austria.

出版信息

Wien Klin Wochenschr. 2025 Mar 4. doi: 10.1007/s00508-025-02509-7.

DOI:10.1007/s00508-025-02509-7

PMID:40035840

Abstract

BACKGROUND

Since January 2022, assisted suicide (AS) has been legal in Austria under specific conditions, allowing medical AS for individuals with incurable, life-ending diseases or severe, enduring illnesses that significantly impact their lives. Palliative sedation therapy (PST) involves the controlled use of drugs to induce unconsciousness and alleviate otherwise untreatable suffering. This study evaluates Austrian physicians' knowledge of AS and PST, comparing the knowledge levels of palliative care (PC) and non-PC physicians.

METHODS

In this explorative study, an online survey was distributed primarily to physicians in Lower Austria through the State Healthcare Agency Lower Austria (Landesgesundheitsagentur Niederösterreich, LGA) and to PC physicians across Austria via the Austrian Association for Palliative Care (Österreichische Palliativgesellschaft, OPG). Questions in this survey focused on basic knowledge of the principles of AS and PST. Participants included physicians who have expertise in PC and physicians from other medical specialties.

RESULTS

In this study, 223 physicians completed the survey. The PC physicians displayed significantly more specialized training, with 74.2% holding a PC diploma compared to 17.9% of non-PC physicians (p < 0.001). Regarding PST, PC physicians were more likely to follow guidelines, using midazolam (97.8% vs. 77.6%, p < 0.001), propofol (56.2% vs. 38.1%, p = 0.009), and levomepromazine (23.6% vs. 11.2%, p = 0.016). In AS, PC physicians emphasized the decision-making capacity more frequently (p = 0.006) and were better informed about the legal requirements.

CONCLUSION

Overall, Austrian physicians demonstrate insufficient knowledge of AS and PST, underlining the need for enhanced education on PC principles to ensure informed practice post-AS legalization. Nonetheless, PC physicians in Austria demonstrate superior adherence to guidelines in managing life-limiting conditions, PST and AS compared to non-PC physicians, highlighting the importance of specialized PC education.

摘要

背景

自2022年1月起，在特定条件下协助自杀（AS）在奥地利已合法化，允许为患有无法治愈的绝症或严重、持久疾病且对其生活有重大影响的个人提供医疗协助自杀。姑息性镇静治疗（PST）涉及有控制地使用药物以诱导昏迷并减轻无法治疗的痛苦。本研究评估奥地利医生对协助自杀和姑息性镇静治疗的了解情况，比较姑息治疗（PC）医生和非PC医生的知识水平。

方法

在这项探索性研究中，通过下奥地利州医疗保健机构（Landesgesundheitsagentur Niederösterreich，LGA）主要向下奥地利州的医生以及通过奥地利姑息治疗协会（Österreichische Palliativgesellschaft，OPG）向奥地利各地的PC医生发放了在线调查问卷。该调查问卷中的问题聚焦于协助自杀和姑息性镇静治疗原则的基础知识。参与者包括在PC方面有专业知识的医生以及来自其他医学专业的医生。

结果

在本研究中，223名医生完成了调查。PC医生接受的专业培训明显更多，74.2%的PC医生持有PC文凭，而非PC医生这一比例为17.9%（p < 0.001）。关于PST，PC医生更有可能遵循指南，使用咪达唑仑（97.8%对77.6%，p < 0.001）、丙泊酚（56.2%对38.1%，p = 0.009）和左美丙嗪（23.6%对11.2%，p = 0.016）。在协助自杀方面，PC医生更频繁地强调决策能力（p = 0.006），并且对法律要求了解得更清楚。