维持生命治疗决定法案的问题和影响:比较临终过程中住院病人的调查数据和临床数据。

IF 3 1区 哲学 Q1 ETHICS BMC Medical Ethics Pub Date : 2024-08-19 DOI:10.1186/s12910-024-01088-y
Eunjeong Song, Dongsoon Shin, Jooseon Lee, Seonyoung Yun, Minjeong Eom, Suhee Oh, Heejung Lee, Jiwan Lee, Rhayun Song
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引用次数: 0

摘要

背景:自2018年《韩国法案》通过以来,医护人员很难选择合适的时机讨论维持生命治疗(LST):本研究旨在了解患者在临床实践中如何决定接受 LST,并比较医护人员、患者和家属对这些决定的看法,提出支持患者自主决定的建议:研究设计:采用电子病历(EMR)和描述性调查进行回顾性观察研究:从电子病历中获得的数据包括 2021 年一家大学医院所有死于临终关怀的成年患者。我们还对214名医疗专业人员和100名患者及其家属进行了调查(中国人民大学附属医院IRB批准号:2022-07-006):根据916名临终关怀患者的EMR数据,78.4%的患者签署了 "不尝试复苏 "同意书,5.6%的患者填写了LST文件,10.2%的患者填写了两种表格。LST 决定大多由家庭成员做出(81.5%)。大多数参与调查者都认为应暂停无意义的 LST,并由患者做出决定。病人和家属(42%-56%)以及医疗专业人员(56%-58%)建议在病人仍有意识但病情预计会恶化时讨论暂停 LST 的问题。在决策过程中,大多数患者(58%)和家属(54%)认为患者遭受的痛苦是优先考虑的问题,而医疗专业人员则认为 "患者康复的可能性 "是最优先考虑的问题(43-55%):结论:尽管对该法案的认知度很高,但医疗专业人员、患者及其家属对 LST 决策的看法仍存在很大差异。这种情况使得实施该法案以确保尊重患者的自决权和有尊严地结束生命的权利面临挑战。需要进一步努力提高人们对生命末期治疗的认识,并澄清文件准备时间的模糊性。
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Issues and implications of the life-sustaining treatment decision act: comparing the data from the survey and clinical data of inpatients at the end-of-life process.

Background: Health professionals had difficulty choosing the right time to discuss life-sustaining treatments (LSTs) since the Korean Act was passed in 2018.

Objective: This study aimed to understand how patients decide to undergo LSTs in clinical practice and to compare the perceptions of these decisions among health professionals, patients, and families with suggestions to support the self-directed decisions of patients.

Research design: A retrospective observational study with electronic medical records (EMRs) and a descriptive survey was used.

Methods: The data obtained from the EMRs included all adult patients who died in end-of-life care at a university hospital in 2021. We also conducted a survey of 214 health professionals and 100 patients and their families (CNUH IRB approval no. 2022-07-006).

Results: Based on the EMR data of 916 patients in end-of-life care, 78.4% signed do-not-attempt-resuscitation consents, 5.6% completed the documents for LSTs, and 10.2% completed both forms. LST decisions were mostly made by family members (81.5%). Most survey participants agreed that meaningless LSTs should be suspended, and the decision should be made by patients. Patients and family members (42-56%) and health professionals (56-58%) recommended discussing LST suspension when the patient is still conscious but with predicted deterioration of their condition. The suffering experienced by the patient was considered to be a priority by most patients (58%) and families (54%) during the decision-making process, while health professionals considered "the possibility of the patient's recovery" to be the highest priority (43-55%).

Conclusions: There is still a significant discrepancy in the perceptions of LST decisions among health professionals, patients, and their families despite high awareness of the Act. This situation makes it challenging to implement the Act to ensure respect for the rights of patients to self-determination and dignified end-of-life. Further effort is needed to improve the awareness of LSTs and to clarify the ambiguity of document preparation timing.

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来源期刊
BMC Medical Ethics
BMC Medical Ethics MEDICAL ETHICS-
CiteScore
5.20
自引率
7.40%
发文量
108
审稿时长
>12 weeks
期刊介绍: BMC Medical Ethics is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies.
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