Physicians’ attitudes toward end-of-life decisions in amyotrophic lateral sclerosis
| Autor: | Adriano Chiò, Tamara Thurn, Christopher J McDermott, Johanna Anneser, Andrea Sylvia Winkler, Gabriele Mora, Walter Sermeus, Miriam Galvin, Gian Domenico Borasio |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty assisted suicide Palliative care MND/motor neuron disease Attitude of Health Personnel palliative sedation Palliative sedation Suicide Assisted 03 medical and health sciences 0302 clinical medicine Physicians medicine Humans Hypnotics and Sedatives Amyotrophic lateral sclerosis Assisted suicide Intensive care medicine health care economics and organizations Terminal Care business.industry ALS/amyotrophic lateral sclerosis end-of-life decisions palliative care Amyotrophic Lateral Sclerosis Palliative Care ALS - Amyotrophic lateral sclerosis Middle Aged medicine.disease Respiration Artificial humanities Europe Religion Withholding Treatment Neurology Fluid Therapy Female Nutrition Therapy Neurology (clinical) business Decision Making Shared 030217 neurology & neurosurgery |
| DOI: | 10.6084/m9.figshare.7751453 |
| Popis: | Objective: This study aims (1) to assess physicians’ attitudes toward different palliative end-of-life (EOL) practices in amyotrophic lateral sclerosis (ALS) care, including forgoing artificial nutrition and hydration (FANH), continuous sedation until death (CSD), and withdrawing invasive ventilation (WIV), and toward physician-assisted dying (PAD) including physician-assisted suicide and euthanasia and (2) to explore variables influencing these attitudes. Methods: We used two clinical vignettes depicting ALS patients in different stages of their disease progression to assess the influence of suffering (physical/psycho-existential) on attitudes toward WIV and the influence of suffering and prognosis (short-term/long-term) on attitudes toward FANH, CSD, and PAD. Results: 50 physicians from European ALS centers and neurological departments completed our survey. Short-term prognosis had a positive impact on attitudes toward offering FANH (p = 0.014) and CSD (p = 0.048) as well as on attitudes toward performing CSD (p = 0.036) and euthanasia (p = 0.023). Predominantly psycho-existential suffering was associated with a more favorable attitude toward WIV but influenced attitudes toward performing CSD negatively. Regression analysis showed that religiosity was associated with more reluctant attitudes toward palliative EOL practices and PAD, whereas training in palliative care was associated with more favorable attitudes toward palliative EOL practices only. Conclusion: ALS physicians seem to acknowledge psycho-existential suffering as a highly acceptable motive for WIV but not CSD. Physicians appear to be comfortable with responding to the patient’s requests, but more reluctant to assume a proactive role in the decision-making process. Palliative care training may support ALS physicians in these challenging situations. |
| Databáze: | OpenAIRE |
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