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- Title
Physicians' experiences and perceptions about withholding and withdrawal life-sustaining treatment in Chiang Mai University Hospital: a cross-sectional study.
- Authors
Ketchaikosol, Nattanit; Pinyopornpanish, Kanokporn; Angkurawaranon, Chaisiri; Dejkriengkraikul, Nisachol; Chutarattanakul, Lalita
- 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.
- Subjects
THAILAND; PSYCHOLOGY of physicians; CONSENSUS (Social sciences); CROSS-sectional method; PATIENTS' families; PALLIATIVE treatment; ACADEMIC medical centers; MEDICAL personnel; RESEARCH funding; TERMINATION of treatment; PHYSICIANS' attitudes; DECISION making in clinical medicine; SURVEYS; LIFE support systems in critical care; QUALITY of life; COMMUNICATION; CARDIOPULMONARY resuscitation; PATIENTS' attitudes; ADVANCE directives (Medical care)
- Publication
BMC Palliative Care, 2024, Vol 23, Issue 1, p1
- ISSN
1472-684X
- Publication type
Article
- DOI
10.1186/s12904-024-01511-6