Physicians' attitudes toward medical and ethical challenges for patients in the vegetative state: comparing Canadian and German perspectives in a vignette survey
Physicians' attitudes toward medical and ethical challenges for patients in the vegetative state: comparing Canadian and German perspectives in a vignette survey
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DOI：
10.1186/1471-2377-14-119
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发表时间：
2014-06-05
期刊：
影响因子：
2.6
通讯作者：
Racine, Eric
中科院分区：
文献类型：
--
作者：
Kuehlmeyer, Katja;Palmour, Nicole;Racine, Eric
背景资料：治疗植物人状态（VS）患者的医生必须处理诊断和预后的不确定性以及伦理问题。方法：对德国和加拿大两个国家的专科医生进行了一项比较调查，基于一个关于VS的案例，用非参数检验分析了两个样本之间参与者对医学和伦理挑战态度的异同结果：总有效率为13.4%。80%的参与者正确应用了VS的诊断类别，各国之间没有显着差异。许多选择正确诊断VS的参与者将能力归因于患者，特别是感觉疼痛（70%），触摸（51%）和体验饥饿和口渴（35%）的能力。绝大多数参与者（94%）认为在某些情况下限制生命维持治疗（LST），但更多的加拿大参与者赞成始终限制LST（32%对12%;卡方：p < 0.001）。寻找长期护理安置被认为是更具挑战性的加拿大参与者，而停止LST是更具挑战性的德国participator.Conclusions：差异被发现在两个国家的医疗实践设置方面的医生的经验和态度治疗限制VS尽管可比的诊断知识。
Background: Physicians treating patients in the vegetative state (VS) must deal with uncertainty in diagnosis and prognosis, as well as ethical issues. We examined whether physicians' attitudes toward medical and ethical challenges vary across two national medical practice settings.Methods: A comparative survey was conducted among German and Canadian specialty physicians, based on a case vignette about the VS. Similarities and differences of participants' attitudes toward medical and ethical challenges between the two samples were analyzed with non-parametric tests (Mann-Whitney-U-Test).Results: The overall response rate was 13.4%. Eighty percent of all participants correctly applied the diagnostic category of VS with no significant differences between countries. Many of the participants who chose the correct diagnosis of VS attributed capabilities to the patient, particularly the ability to feel pain (70%), touch (51%) and to experience hunger and thirst (35%). A large majority of participants (94%) considered the limitation of life-sustaining treatment (LST) under certain circumstances, but more Canadian participants were in favor of always limiting LST (32% vs. 12%; Chi-square: p < 0.001). Finding long-term care placement was considered more challenging by Canadian participants whereas discontinuing LST was much more challenging for German participants.Conclusions: Differences were found between two national medical practice settings with respect to physicians' experiences and attitudes about treatment limitation about VS in spite of comparable diagnostic knowledge.