The impact of regional culture on intensive care end of life decision making: an Israeli perspective from the ETHICUS study
The impact of regional culture on intensive care end of life decision making: an Israeli perspective from the ETHICUS study
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DOI：
10.1136/jme.2005.012542
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发表时间：
2006-04-01
影响因子：
4.1
通讯作者：
Sprung, CL
中科院分区：
文献类型：
--
作者：
Ganz, FD;Benbenishty, J;Sprung, CL
背景资料：患者、家属和医疗保健提供者在生命结束时对医疗保健的决定取决于许多因素，包括社会文化。进行了一项泛欧洲研究，以确定欧洲重症监护室（ICU）（包括以色列的ICU）中临终实践的频率和类型。以色列子样本的几个结果与总体样本的结果不同。目的：本文的目的是探索这些差异，并根据文化对生命结束决策的影响提供一种可能的解释。方法：所有连续入住三个以色列ICU的成人患者对1999年1月1日至2000年6月30日期间死亡或接受任何救生干预措施限制的患者（n = 2778）进行了前瞻性研究（n = 363）。将这些患者与在37个欧洲ICU中进行的大型研究（欧洲重症监护病房伦理学：ETHIUS）中的类似样本进行比较。随访患者直至出院、死亡或决定限制治疗后2个月。生命结束的决定被前瞻性地组织成五个相互排斥的类别之一：心肺复苏术（CPR），脑死亡，停止治疗，停止治疗和主动缩短死亡过程（SDP）。数据还包括患者特征（性别、年龄、ICU入院诊断、慢性疾病、入院日期、决定限制治疗的日期和时间、出院日期、住院死亡日期和时间）、限制的具体治疗和SDP方法。大多数患者（n = 252，69%）暂停治疗，无患者接受SDP，62例接受CPR（17%），31例脑死亡（9%），18例退出治疗（5%）。限制治疗的主要原因是患者对治疗无反应（n = 187）。与132个家庭（36%）进行了生命结束讨论，其中绝大多数围绕停止治疗（91%的讨论），其余涉及停止治疗（n = 11，9%）。有一个统计学上的显着关联（chi（2）= 830.93，df = 12，p < 0.0001）之间的类型结束生命的决定和区域-即欧洲的北方地区，中部地区，南部地区，和Israel.Conclusions：区域文化发挥了重要作用，在结束生命的决策。不同地区之间在生命终结决策方面存在差异，这些差异往往归因于文化因素。这种文化不仅影响病人及其家属，而且影响作出和执行这种决定的卫生保健工作者。
Background: Decisions of patients, families, and health care providers about medical care at the end of life depend on many factors, including the societal culture. A pan- European study was conducted to determine the frequency and types of end of life practices in European intensive care units ( ICUs), including those in Israel. Several results of the Israeli subsample were different to those of the overall sample.Objective: The objective of this article was to explore these differences and provide a possible explanation based on the impact of culture on end of life decision making.Method: All adult patients admitted consecutively to three Israeli ICUs ( n = 2778) who died or underwent any limitation of life saving interventions between 1 January 1999 and 30 June 2000 were studied prospectively ( n = 363). These patients were compared with a similar sample taken from the larger study ( ethics in European intensive care units: ETHICUS) carried out in 37 European ICUs. Patients were followed until discharge, death, or 2 months from the decision to limit therapy. End of life decisions were prospectively organised into one of five mutually exclusive categories: cardiopulmonary resuscitation ( CPR), brain death, withholding treatment, withdrawing treatment, and active shortening of the dying process ( SDP). The data also included patient characteristics ( gender, age, ICU admission diagnosis, chronic disorders, date of hospital admission, date and time of decision to limit therapy, date of hospital discharge, date and time of death in hospital), specific therapies limited, and the method of SDP.Results: The majority of patients ( n = 252, 69%) had treatment withheld, none underwent SDP, 62 received CPR ( 17%), 31 had brain death ( 9%), and 18 underwent withdrawal of treatment ( 5%). The primary reason given for limiting treatment was that the patient was unresponsive to therapy ( n = 187). End of life discussions were held with 132 families ( 36%), the vast majority of which revolved around withholding treatment ( 91% of the discussions) and the remainder concerned withdrawing treatment ( n = 11, 9%). There was a statistically significant association ( chi(2) = 830.93, df = 12, p < 0.0001) between the type of end of life decision and region - that is, the northern region of Europe, the central region, the southern region, and Israel.Conclusions: Regional culture plays an important part in end of life decision making. Differences relating to end of life decision making exist between regions and these differences can often be attributed to cultural factors. Such cultures not only affect patients and their families but also the health care workers who make and carry out such decisions.