Health workers' view of futile therapy and care of dying patients

Cilj istraživanja: Utvrditi stavove zdravstvenih djelatnika prema zbrinjavanju umirućih bolesnika u jedinici intenzivnog liječenja (JIL) te moguće čimbenike koji utječu na formiranje njihovih stavova. Nacrt studije: Presječna studija. Ispitanici i metode: U istraživanje su uključeni anesteziolozi i specijalisti intenzivne medicine iz četiri bolnice u Hrvatskoj. Intervjuirani su putem upitnika. Njihovo sudjelovanje bilo je dragovoljno i anonimno. Rezultati: Podijeljena su 92, a vraćen je 61 ispunjen upitnik. Većina je anesteziologa protiv zbrinjavanja umirućih bolesnika u JIL-u. Smatraju opravdanim odredbe o neprovođenju kardiopulmonalne reanimacije u beznadno oboljelih, a 78,49% ispitanika podržava pisanu formu odredbi. Neki anesteziolozi (36,07%) podržavaju opoziv beskorisnog životno podržavajućeg liječenja, a njih 27,87% smatra etički prihvatljivijim uskraćivanje od prekida već započetoga liječenja. Gotovo 2/3 ispitanika smatra da umirućima treba olakšati bol i patnju primjenom opioida i sedativa. Čak 72,3% intervjuiranih smatra da odluku o ograničenju liječenja treba donositi zdravstveni tim uz uključivanje bolesnika ili članova obitelji. Specijalisti s više radnog iskustva (>34 godine), a pri tome većina žena, protive se ukidanju minimalne terapije. Zaključak: Anesteziolozi su načelno protiv primanja umirućih bolesnika u JIL. Uskraćivanje i opoziv beskorisnog podržavajućeg liječenja u beznadno oboljelih smatraju stručno i etički opravdanim. Zalažu se za primjenu adekvatne analgezije i sedacije, a izričito se protive namjernom skraćenju života. Stariji specijalisti i žene protive se ukidanju minimalne terapije. Stav je anesteziologa da odluke o ograničenju beskorisnog liječenja treba donositi timski, u suglasnosti s bolesnikom ili članovima njegove obitelji.Objectives: Our goal is to determine the attitudes of health workers toward the care of dying patients in Intensive care units (ICU) and possible factors that affect their attitudes. Study Design: Cross -sectional study. Participans and Methods: The participants are anaesthesiologists and intensive care specialists from four hospitals in Croatia. They were interwieved by a questionnaire. Their participation was voluntary and anonimous. Results: We distributed 92 questionnaires and 61 of them were fulfilled. Most of the participans are against taking care of dying patients in Intensive care units. They justify the provisions of not implementing cardiopulmonary resuscitation in the hopelessly ill, and 78.49% of respondents support the written form provision. Some anesthesiologists (36.07%) support the recall of useless life supportive treatment, and 27.87% of them think that the withholding of treatment is ethically more acceptable than withdrawal. Almost two thirds of respondents would give opioids and sedatives to relieve pain and suffering in dying patients. 72,3% of respondents think that decisions of foregoing life-sustaining treatment should be made by the medical team with inclusion of patient and family members. Specialists with more working experience (>34 years) and most of the women participants are against the abolition of infusions and enteral nutrition (minimum therapy). Conclusion: Anaesthesiologists are generally against admitting dying patients in ICU. Withholding and withdrawal of useless treatment in dying patients is considered proffesionaly and ethically justified. Respondents are using opioids and sedatives to keep the patient pain-free and they explicitly oppose the deliberate shortening of life. More experienced anaesthesiologists and women anaesthesiologists are against the abolition of infusion and enteral nutrition. Respondents think that end-of-life decisions should be made by the medical team including the patient and his family members