The Current Status of Medical Decision-Making for Dying Patients in a Medical Intensive Care Unit: A Single-Center Study / 대한구급학회지
The Korean Journal of Critical Care Medicine
;
: 160-165, 2014.
Article
in English
| WPRIM
| ID: wpr-645244
ABSTRACT
BACKGROUND:
Many terminally ill patients die while receiving life-sustaining treatment. Recently, the discussion of life-sustaining treatment in intensive care units (ICUs) has increased. This study is aimed to evaluate the current status of medical decision-making for dying patients.METHODS:
The medical records of patients who had died in the medical ICU from March 2011 to February 2012 were reviewed retrospectively.RESULTS:
Eighty-nine patients were enrolled. Their mean age was 65.8 +/- 13.3 years and 73.0% were male. The most common diagnosis was acute respiratory failure, and the most common comorbidity was hemato-oncologic malignancy. Withdrawing or withholding life-sustaining treatment including do-not-resuscitate (DNR) orders was discussed for 64 (71.9%) patients. In almost all cases, the discussion involved a physician and the patient's family. No patient wrote advance directives themselves before ICU admission. Of the patients for whom withdrawing or withholding life-sustaining treatment was discussed, the decisions were recorded in formal consent documents in 36 (56.3%) cases, while 28 (43.7%) cases involved verbal consent. In patients granting verbal consent, death within one day of the consent was more common than in those with formal document consent (85.7% vs. 61.1%, p < 0.05). The most common demand was a DNR order. Patients died 2.7 +/- 1.0 days after the decision for removal of life-sustaining treatment.CONCLUSIONS:
The decision-making for life-sustaining treatment of dying patients in the ICU very often involves conflict. There is a general need to heighten our sensitivity on the objective decision-making based on patient autonomy.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Respiratory Insufficiency
/
Terminal Care
/
Comorbidity
/
Medical Records
/
Retrospective Studies
/
Advance Directives
/
Terminally Ill
/
Consent Forms
/
Diagnosis
/
Financing, Organized
Type of study:
Diagnostic study
/
Practice guideline
/
Observational study
/
Prognostic study
Limits:
Humans
/
Male
Language:
English
Journal:
The Korean Journal of Critical Care Medicine
Year:
2014
Type:
Article
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