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Titolo:
Neonatal end-of-life decision making - Physicians' attitudes and relationship with self-reported practices in 10 European countries
Autore:
Rebagliato, M; Cuttini, M; Broggin, L; Berbik, I; de Vonderweid, U; Hansen, G; Kaminski, M; Kollee, LAA; Kucinskas, A; Lenoir, S; Levin, A; Persson, J; Reid, M; Saracci, R;
Indirizzi:
Miguel Hernandez Univ, Dept Publ Hlth, Alicante 03550, Spain Miguel Hernandez Univ Alicante Spain 03550 l Hlth, Alicante 03550, Spain Burlo Garofolo Childrens Hosp, Epidemiol Unit, Trieste, Italy Burlo Garofolo Childrens Hosp Trieste Italy demiol Unit, Trieste, Italy Burlo Garofolo Childrens Hosp, Neonatal Intens Care Unit, Trieste, Italy Burlo Garofolo Childrens Hosp Trieste Italy s Care Unit, Trieste, Italy Natl Res Council, IFC, Div Epidemiol, Pisa, Italy Natl Res Council Pisa Italy es Council, IFC, Div Epidemiol, Pisa, Italy Vaszary Kolos Hosp, Dept Obstet & Gynaecol, Tergoti, Hungary Vaszary KolosHosp Tergoti Hungary Obstet & Gynaecol, Tergoti, Hungary Univ Halle Wittenberg, Dept Pediat, Halle, Germany Univ Halle Wittenberg Halle Germany enberg, Dept Pediat, Halle, Germany Inst Gustave Roussy, INSERM, U149, Epidemiol Res Unit Perinatal & Womens Hlth, F-94805 Villejuif, France Inst Gustave Roussy Villejuif France F-94805 , F-94805 Villejuif, France Fac Med Toulouse, INSERM, Unit Res Reprod, F-31073 Toulouse, France Fac Med Toulouse Toulouse France F-31073 eprod, F-31073 Toulouse, France Univ Nijmegen Hosp, Dept Neonatol, NL-6500 HB Nijmegen, Netherlands Univ Nijmegen Hosp Nijmegen Netherlands NL-6500 HB Nijmegen, Netherlands Vilnius State Univ, Neonatal Clin, Vilnius, Lithuania Vilnius State Univ Vilnius Lithuania Neonatal Clin, Vilnius, Lithuania Tallinn Hosp, Newborn & Premature Childrens Dept, Tallinn, Estonia TallinnHosp Tallinn Estonia Premature Childrens Dept, Tallinn, Estonia Linkoping Univ, Ctr Med Technol Assessment, Linkoping, Sweden Linkoping Univ Linkoping Sweden d Technol Assessment, Linkoping, Sweden Univ Glasgow, Dept Publ Hlth, Glasgow, Lanark, Scotland Univ Glasgow Glasgow Lanark Scotland ubl Hlth, Glasgow, Lanark, Scotland
Titolo Testata:
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
fascicolo: 19, volume: 284, anno: 2000,
pagine: 2451 - 2459
SICI:
0098-7484(20001115)284:19<2451:NEDM-P>2.0.ZU;2-4
Fonte:
ISI
Lingua:
ENG
Soggetto:
EXTREMELY PREMATURE NEWBORNS; INTENSIVE-CARE; ETHICAL DECISIONS; DANISH PHYSICIANS; MORTALITY; SUPPORT; NURSERY; UNITS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
39
Recensione:
Indirizzi per estratti:
Indirizzo: Rebagliato, M Miguel Hernandez Univ, Dept Publ Hlth, Campus San Juan,Ctra Valencia,Km 87, Alicante 03550, Spain Miguel Hernandez Univ Campus San Juan,Ctra Valencia,Km 87 Alicante Spain 03550
Citazione:
M. Rebagliato et al., "Neonatal end-of-life decision making - Physicians' attitudes and relationship with self-reported practices in 10 European countries", J AM MED A, 284(19), 2000, pp. 2451-2459

Abstract

Context The ethical issues surrounding end-of-life decision making for infants with adverse prognoses are controversial. Little empirical evidence isavailable on the attitudes and values that underlie such decisions in different countries and cultures. Objective To explore the variability of neonatal physicians' attitudes among 10 European countries and the relationship between such attitudes and self-reported practice of end-of-life decisions. Design and Setting Survey conducted during 1996-1997 in 10 European countries (France, Germany, Italy, the Netherlands, Spain, Sweden, the United Kingdom, Estonia, Hungary, and Lithuania). Participants A total of 1391 physicians (response rate, 89%) regularly employed in 142 neonatal intensive care units (NICUs). Main Outcome Measures Scores on an attitude scale, which measured views regarding absolute value of life (score of 0) vs value of quality of life (score of 10); self-report of having ever set limits to intensive neonatal interventions in cases of poor neurological prognosis. Results Physicians more likely to agree with statements consistent with preserving life at any cost were from Hungary (mean attitude scores, 5.2 [95%confidence interval {CI}, 4.9-5.5]), Estonia (4.9 [95% CI, 4.3-5.5]), Lithuania (5.5 [95% CI, 4.8-6.1]), and Italy (5.7 [95% CI, 5.3-6.0]), while physicians more likely to agree with the idea that quality of life must be taken into account were from the United Kingdom (attitude scores, 7.4 [95% CI,7.1-7.7]), the Netherlands (7.3 [95% CI, 7.1-7.5]), and Sweden (6.8 [95% CI, 6.4-7.3]). Other factors associated with having a pro-quality-of-life view were being female, having had no children, being Protestant or having noreligious background, considering religion as not important, and working in an NICU with a high number of very low-birth-weight newborns. Physicians with scores reflecting a more quality-of-life view were more likely to report that in their practice, they had set limits to intensive interventions in cases of poor neurological prognosis, with an adjusted odds ratio of 1.5 (95% CI, 1.3-1.7) per unit change in attitude score. Conclusions In our study, physicians' likelihood of reporting setting limits to intensive neonatal interventions in cases of poor neurological prognosis is related to their attitudes. After adjusting for potential confounders, country remained the most important predictor of physicians' attitudes and practices.

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Documento generato il 29/09/20 alle ore 19:59:12