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Titolo:
Conflict resolution at the end of life
Autore:
Fetters, MD; Churchill, L; Danis, M;
Indirizzi:
Univ Michigan Hlth Syst, Dept Family Med, Ann Arbor, MI 48109 USA Univ Michigan Hlth Syst Ann Arbor MI USA 48109 d, Ann Arbor, MI 48109 USA Univ Michigan Hlth Syst, Japanese Family Hlth Program, Ann Arbor, MI 48109USA Univ Michigan Hlth Syst Ann Arbor MI USA 48109 am, Ann Arbor, MI 48109USA Univ N Carolina, Chapel Hill, NC USA Univ N Carolina Chapel Hill NC USAUniv N Carolina, Chapel Hill, NC USA NIH, Warren G Magnuson Clin Ctr, Bethesda, MD 20892 USA NIH Bethesda MD USA 20892 ren G Magnuson Clin Ctr, Bethesda, MD 20892 USA
Titolo Testata:
CRITICAL CARE MEDICINE
fascicolo: 5, volume: 29, anno: 2001,
pagine: 921 - 925
SICI:
0090-3493(200105)29:5<921:CRATEO>2.0.ZU;2-E
Fonte:
ISI
Lingua:
ENG
Soggetto:
SUSTAINING TREATMENT; PATIENT-RELATIONSHIP; INFORMED CONSENT; PHYSICIANS; AUTONOMY; FUTILITY; MODELS; FAMILY; CARE; COST;
Keywords:
terminal care; decision making; resuscitation orders; life support care; ethics; medical; patient participation; physician-patient relations; competence; communication; palliation;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
45
Recensione:
Indirizzi per estratti:
Indirizzo: Fetters, MD Univ Michigan Hlth Syst, Dept Family Med, 1018 Fuller St, Ann Arbor, MI 48109 USA Univ Michigan Hlth Syst 1018 Fuller St Ann Arbor MI USA48109
Citazione:
M.D. Fetters et al., "Conflict resolution at the end of life", CRIT CARE M, 29(5), 2001, pp. 921-925

Abstract

Objective: Limited empirical research has examined how decisions are made when the preferences of terminally ill patients conflict with physicians' recommendations. This study sought to investigate physicians' strategies forresolving conflicts with dying patients,Design: Cross-sectional, qualitative interviews,Subjects, Subjects were 158 physicians caring for at least one terminally ill patient. Setting: University medical center. Measurements and Main Results: We analyzed physicians' responses to the open-ended interview questions, "How do you handle a situation when a patientwants a treatment that you believe does not provide any benefit?" and "Howdo you handle a situation when a patient does not want a treatment you think would be beneficial? " For patient requests of nonbeneficial treatments, physicians reported the following as important: negotiating with and educating patients (71%), deferring to patient requests for benign or uncomplicated treatments (34%), convincing patients to forgo treatments (33%), refusing patient requests for nonbeneficial treatment (22%), using family influence (16%), not offering futile treatments (13%), and referring to other physicians for disputed care (9%), Potential harm (23%) and cost of treatment (18%) were reasons cited for withholding treatments, In response to patient refusals of beneficial treatments, physicians report the following as important: negotiating with patients (59%), convincing patients to receive treatment (41%), assessing patient competence (32%), using family influence (27%), and referring to other physicians (21%),Conclusions: Physicians vary in the communication and negotiation strategies they use when their medical judgment conflicts with dying patients' preferences. Medical ethicists could play a greater role in teaching ethically important communication skills. Physicians providing care at the end of life report strategies for respecting patients that reflect graduated degrees of accommodation tailored to the costliness and riskiness of requests; theyare most accepting of patient requests for benign, technically easy, inexpensive, and medically effective treatments.

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Documento generato il 22/09/20 alle ore 16:56:11