The ideas about advanced life support and affecting factors at the end-stage of life in a hospital in Turkey

Abstract

BackgroundThe participation of the people in health decisions may be structured in various levels. One of these is participation in decisions for the treatment. “Advanced directives” is one of the examples for the participation in decisions for the treatment.AimWe wanted to determine the decisions on advanced life support at the end-stage of life in case of a life-threatening illness for the people themselves and their first degree relatives and the factors effecting these decisions.Design and settingThe cross-sectional study was conducted with volunteers among patients and patient relatives who applied to all polyclinics of the Ankara Numune Training and Research Hospital except the emergency, oncology and psychiatry polyclinics between 15.12.2012 and 15.03.2013.MethodA questionnaire, the Hospital Anxiety Depression (HAD) scale, and Templer’s Death Anxiety Scale (TDA) were applied to all individuals. SPSS for Win. Ver. 17.0 and MS-Excel 2010 Starter software bundles were used for all statistical analysis and calculations.ResultsThe participants want both themselves and their first degree relatives included in end-stage decision-making process. Therefore, the patients and their families should be informed adequately during decision making process and quality communication must be provided.ConclusionParticipants who have given their end-stage decisions previously want to be treated according to these decisions. This desire can just be possible by advanced directives.When moral and material loads of end-stage process are taken into consideration, countries, in which advanced directives are practiced, should be examined well and participants’ desire should be evaluated in terms of practicability.

Factors affecting the attitudes and opinions of ICU physicians regarding end-of-life decisions for their patients and themselves: A survey study from Turkey

“…The demographic characteristics of the participants are shown in Table 1. The median age of the ICU physician participants was 39 (33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45), and 54.5% were female. The primary specialty of the great majority of the ICU physicians was anesthesiology (88.2%), followed by internal medicine (9.9%) and surgery (1.9%).…”

“…One of the reasons for this decline might be rising violence against doctors in Turkey in recent years, which is mostly perpetrated by families of their patients [44]. However, in a recent study performed among 350 patients and relatives in Turkey, the participants wanted both themselves and their firstdegree relatives included in the EOL decision process [45]. In previous studies, 70-80% of family members in the USA [46], 100% of family members in India [47], 79% of family members in Lebanon [48], and 44% of the family members [49] in France were involved in EOL decisions.…”

Perspectives of healthcare professionals and older patients on shared decision-making for treatment escalation planning in the acute hospital setting: a systematic review and qualitative thematic synthesis

“… 72 , 89 The surrogate role in TEP is complex and important in several cultural contexts. 90 , 91 , 92 , 93 Although not our focus, family involvement was highlighted by both clinicians and patients: clinicians anticipated conflict about treatment limitations; patients were highly aware of their families but the nature of influence on decision-making was not clear. Clinicians were influenced by organisational expectations and environmental pressures, consistent with existing research.…”