End-of-life perceptions among physicians in intensive care units managed by anesthesiologists in Germany: a survey about structure, current implementation and deficits

BMC Anesthesiology

Research Article

Manfred Weiss¹  Anke Toenjes¹  Thomas Bein²  Andrej Michalsen³  Christian Putensen⁴  Heinrich Groesdonk⁵  Franz Porzsolt⁶  Alexander Brinkmann⁷  Friedhelm Bach⁸  Marc Theisen⁹  Dietrich Henzler^1,10 

[1] Clinic of Anaesthesiology, University Hospital Medical School, Alber-Einstein-Allee 23, 89081, Ulm, Germany;Department of Anaesthesia, University of Regensburg, Regensburg, Germany;Department of Anesthesiology and Critical Care Medicine, Tettnang Hospital, Tettnang, Germany;Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany;Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany;Institute of Clinical Economics, Health Care Research at the Hospital of General and Visceral Surgery University Hospital Ulm, Ulm, Germany;Klinik für Anästhesie, operative Intensivmedizin und spezielle Schmerztherapie, Klinikum Heidenheim, Heidenheim, Germany;Klinik für Anästhesiologie, Intensiv-, Transfusions-, Notfallmedizin und Schmerztherapie (AINS), Ev. Krankenhaus Bielefeld, Akad. Lehrkrankenhaus der WWU Münster, Bielefeld, Germany;Palliative Care Einheit, Anästhesie, operative Intensivmedizin, Schmerztherapie, Raphaelsklinik GmbH, Akademisches Lehrkrankenhaus der Westfälischen Wilhelms-Universität Münster, Münster, Germany;Universitätsklinik für Anästhesiologie, op. Intensivmedizin, Rettungsmedizin, Schmerztherapie der Ruhr-Universität Bochum, Klinikum Herford, Herford, Germany;

关键词: Anesthesiologists;    Education, Continuing;    End-of-life care;    Goals;    Intensive care units;    Palliative care;    Patient care planning;    Prognosis;    Quality of life;    Surveys and questionnaires;   

DOI  :  10.1186/s12871-017-0384-5

 received in 2017-03-06, accepted in 2017-06-30,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundStructural aspects and current practice about end-of-life (EOL) decisions in German intensive care units (ICUs) managed by anesthesiologists are unknown. A survey among intensive care anesthesiologists has been conducted to explore current practice, barriers and opinions on EOL decisions in ICU.MethodsIn November 2015, all members of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anesthesiologists (BDA) were asked to participate in an online survey to rate the presence or absence and the importance of 50 items. Answers were grouped into three categories considering implementation and relevance: Category 1 reflects high implementation and high relevance, Category 2 low and low, and Category 3 low and high.ResultsFive-hundred and forty-one anesthesiologists responded. Only four items reached ≥90% agreement as being performed “yes, always” or “mostly”, and 29 items were rated “very” or “more important”. A profound discrepancy between current practice and attributed importance was revealed. Twenty-eight items attributed to Category 1, six to Category 2 and sixteen to Category 3. Items characterizing the most urgent need for improvement (Category 3) referred to patient outcome data, preparation of health care directives and interdisciplinary discussion, standard operating procedures, implementation of practical instructions and inclusion of nursing staff and families in the process.ConclusionThe present survey affirms an urgent need for improvement in EOL practice in German ICUs focusing on advanced care planning, distinct aspects of changing goals of care, implementation of standard operating procedures, continuing education and reporting of outcome data.

【 授权许可】

CC BY   
© The Author(s). 2017