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Does special education in palliative medicine make a difference in end-of-life decision-making?

BACKGROUND: Characteristics of the physician influence the essential decision-making in end-of-life care. However, the effect of special education in palliative medicine on different aspects of decision-making in end-of-life care remains unknown. The aim of this study was to explore the decision-mak...

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Autores principales: Piili, Reetta P., Lehto, Juho T., Luukkaala, Tiina, Hinkka, Heikki, Kellokumpu-Lehtinen, Pirkko-Liisa I.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052558/
https://www.ncbi.nlm.nih.gov/pubmed/30021586
http://dx.doi.org/10.1186/s12904-018-0349-6
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author Piili, Reetta P.
Lehto, Juho T.
Luukkaala, Tiina
Hinkka, Heikki
Kellokumpu-Lehtinen, Pirkko-Liisa I.
author_facet Piili, Reetta P.
Lehto, Juho T.
Luukkaala, Tiina
Hinkka, Heikki
Kellokumpu-Lehtinen, Pirkko-Liisa I.
author_sort Piili, Reetta P.
collection PubMed
description BACKGROUND: Characteristics of the physician influence the essential decision-making in end-of-life care. However, the effect of special education in palliative medicine on different aspects of decision-making in end-of-life care remains unknown. The aim of this study was to explore the decision-making in end-of-life care among physicians with or without special competency in palliative medicine (cPM). METHODS: A questionnaire including an advanced lung cancer patient-scenario with multiple decision options in end-of-life care situation was sent to 1327 Finnish physicians. Decisions to withdraw or withhold ten life-prolonging interventions were asked on a scale from 1 (definitely would not) to 5 (definitely would) – first, without additional information and then after the family’s request for aggressive treatment and the availability of an advance directive. Values from chronological original scenario, family’s appeal and advance directive were clustered by trajectory analysis. RESULTS: We received 699 (53%) responses. The mean values of the ten answers in the original scenario were 4.1 in physicians with cPM, 3.4 in general practitioners, 3.4 in surgeons, 3.5 in internists and 3.8 in oncologists (p < 0.05 for physicians with cPM vs. oncologists and p < 0.001 for physicians with cPM vs. others). Younger age and not being an oncologist or not having cPM increased aggressive treatment decisions in multivariable logistic regression analysis. The less aggressive approach of physicians with cPM differed between therapies, being most striking concerning intravenous hydration, nasogastric tube and blood transfusions. The aggressive approach increased by the family’s request (p < 0.001) and decreased by an advance directive (p < 0.001) in all physicians, regardless of special education in palliative medicine. CONCLUSION: Physicians with special education in palliative medicine make less aggressive decisions in end-of-life care. The impact of specialty on decision-making varies among treatment options. Education in end-of-life care decision-making should be mandatory for young physicians and those in specialty training. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12904-018-0349-6) contains supplementary material, which is available to authorized users.
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spelling pubmed-60525582018-07-20 Does special education in palliative medicine make a difference in end-of-life decision-making? Piili, Reetta P. Lehto, Juho T. Luukkaala, Tiina Hinkka, Heikki Kellokumpu-Lehtinen, Pirkko-Liisa I. BMC Palliat Care Research Article BACKGROUND: Characteristics of the physician influence the essential decision-making in end-of-life care. However, the effect of special education in palliative medicine on different aspects of decision-making in end-of-life care remains unknown. The aim of this study was to explore the decision-making in end-of-life care among physicians with or without special competency in palliative medicine (cPM). METHODS: A questionnaire including an advanced lung cancer patient-scenario with multiple decision options in end-of-life care situation was sent to 1327 Finnish physicians. Decisions to withdraw or withhold ten life-prolonging interventions were asked on a scale from 1 (definitely would not) to 5 (definitely would) – first, without additional information and then after the family’s request for aggressive treatment and the availability of an advance directive. Values from chronological original scenario, family’s appeal and advance directive were clustered by trajectory analysis. RESULTS: We received 699 (53%) responses. The mean values of the ten answers in the original scenario were 4.1 in physicians with cPM, 3.4 in general practitioners, 3.4 in surgeons, 3.5 in internists and 3.8 in oncologists (p < 0.05 for physicians with cPM vs. oncologists and p < 0.001 for physicians with cPM vs. others). Younger age and not being an oncologist or not having cPM increased aggressive treatment decisions in multivariable logistic regression analysis. The less aggressive approach of physicians with cPM differed between therapies, being most striking concerning intravenous hydration, nasogastric tube and blood transfusions. The aggressive approach increased by the family’s request (p < 0.001) and decreased by an advance directive (p < 0.001) in all physicians, regardless of special education in palliative medicine. CONCLUSION: Physicians with special education in palliative medicine make less aggressive decisions in end-of-life care. The impact of specialty on decision-making varies among treatment options. Education in end-of-life care decision-making should be mandatory for young physicians and those in specialty training. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12904-018-0349-6) contains supplementary material, which is available to authorized users. BioMed Central 2018-07-18 /pmc/articles/PMC6052558/ /pubmed/30021586 http://dx.doi.org/10.1186/s12904-018-0349-6 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Piili, Reetta P.
Lehto, Juho T.
Luukkaala, Tiina
Hinkka, Heikki
Kellokumpu-Lehtinen, Pirkko-Liisa I.
Does special education in palliative medicine make a difference in end-of-life decision-making?
title Does special education in palliative medicine make a difference in end-of-life decision-making?
title_full Does special education in palliative medicine make a difference in end-of-life decision-making?
title_fullStr Does special education in palliative medicine make a difference in end-of-life decision-making?
title_full_unstemmed Does special education in palliative medicine make a difference in end-of-life decision-making?
title_short Does special education in palliative medicine make a difference in end-of-life decision-making?
title_sort does special education in palliative medicine make a difference in end-of-life decision-making?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052558/
https://www.ncbi.nlm.nih.gov/pubmed/30021586
http://dx.doi.org/10.1186/s12904-018-0349-6
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