https://scholars.lib.ntu.edu.tw/handle/123456789/517893
標題: | Prevailing Ethical Dilemmas Encountered by Physicians in Terminal Cancer Care Changed After the Enactment of the Natural Death Act: 15 Years’ Follow-up Survey | 作者: | HSIEN-LIANG HUANG CHIEN-AN YAO WEN-YU HU SHAO-YI CHENG Hwang S.-J. Chen C.-D. Lin W.-Y. Lin Y.-C. TAI-YUAN CHIU |
公開日期: | 2018 | 出版社: | Elsevier Inc. | 卷: | 55 | 期: | 3 | 起(迄)頁: | 843-850 | 來源出版物: | Journal of Pain and Symptom Management | 摘要: | Context: Advance directive laws have influences on ethical dilemmas encountered by physicians caring for terminal cancer patients. Objectives: To identify the prevailing ethical dilemmas among terminal care physicians 15 years after the Natural Death Act was enacted in Taiwan. Methods: This study is a cross-sectional survey from April 2014 to February 2015 using the clustering sampling method and a well-structured questionnaire. Targeted participants included physicians at oncology and related wards or palliative care units where terminal cancer care may be provided in Taiwan. Results: Among the 500 physicians surveyed, 383 responded (response rate 76.6%) and 346 valid questionnaires were included in the final analysis (effective response rate 69.2%). The most frequently identified ethical dilemma was “place of care,” followed by “use of antimicrobial agents” and “artificial nutrition and hydration.” The dilemma of “truth telling,” which ranked first in the 2005–2006 survey, now ranked at the fourth place. Stepwise logistic regression analysis revealed that female gender and knowledge of palliative care were negatively correlated with the extent of dilemmas regarding issues of “life and death.” Conclusion: The prevailing ethical dilemmas have changed in Taiwan 15 years after the enactment of the Natural Death Act, supporting that some previous strategies had worked. Our results suggest that education on the core values of palliative care, improvement of community-based hospice care program, and creating treatment guidelines with prognostication may resolve the current dilemmas. This type of survey should be adapted by individual countries to guide policy decisions on end-of-life care. ? 2017 American Academy of Hospice and Palliative Medicine |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85039997281&doi=10.1016%2fj.jpainsymman.2017.11.033&partnerID=40&md5=775893d2700d1a2880a665dfead02fb3 https://scholars.lib.ntu.edu.tw/handle/123456789/517893 |
ISSN: | 0885-3924 | DOI: | 10.1016/j.jpainsymman.2017.11.033 | SDG/關鍵字: | antiinfective agent; adult; Article; cancer palliative therapy; cross-sectional study; drug use; female; follow up; human; hydration; knowledge; law; living will; major clinical study; male; medical ethics; nutrition; physician; Taiwan; terminal care; ethics; health personnel attitude; legislation and jurisprudence; neoplasm; psychology; terminal care; trends; Adult; Attitude of Health Personnel; Cross-Sectional Studies; Female; Follow-Up Studies; Humans; Male; Neoplasms; Physicians; Taiwan; Terminal Care |
顯示於: | 醫學系 |
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