11 september 2017: Bron: PLoS One. 2014; 9(5): e98246. Published online 2014 May 28.

Al jaren krijg ik regelmatig links toegestuurd van artikelen die beschrijven dat groot onderzoek zou hebben uitgewezen dat 88,3 procent van de artsen chemo zouden afwijzen als ze zelf ongeneeslijke kanker zouden hebben. Afgelopen week weer drie mailtjes van mensen die me daarop wezen n.a.v. artikel over Wim Huppes in de NRC

En altijd wijs ik die mensen op de originele studie die m.i. toch wat genuanceerder bekeken en beoordeeld moet worden. Ik geef deze informatie nu dan maar in een vraag en antwoord:

Hier een interview met dr. Periyakoil, de arts die deze studie uitvoerde. Zij zegt o.a. in dat interview:

"Waarom kiezen artsen ervoor om zo'n agressieve behandeling voor onze patiënten uit te voeren wanneer we het niet voor onszelf zouden kiezen?",  aldus dr. Periyakoil, "De redenen zijn waarschijnlijk veelzijdig en complex."

De redenen waarom patienten wel of niet voor een behandeling kiezen waren deze:

    1. Kueze om door te gaan (full-code status): “Ik wil dat mijn leven zo lang mogelijk wordt verlengd binnen de grenzen van algemeen aanvaarde medische behandelingsnormen "(of)
    1. Keuze om niet door te gaan (no-code): “Ik wil niet dat mijn leven verlengd wordt als de waarschijnlijke risico's en lasten van de behandeling niet zouden opwegen tegen de verwachte voordelen, of als ik bewusteloos raak en gedacht vanuit een realistische mate van medische zekerheid niet meer tot bewustzijn zal komen of als ik een ongeneeslijke en onomkeerbare aandoening heb die tot mijn dood zal leiden."

Hier het volledige interview met dr. Periyakoil. daaronder het volledige originele studierapprot

Most physicians would forgo aggressive treatment for themselves at the end of life, study finds

Most physicians would choose a "no-code" status for themselves if they were terminally ill, but would tend to pursue aggressive treatment for patients facing a similar prognosis

Most physicians would choose a do-not-resuscitate or “no code” status for themselves when they are terminally ill, yet they tend to pursue aggressive, life-prolonging treatment for patients facing the same prognosis, according to a study from the Stanford University School of Medicine.

It’s a disconnect that needs to be better understood, said VJ Periyakoil, MD, clinical associate professor of medicine and lead author of the study, which was published May 28 in PLOS ONE.

“Why do we physicians choose to pursue such aggressive treatment for our patients when we wouldn’t choose it for ourselves?” said Periyakoil, director of the Stanford Palliative Care Education and Training Program. “The reasons likely are multifaceted and complex.”

In the study, Periyakoil and her colleagues set out to determine how physicians’ attitudes have changed toward advance directives since passage of the Self-Determination Act in 1990, a law designed to give patients more control over determining end-of-life-care decisions. Advance directives are documents that patients can use to indicate end-of-life care preferences.>>>>>>lees verder het hele interview:

Hier de originele studie:

Do Unto Others: Doctors' Personal End-of-Life Resuscitation Preferences and Their Attitudes toward Advance Directives

De originele studie is in 2014 in PLIOS ONE online gepubliceerd: Do Unto Others: Doctors' Personal End-of-Life Resuscitation Preferences and Their Attitudes toward Advance Directives en gratis in te zien.

Hier het abstract van deze studie:

Our study raises questions about why doctors continue to provide high-intensity care for terminally ill patients but personally forego such care for themselves at the end of life.

PLoS One. 2014; 9(5): e98246.
Published online 2014 May 28. doi:  10.1371/journal.pone.0098246
PMCID: PMC4037207

Do Unto Others: Doctors' Personal End-of-Life Resuscitation Preferences and Their Attitudes toward Advance Directives

Sam Eldabe, Editor

Abstract

Objective

High-intensity interventions are provided to seriously-ill patients in the last months of life by medical sub-specialists. This study was undertaken to determine if doctors' age, ethnicity, medical sub-specialty and personal resuscitation and organ donation preferences influenced their attitudes toward Advance Directives (AD) and to compare a cohort of 2013 doctors to a 1989 (one year before the Patient Self Determination Act in 1990) cohort to determine any changes in attitudes towards AD in the past 23 years.

Design

Doctors in two academic medical centers participated in an AD simulation and attitudes survey in 2013 and their responses were compared to a cohort of doctors in 1989.

Outcomes

Resuscitation and organ donation preferences (2013 cohort) and attitudes toward AD (1989 and 2013 cohorts).

Results

In 2013, 1081 (94.2%) doctors of the 1147 approached participated. Compared to 1989, 2013 cohort did not feel that widespread acceptance of AD would result in less aggressive treatment even of patients who do not have an AD (p<0.001, AUC = 0.77); had greater confidence in their treatment decisions if guided by an AD (p<.001, AUC = 0.58) and were less worried about legal consequences of limiting treatment when following an AD (p<.001, AUC  = 0.57). The gender (p = 0.00172), ethnicity (χ2 14.68, DF = 3,p = .0021) and sub-specialty (χ2 28.92, p = .004, DF = 12) influenced their attitudes towards AD. 88.3% doctors chose do-not-resuscitate status and wanted to become organ donors. Those less supportive of AD were more likely to opt for “full code” even if terminally ill and were less supportive of organ donation.

Conclusions

Doctors' attitudes towards AD has not changed significantly in the past 23 years. Doctors' gender, ethnicity and sub-specialty influence their attitudes towards AD. Our study raises questions about why doctors continue to provide high-intensity care for terminally ill patients but personally forego such care for themselves at the end of life.

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