학술논문
Withholding and withdrawal of life-sustaining treatments in low-middle-income versus high-income Asian countries and regions
Document Type
Original Paper
Author
Phua, Jason; Joynt, Gavin M.; Nishimura, Masaji; Deng, Yiyun; Myatra, Sheila Nainan; Chan, Yiong Huak; Binh, Nguyen Gia; Tan, Cheng Cheng; Faruq, Mohammad Omar; Arabi, Yaseen M.; Wahjuprajitno, Bambang; Liu, Shih-Feng; Hashemian, Seyed Mohammad Reza; Kashif, Waqar; Staworn, Dusit; Palo, Jose Emmanuel; Koh, Younsuck; Gomersall, Charles D.; Du, Bin; Divatia, Jigeeshu V.; Tu, Mei-Lien; Patjanasoontorn, Boonsong; Khatun, U. H. Shahera; Mannan, Md Abdul; Uddin, Mirza Nazim; Manzoor, Raghib; Maniruzzaman, Mohammad; Ahsan, A. S. M. Areef; Fatema, Kaniz; Ahmed, Fatema; Nooruzzaman, A. R. M.; Mahmud, Asif Mujtaba; Hossain Shahid, S. M.; Tamanna, Rownak Jahan; Islam, Md Sayedul; Alam, A. K. M. Shamsul; Karim, Abdul; Mahmud, Mohammad Rashed; Chowdhury, Rashed; Faruk, Mohammad; Karim, Md Rezaul; Iqbal, Sarwar; Huda, Qumrul; Du, Bin; Qiu, Haibo; Zhang, Xiangyu; Dong, Yun; Wan, Yong; Gan, Cihai; Zhang, Yawei; Gao, Peiyang; Chen, Hong; Jia, Chao; Xiao, Xianhua; Xiang, Nutao; Li, Jingsong; Wang, Yushan; Tang, Yaoqing; Li, Jianguo; An, Youzhong; Ma, Xiaochun; Wang, Xue; Hu, Zhenjie; Qin, Tiehe; Chow, Fu Loi; Watt, Chi Lung; Wong, K. K.; Yan, Wing-Wa; Buckley, Tom; Lai, Kang Yiu; Young, Karl; Ching, Chi Keung; Law, Kin-Ip; Divatia, Jigeeshu Vasishtha; Kapadia, Farhad N.; Ramakrishnan, Nagarajan; Sircar, Mrinal; Amin, Pravin; Singh, Charu; Chawla, Rajesh; Mani, Raj Kumar; Nayyar, Ashwani; Shah, Jignesh; Tampubolon, Oloan; Singh, Tinni T.; Jamaati, Hamidreza; Fallahian, Farahnaz; Radpay, Badiozaman; Zali, Alireza; Bagheri, Ahmad; Tada, Keiichi; Nakamura, Toshiaki; Sanui, Masamitsu; Fujino, Yuji; Shiragami, Gotaroh; Kotani, Joji; Miyasho, Kohji; Morisaki, Hiroshi; Eguchi, Yutaka; Takeda, Shinhiro; Nishimura, Shinya; Nishida, Osamu; Tanigawa, Koichi; Takada, Koji; Oda, Sigeto; Fukuoka, Toshio; Sawamoto, Toru; Hashimoto, Satoru; Sobue, Kazuya; Nishiyama, Kingo; Morita, Kiyoshi; Taniguchi, Hiroyuki; Sumita, Shinzo; Tong, Jenny May Geok; Hashmi, Madiha; Awan, Dreema; King, Larry S.; Al-Dorzi, Hasan M.; Sadat, Musharaf; Al-Hameed, Fahad M.; Tan, Chee Keat; Tee, Augustine; Ooi, E-Lin; Tan, Addy Y. H.; Chan, Yeow; Ho, Benjamin; Johan, Azman; Soh, Chai Rick; Shin, Cheung Soo; Jun, Jong Hun; Kwak, Sang Hyun; Suh, Gee Young; Lim, Chae-Man; Tu, Mei-Lien; Chou, Shao-Ting; Liang, Yu-Feng; Wei, Yu-Feng; Cheng, Kuo-Chen; Chatrkaw, Phornlert; Permpikul, Chairat; Pothirat, Chaicharn; Nguyen, Dang Tuan; Le, Duc Nhan; ACME Study Investigators and the Asian Critical Care Clinical Trials Group
Source
Intensive Care Medicine. July 2016 42(7):1118-1127
Subject
Language
English
ISSN
0342-4642
1432-1238
1432-1238
Abstract
Purpose:To compare the attitudes of physicians towards withholding and withdrawing life-sustaining treatments in intensive care units (ICUs) in low-middle-income Asian countries and regions with those in high-income ones, and to explore differences in the role of families and surrogates, legal risks, and financial considerations between these countries and regions.Methods:Questionnaire study conducted in May–December 2012 on 847 physicians from 255 ICUs in 10 low-middle-income countries and regions according to the World Bank’s classification, and 618 physicians from 211 ICUs in six high-income countries and regions.Results:After we accounted for personal, ICU, and hospital characteristics on multivariable analyses using generalised linear mixed models, physicians from low-middle-income countries and regions were less likely to limit cardiopulmonary resuscitation, mechanical ventilation, vasopressors and inotropes,tracheostomy and haemodialysis than those from high-income countries and regions. They were more likely to involve families in end-of-life care discussions and to perceive legal risks with limitation of life-sustaining treatments and do-not-resuscitate orders. Nonetheless, they were also more likely to accede to families’ requests to withdraw life-sustaining treatments in a patient with an otherwise reasonable chance of survival on financial grounds in a case scenario (adjusted odds ratio 5.05, 95 % confidence interval 2.69–9.51, P < 0.001).Conclusions:Significant differences in ICU physicians’ self-reported practice of limiting life-sustaining treatments, the role of families and surrogates, perception of legal risks and financial considerations exist between low-middle-income and high-income Asian countries and regions.