PDF(Pubmed)
Abstract：
BACKGROUND: Despite medical advancements in neonatal survival rates, many children have poor neurological outcomes. Because the law in Korea restricts the withdrawal of life-sustaining treatment to only cases of imminent death, treatment discontinuation may not be an option, even in patients with poor neurological prognosis. This study investigated the opinions of the general population and clinicians regarding life-sustaining treatment withdrawal in such cases using hypothetical scenarios.
METHODS: We conducted a cross-sectional study on the general population and clinicians using a web-based questionnaire. The sample of the general population from an online panel comprised 500 individuals aged 20-69 years selected by quota sampling. The clinician sample comprised 200 clinicians from a tertiary university hospital. We created hypothetical vignettes and questionnaire items to assess attitudes regarding mechanical ventilation withdrawal for an infant at risk of poor neurological prognosis due to birth asphyxia at 2 months and 3 years after the incidence.
RESULTS: Overall, 73% of the general population and 74% of clinicians had positive attitudes toward mechanical ventilator withdrawal at 2 months after birth asphyxia. The proportion of positive attitudes toward mechanical ventilator withdrawal was increased in the general population (84%, P < 0.001) and clinicians (80.5%, P = 0.02) at 3 years after birth asphyxia. Religion, spirituality, the presence of a person with a disability in the household, and household income were associated with the attitudes of the general population. In the multivariable logistic regression analysis of the general population, respondents living with a person with a disability or having a disability were more likely to find the withdrawal of the ventilator at 2 months and 3 years after birth asphyxia not permissible. Regarding religion, respondents who identified as Christians were more likely to find the ventilator withdrawal at 2 months after birth asphyxia unacceptable.
CONCLUSIONS: The general population and clinicians shared the perspective that the decision to withdraw life-sustaining treatment in infants with a poor neurological prognosis should be considered before the end of life. A societal discussion about making decisions centered around the best interest of pediatric patients is warranted.
METHODS: We conducted a cross-sectional study on the general population and clinicians using a web-based questionnaire. The sample of the general population from an online panel comprised 500 individuals aged 20-69 years selected by quota sampling. The clinician sample comprised 200 clinicians from a tertiary university hospital. We created hypothetical vignettes and questionnaire items to assess attitudes regarding mechanical ventilation withdrawal for an infant at risk of poor neurological prognosis due to birth asphyxia at 2 months and 3 years after the incidence.
RESULTS: Overall, 73% of the general population and 74% of clinicians had positive attitudes toward mechanical ventilator withdrawal at 2 months after birth asphyxia. The proportion of positive attitudes toward mechanical ventilator withdrawal was increased in the general population (84%, P < 0.001) and clinicians (80.5%, P = 0.02) at 3 years after birth asphyxia. Religion, spirituality, the presence of a person with a disability in the household, and household income were associated with the attitudes of the general population. In the multivariable logistic regression analysis of the general population, respondents living with a person with a disability or having a disability were more likely to find the withdrawal of the ventilator at 2 months and 3 years after birth asphyxia not permissible. Regarding religion, respondents who identified as Christians were more likely to find the ventilator withdrawal at 2 months after birth asphyxia unacceptable.
CONCLUSIONS: The general population and clinicians shared the perspective that the decision to withdraw life-sustaining treatment in infants with a poor neurological prognosis should be considered before the end of life. A societal discussion about making decisions centered around the best interest of pediatric patients is warranted.
摘要：
背景：尽管医学在新生儿存活率方面取得了进步，许多儿童的神经系统表现不佳。因为韩国的法律限制了仅在即将死亡的情况下取消维持生命的治疗，停止治疗可能不是一种选择，即使是神经系统预后不良的患者。这项研究使用假设的情况调查了一般人群和临床医生对此类病例中维持生命的治疗退出的意见。
方法：我们使用基于网络的问卷对一般人群和临床医生进行了横断面研究。来自在线小组的一般人群样本包括通过配额抽样选择的500名年龄在20-69岁之间的个体。临床医生样本包括来自第三大学医院的200名临床医生。我们创建了假设的小插图和问卷项目，以评估在发病后2个月和3年因出生窒息而有神经系统预后不良风险的婴儿对机械通气停药的态度。
结果：总体而言，出生窒息后2个月，73％的普通人群和74％的临床医生对机械呼吸机退出持积极态度。在普通人群中，对机械呼吸机退出的积极态度的比例有所增加(84%，P<0.001）和临床医生（80.5%，P=0.02)在出生后3年窒息。宗教,灵性,一个残疾人出现在家里，家庭收入与普通民众的态度有关。在一般人群的多变量逻辑回归分析中，与有残疾或有残疾的人一起生活的受访者更有可能发现在出生窒息后2个月和3年停用呼吸机是不允许的.关于宗教,被认定为基督徒的受访者更有可能在出生后2个月发现窒息是不可接受的。
结论：一般人群和临床医生都认为，对于神经系统预后较差的婴儿，在其生命结束前，应考虑退出维持生命治疗的决定。关于以儿科患者的最大利益为中心的决策的社会讨论是必要的。
方法：我们使用基于网络的问卷对一般人群和临床医生进行了横断面研究。来自在线小组的一般人群样本包括通过配额抽样选择的500名年龄在20-69岁之间的个体。临床医生样本包括来自第三大学医院的200名临床医生。我们创建了假设的小插图和问卷项目，以评估在发病后2个月和3年因出生窒息而有神经系统预后不良风险的婴儿对机械通气停药的态度。
结果：总体而言，出生窒息后2个月，73％的普通人群和74％的临床医生对机械呼吸机退出持积极态度。在普通人群中，对机械呼吸机退出的积极态度的比例有所增加(84%，P<0.001）和临床医生（80.5%，P=0.02)在出生后3年窒息。宗教,灵性,一个残疾人出现在家里，家庭收入与普通民众的态度有关。在一般人群的多变量逻辑回归分析中，与有残疾或有残疾的人一起生活的受访者更有可能发现在出生窒息后2个月和3年停用呼吸机是不允许的.关于宗教,被认定为基督徒的受访者更有可能在出生后2个月发现窒息是不可接受的。
结论：一般人群和临床医生都认为，对于神经系统预后较差的婴儿，在其生命结束前，应考虑退出维持生命治疗的决定。关于以儿科患者的最大利益为中心的决策的社会讨论是必要的。
