Denying the dying : Advances directives and dialysis discontinuation.
A structured interview was administered to a sample of patients on maintenance dialysis and their attending physicians to obtain information on the documentation of their end-of-life treatment preferences.
The majority of the patients reported never having considered stopping dialysis, or having discussed with their nephrologist or family the circumstances in which treatment should be discontinued.
Only 7 patients (6%) had completed an advance directive ; these patients were all men (P=0.01) and tended to be better educated (P=0.02).
Only one of the nine physicians had completed an advance directive.
In most cases, the dialysis patients and their treatment team staff were preoccupied with the struggles of daily life and had avoided or denied considerations of terminal illness and death.
The literature on denial, medical illness, and dying is also reviewed as it relates to dialysis patients, end-of-life treatment, and terminal care.
Mots-clés Pascal : Hémodialyse, Prise décision, Traitement, Stade terminal, Dénégation, Mort, Relation médecin malade, Homme, Epuration extrarénale
Mots-clés Pascal anglais : Hemodialysis, Decision making, Treatment, Terminal stage, Denegation, Death, Physician patient relation, Human, Extrarenal dialysis
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0070932
Code Inist : 002A26N05. Création : 21/05/1997.