緩和ケアと医学

抽象的な

Factors Influencing a Family's Decision Regarding the Withdrawal of Life Support in Palliative Care Patients

Weerajit Thipprasert

Objective: Thailand has just applied Withdrawal of life support (WDLS) in palliative care patients. In Asian cultures, family members often conceal the diagnosis and prognosis from the patient; hence, the WDLS decision mostly falls on the family members. This study’s objective is to explore the factors that influence a family’s decision regarding WDLS in palliative care patients.

Method: A prospective, cross-sectional survey was conducted at Roi Et Hospital in northeast Thailand between 1 August 2019 and 31 July 2020. Data were collected via interviews with 282 surrogated family members of palliative care patients who had undergone intubation. The structured questionnaire comprised the following: 1) patient’s demographic data, 2) family’s demographic data, and 3) factors influencing the family’s decision regarding the WDLS. Descriptive, univariate, and multivariate analyses were performed using multiple logistic regressions.

Results: Of the 282 participants, 85.1% lacked palliative care knowledge and 86.9% had no experience of terminal illness care. Furthermore, 61.3% of the family members agreed to WDLS. The factors influencing the family’s decision were usage of inotropic drug (OR Adj. = 3.84; 95% CI: 2.05-7.17), family consensus (OR Adj. = 3.30; 95% CI: 1.42-7.71), experience of terminal illness care (OR Adj. = 3.20; 95% CI: 1.21-8.42), advance care plan (ORAdj. = 2.87; 95% CI: 1.17-6.23), place of death (OR Adj. = 3.59; 95% CI: 1.84-7.02), and personal aspects (OR Adj. = 1.18; 95% CI: 1.10-1.25).

Conclusion: The factors influencing the decision of WDLS were recognition of disease severity by family
members, family’s experience, and patient’s wish. This was related to the local culture. Hence, measures should be taken to develop palliative care in Thailand considering its unique culture. Programs to educate the citizens, promote living wills, provide advanced directive care to decrease caregiver burden, and prepare for the increasingly ageing society are necessary.