Biomedical subjects

B van Oorschot

Publications and source records attributed to B van Oorschot.

5 recordsLinked to original sources

PubMed2006

Importance of the advance directive and the beginning of the dying process from the point of view of German doctors and judges dealing with guardianship matters: results of an empirical survey.

OBJECTIVES: To analyse and compare the surveys on German doctors and judges on end of life decision making regarding their attitudes on the advance directive and on the dying process. DESIGN: The respondents were to indicate their agreement or disagreement to eight statements on the advance directive and to specify their personal view on the beginning of the dying process. PARTICIPANTS: 727 doctors (anaesthetists or intensive-care physicians, internal specialists and general practitioners) in three federal states and 469 judges dealing with guardianship matters all over Germany. MAIN MEASUREMENTS: Comparisons of means, analyses of variance, pivot tables (chi(2) test) and factor analyses (varimax with Kaiser normalisation). RESULTS: Three attitude groups on advance directive were disclosed by the analysis: the decision model, which emphasises the binding character of a situational advance directive; the deliberation model, which puts more emphasis on the communicative aspect; and the delegation model, which regards the advance directive as a legal instrument. The answers regarding the beginning of the dying process were broadly distributed, but no marked difference was observed between the responding professions. The dying process was assumed by most participants to begin with a life expectancy of only a few days. CONCLUSIONS: A high degree of valuation for advance directive was seen in both German doctors and judges; most agreed to the binding character of the situational directive. Regarding the different individual concepts of the dying process, a cross-professional discourse on the contents of this term seems to be overdue.

Advance Directives↗

PubMed2005

[Attitudes on euthanasia and medical advance directives].

BACKGROUND: With regard to medical decisions and measures at the end of life, the values and attitudes of those concerned are crucial. However, they have hardly been taken into account so far in German empirical studies on euthanasia and medical advance directives. METHOD: Between October 2003 and May 2004, a mail survey of a representative group of internists, anaesthetists and general practitioners from Bavaria, Westphalia-Lippe and Thuringia was conducted. RESULTS: Of 1,557 mailed questionnaires 727 were returned (rate of returns: 46 %). The survey showed, high of appreciation for medical advance directives and, at the same, time scepticism regarding surrogate decision-making by legal guardians and authorized representatives. Furthermore, the survey revealed a considerable amount of uncertainty in the physicians about the application of certain measures at the end of life to the different forms of euthanasia. In practice, many physicians do not comprehend the juridical differentiation between (illegal) active and (legal) passive or indirect euthanasia. CONCLUSIONS: In training and further education more scope should be given to the reflection of medical decisions at the end of life. At the same time, the usual, partly counterintuitive legal definitions should be brought more into line with medical decision making, while taking into account developments in English speaking areas. A transdisciplinary discourse is indispensable for the development of medical ethical and legal justifications suitable as guidance for action.

Adult↗

PubMed2004

[Development and validation of assessment instruments for shared decision making].

The German Ministry for Health and Social Security is funding ten projects to introduce shared decision making into clinical practice. The medical problems the projects are focussing on were chosen from among various diseases (e. g. depression, multiple sclerosis, cancer). The ten projects achieved consensus on a core set of instruments for the measurement of process and outcome of the shared decision making. Instruments developed in German-speaking countries are currently not available. Thus, linguistic and cultural validation had to be performed for the core set instruments. The results of the data analysis as well as patient interviews demonstrate the need for improving these instruments. Therefore, the members of the methodological working group concentrated on the integration of these results in a new instrument. In a first step the construct of "shared decision making" was defined, followed by a definition of the process elements characterising shared decision making. Thereafter, items were developed on the basis of the process elements. The new instrument will now be validated for different diseases.

Decision Making↗

PubMed2004

[Patients as partners. Tumor patients and their participation in medical decisions].

Between March 2002 and August 2003 as part of the research project "Patients as partners -- tumour patients and their participation in medical decisions" tumour patients undergoing palliative therapy (n=272) were interviewed and asked about their level of information, their desired place to die and whether they had prepared an advance directive. Furthermore, 72 relatives of deceased patients who had been looked after by the project's palliative care team were given a similar questionnaire including questions concerning their knowledge about disease and prognosis, the actual place of death and the relevance of advance directives. According to patients and relatives, information particularly about prognosis is unsatisfactory. Of the inter-viewed patients, 75% said they wanted to die at home and 15% in a hospital. According to their relatives, 36% of the patients looked after by the palliative care team had an advance directive. The survey of the relatives showed a significant relation between the preparation of an advance directive and dying at the desired place. According to the relatives, medical and health reasons, hope for an improvement up to the very end,acute worsening of the condition and deficits in medical care were important reasons for dying in hospital against the patient'swish. In future, advance directives should be used as an aid for communication and the planning of care. Therefore, cooperation between doctors and patients based on a partnership is necessary. The required competence in communication should be improved.

Adolescent↗

PubMed2003

[Ambulant care of patients in the terminal phase of malignant tumor: answers by general practioners in Thuringia to a questionnaire].

BACKGROUND AND OBJECTIVE: Palliative care and care of the dying are not widely taught in medical education. Yet, through the guidelines of the Federal Medical Council (Bundesärztekammer), doctors are obliged professionally to accompany the dying process. Systematic studies concerning doctors' motivation and action in this special situation are rare. This study aims to evaluate the views and attitudes of general practitioners towards the care for cancer patients in the terminal stage of disease. METHODS: In association with the project of the German Ministry of Health "Patienten als Partner-Tumorpatienten und ihr Mitwirken in medizinischen Entscheidungen" ("Patients as partners: patients with malignant tumor and their collaboration in medical decision making"), a questionnaire was designed for general practitioners based on qualitative interviews. The self-guiding questionnaire comprised questions concerning death and dying, patient-doctor relationship and day-to-day medical actions. RESULTS: 505 general practitioners (GPs) received the questionnaires. 170 were filled in and sent back (33%). The GPs felt responsible for the care of the dying patients. Pain control was the main goal (97%). Symptom control was thought to be important/very important in 87%, the application of life-prolonging measures in 12 %. Basic analgesic medication was prescribed by 93% of GPs. 89%/77% of the general practitioners answered that they were satisfied with the technical equipment of the hospital/clinic, whereas there was a dissatisfaction with psychological and spiritual support. CONCLUSION: General practitioners widely accept their responsibility for the care of the dying patients. Pain control is the major goal in this group of patients. Some items (use of co-analgesia, prescription of peak analgesia) seem to be open to improvements. Despite a high motivation, general practitioners show their dissatisfaction with some aspects of the care for dying people. Palliative care teams could be helpful in this situation.

Ambulatory Care↗