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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2011 February;77(2):172-9
Prehospital emergency physicians’ experiences with advance directives in Germany: A questionnaire-based multicenter study
Wiese C. H. R. 1, Bartels U. E. 2, Ruppert D. B. 3, Graf B. M. 1, Hanekop G. G. 4 ✉
¹ Department of Anesthesiology, University Medical Center Regensburg, Regensburg Germany;
2 Department of Cardiac Anesthesiology, University Medical Center Ulm, Ulm, Germany;
3 Department of Anesthesiology, Medical Center Lüneburg, Lüneburg, Germany;
4 Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany
BACKGROUND: Palliative medical emergencies and end-of-life decisions resulting from the exacerbation of cancer account for approximately 3% of all out-of-hospital emergency applications in Germany. Therefore, prehospital emergency physicians (EP) may be confronted with advance directives and ethical and end-of-life decisions. The purpose of the study was to identify EPs’ knowledge about ethical and end-of-life decisions and their legal education and experiences concerning advance directives.
METHODS: Over a six-month period, we questioned all 150 EPs from three emergency medical services (Braunschweig, Göttingen und Kaiserslautern). An anonymous, self-administered questionnaire with a mixed-methods design was used. The main outcome measures included responses regarding experiences related to advance directives and end-of-life decisions in palliative care patients. For statistical assessment, EPs were divided into three categories: competent, skilled, and unskilled.
RESULTS: A total of 104 EPs returned the questionnaire (response rate 69%). Eighty-nine percent of the respondents treated patients who had advance directives. The existence of an advance directive influenced the EP’s therapy decision in about 77% of their encounters. Eighty-seven percent of the EPs reported the need for defined end-of-life care pathways and/or standard operating procedures. Eighty-two percent desired educational training concerning end-of-life decisions and the validity of advance directives.
CONCLUSION: The prehospital emergency treatment of palliative care patients can be particularly challenging for any EP. A high percentage of the EPs in our study felt insecure in dealing with advance directives and ethical and end-of-life decisions in palliative care patients. Our results suggest that EPs may need more information and education about palliative medical care, legal issues and ethical and end-of-life decisions to provide adequate patient-oriented palliative care in prehospital emergency situations.