Akademik Veri Yönetim Sistemi
Cevizci M., User I., Demir F., Işıl Ülman F. Y. (Yürütücü)
Diğer Özel Kurumlarca Desteklenen Proje, 2018 - 2019
An Approach to Patients at the end of life through physicians’ experiences and views:, a qualitative study.
Metin Cevizci, İnci User, Figen Demir, Yesim Isil Ulman
Introduction
and Aims
Patients at the end life may encounter
hardships straining their physical, mental integrity. Physicians who are to provide
healthcare for them may experience impasse to develop strategies how to
approach the patients at the end of life. It may not be easy to make decisions
for the patients to ease their pains, to increase their quality of life, and to
assist them for an honourable end. This study aims to understand the problems,
difficulties, experiences of physicians facing dilemmas in making decisions for
the dying patients, and to explore the notion of ‘dying as dignified and
comfortable as possible’ (1).
Methods
This is an ongoing qualitative
study. The sample consists of physicians working in intensive care, cardiology,
oncology and nephrology in different hospitals of Istanbul. Data are generated
via in-depth interviews (so far nine) that focus on views and experiences
regarding decision making and related problems at the end of life.
Preliminary
Results
1.
In
Turkey, hospices and palliative care centers do not exist and their functions
are carried out by intensive care units which are not appropriate to integrate
families to the treatment processes. Hence, families have certain doubts about
treatment and imminent decisions, and they experience conflicts with physicians.
2.
Different
specialists are convinced that the act of saying the truth about disease is the
responsibility of others.
3.
The
lack of support for doctors: Doctors construct their communication frameworks
in practice by trial and error. They are not psychologically supported in their
professional experiences which have traumatic influences on them.
4.
There
are some codes of communication between doctors and patients’ relatives and
they are unequally distributed among people from different social backgrounds.
Conclusion
For a more effective and
ethically acceptable framework for end of life decisions the Turkish health
system needs an organizational transformation. Governmental policies and
institutions (hospitals, nursing homes) should serve the patients’ good
(principle of beneficence), promote appropriate treatment and equitable access
to end of life care. Resources for end of life care, which are costly and
limited, should be allocated as fairly as possible among patients (2).
Sources:
1. 1. World Medical Association Declaration of Lisbon on the Rights of the Patient https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/ Accessed 08.04.2018.
2. End of Life Care Symposium
Booklet, Introducing the Council of Europe’s “Guide on the
decision-making process regarding medical treatment in end-of-life situations”,
jointly organized by the Council of Europe and Acibadem University, Istanbul,
25 October 2016.
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Yaşamın Sonundaki Hastalara Yaklaşım: Hekimlerin Deneyimleri ve Bakış Açıları, Niteliksel bir Araştırma
İyileşme olasılığı kalmamış olan hastalar, yaşamlarının sonunda, bedensel ve ruhsal bütünlüklerini zorlayan bir süreç yaşayabilir. Bu durumdaki hastalara hizmet sunmakla yükümlü hekimler de hastalarına yaklaşım konusunda birçok sorun ve açmazla karşı karşıya kalabilirler. Hastalar için kararlar almak, onların acılarını dindirerek yaşam kalitelerini arttırmak ve onurlu bir son için yardımcı olmak kolay olmayabilir. Bu araştırmanın amacı, hekimlerin yaşamın sonuna yaklaşan hastalar konusundaki deneyimlerini, bu süreçte neler yapmayı istediklerini, hangi sorunlarla karşılaştıklarını ve neler hissettiklerini anlamak; ve bir hasta hakkı olan “onurlu ve rahat ölüm” hakkının (World Medical Association Declaration of Lisbon, on the Rights of the Patient, madde: 10-c http://www.wma.net/en/30publications/10policies/l4/index.html; erişim: 22.08.2016) klinik ortamdaki karşılığını incelemektir.
Araştırma niteliksel yöntemle yapılacak, katılımcılar bir hekim grubu olacaktır. Veri oluşturma tekniği bireysel derinlemesine görüşme olarak öngörülmüştür.