Attitudes and behaviors of Japanese physicians concerning withholding and withdrawal of life-sustaining treatment for end-of-life patients: results from an Internet survey.
BACKGROUND
Evidence concerning how Japanese physicians think and behave in specific clinical situations that involve withholding or withdrawal of medical interventions for end-of-life or frail elderly patients is yet insufficient.


METHODS
To analyze decisions and actions concerning the withholding/withdrawal of life-support care by Japanese physicians, we conducted cross-sectional web-based internet survey presenting three scenarios involving an elderly comatose patient following a severe stroke. Volunteer physicians were recruited for the survey through mailing lists and medical journals. The respondents answered questions concerning attitudes and behaviors regarding decision-making for the withholding/withdrawal of life-support care, namely, the initiation/withdrawal of tube feeding and respirator attachment.


RESULTS
Of the 304 responses analyzed, a majority felt that tube feeding should be initiated in these scenarios. Only 18% felt that a respirator should be attached when the patient had severe pneumonia and respiratory failure. Over half the respondents felt that tube feeding should not be withdrawn when the coma extended beyond 6 months. Only 11% responded that they actually withdrew tube feeding. Half the respondents perceived tube feeding in such a patient as a "life-sustaining treatment," whereas the other half disagreed. Physicians seeking clinical ethics consultation supported the withdrawal of tube feeding (OR, 6.4; 95% CI, 2.5-16.3; P < 0.001).


CONCLUSIONS
Physicians tend to harbor greater negative attitudes toward the withdrawal of life-support care than its withholding. On the other hand, they favor withholding invasive life-sustaining treatments such as the attachment of a respirator over less invasive and long-term treatments such as tube feeding. Discrepancies were demonstrated between attitudes and actual behaviors. Physicians may need systematic support for appropriate decision-making for end-of-life care.
Bito
Seiji
S
National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan. bitoseiji@kankakuki.go.jp
Asai
Atsushi
A
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003128:Coma; D003657:Decision Making / Q000941:ethics; D004750:Enteral Nutrition / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly; D019538:Health Care Surveys; D006801:Humans; D020407:Internet; D007564:Japan; D008020:Life Support Care / Q000941:ethics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000941:ethics / Q000523:psychology*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D020521:Stroke / Q000150:complications*; D013727:Terminal Care / Q000941:ethics / Q000379:methods*; D028761:Withholding Treatment / Q000941:ethics / Q000706:statistics & numerical data