20.500.12556/ReVIS-11059 SPREJEMANJE ODLOČITVE ZA PRENEHANJE MEDICINSKO NEUTEMELJENEGA ZDRAVLJENJA MAKING A DECISION TO STOP MEDICALLY UNFOUNDED TREATMENT Teoretična izhodišča: Opustitev zdravljenja je pomembno etično in pravno vprašanje, zlasti kadar to ne prinaša več koristi za bolnika. Pri bolnikih s kroničnimi ali terminalnimi boleznimi je nadaljevanje invazivnega zdravljenja pogosto neupravičeno, saj poslabšuje kakovost življenja. Namen raziskave je analizirati standardizirane obrazce za sprejemanje odločitve o prenehanju medicinsko neutemeljenega zdravljenja na internistični prvi pomoči Univerzitetnega kliničnega centra Ljubljana. Cilj je raziskati pobudo za prenehanje zdravljenja, bolnikovo zmožnost odločanja oziroma vnaprejšnjo voljo ter analizirati diagnoze in predlagane opustitve zdravljenja. Metode: Uporabljena sta kvantitativni raziskovalni pristop in deskriptivna metoda dela. Raziskovalni vzorec obsega 747 standariziranih obrazcev internistične prve pomoči iz leta 2023. Zbrani podatki so bili računalniško obdelani in prikazani s programom Microsoft Excel. Rezultati: V letu 2023 je bilo na IPP UKCLJ pregledanih 23.454 bolnikov, pri 747 je bil sklican konzilij o prenehanju zdravljenja. Največkrat je bila pobuda podana s strani zdravnikov (68,1 %). Več kot 62 % bolnikov ni bilo sposobnih odločanja, vnaprej izražena volja pa je bila redko prisotna (2,5 %). Najpogosteje je bila predlagana opustitev oživljanja in intubacije (99,7 %). V redkih primerih je bila predlagana odtegnitev zdravljenja, najpogosteje mehanske ventilacije (2 %). Glavna diagnoza za prenehanje zdravljenja je bila akutna respiratorna insuficienca (30 %), med pogostimi simptomi sta bili še nepokretnost in demenca. Razprava: Prenehanje zdravljenja je bistven dejavnik za izboljšanje kakovosti oskrbe in učinkovito rabo virov v zdravstvu. Medicinsko neutemeljeno zdravljenje je tisto, ki nima znanstveno potrjenih koristi oziroma upravičenosti. Poleg kliničnih argumentov je prenehanje neučinkovitih postopkov pomembno tudi z etičnega in ekonomskega vidika, saj omogoča pravično razporeditev zdravstvenih virov. Theoretical background: Withdrawal from treatment is an important topic with ethical and legal issues, especially when it is no longer beneficial. In patients with chronic or terminal diseases, continuing invasive treatment is often unjustified as it impairs quality of life. The aim of the study is to analyse standardised forms on decision-making about the discontinuation of medically unjustified treatment at the Internists' Emergency Department of the University Medical Centre Ljubljana. The aim is to investigate the initiative to discontinue treatment, the patient's decision-making capacity and advance will, to analyse diagnoses and proposed treatment discontinuations. Methods: The research adopts a quantitative research approach and a descriptive method of work. The survey sample includes 747 standardised internal medicine first aid forms from the year 2023. The collected data were computerised and displayed using Microsoft Excel. Results: In 2023, 23,454 patients were screened at the UKCLJ IPP and 747 patients had a discontinuation conference. The initiative was most frequently taken by physicians (68.1%). More than 62% of patients were not able to make a decision, and advance volition was rarely present (2.5%). The most frequent suggestion was to discontinue resuscitation and intubation (99.7%). In rare cases, withdrawal of treatment was suggested, most commonly mechanical ventilation (2%). The main diagnosis for discontinuation of treatment was acute respiratory insufficiency (30%), with immobility and dementia being common symptoms. Discussion: Treatment interruptions are key to improving the quality of care and the efficient use of resources. Such treatments often lack proven benefits, which makes them difficult to justify. In addition to the clinical arguments, discontinuing treatments is also important from an ethical and economic point of view, as it allows for a fair allocation of health resources. internistična prva pomoč prenehanje zdravljenja paliativna oskrba evtanazija opustitev zdravljenja internal medicine first aid discontinuation of treatment palliative care euthanasia discontinuation of treatment true false false Slovenski jezik Angleški jezik Diplomsko delo/naloga 2024-11-29 18:22:20 2024-11-29 18:22:20 2025-01-09 08:45:17 0000-00-00 00:00:00 2024 0 0 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 1970-01-01 21118 221067779 DIP_Skocir_Zan_2024.pdf DIP_Skocir_Zan_2024.pdf 1 E18B537B72068A6618766AAFE5335D1C d2a8da5ea78b886e00335c36303fe8a86e30c9aac4e65df6d0501f0550bfb3d8 7df4875c-ae76-11ef-ba3f-001a4af901a5 https://revis.openscience.si/Dokument.php?lang=slv&id=12636 Univerza v Novem mestu - Fakulteta za zdravstvene vede 0 0 0