Kvalita péče v závěru života hospitalizovaných je v českém prostředí zatím málo prozkoumané téma. Cílem studie bylo zmapovat proces rozhodování o péči v závěru života pacientů ve vybraných českých zdravotnických zařízeních. Byly zahrnuty údaje získané ze zdravotnické dokumentace 240 zemřelých (průměrný věk 76,9 let, 41,6 % žen). Výzkumný soubor lékařů, kteří se vyjadřovali k rozhodování o péči v závěru života u těchto pacientů, tvořilo 369 lékařů (průměrný věk 35,9 let, 61 % žen). Výsledky poukázaly na přetrvávající rezervy v písemném zaznamenávání rozvahy o cílech péče, prognózy a případném rozhodnutí o limitaci péče. Lékaři limitují zdravotní péči primárně na základě konsensu mezi lékaři, pacient většinou není do procesu rozhodování přizván. Preference pacientů pro období závěru života nejsou ve většině případů zjišťovány, případně je tato otázka odkládána. Institut dříve vysloveného přání se ve zkoumaném souboru neobjevil. Rozhodování o péči v závěru života se většinou odehrává bez znalosti hodnot a preferencí pacientů. Výstupy svědčí o potřebě zkvalitnění profesní přípravy lékařů a mediků, jež by měla kromě budování odborných kompetencí zahrnovat nácvik efektivní komunikace s pacienty v závěru života.
The quality of end-of-life care of hospitalized patients is an important topic, but so far little explored in the Czech Republic. The aim of this study was to map the factors influencing the end-of-life care decision-making process in selected Czech hospitals and to describe it based on data from medical records and from the perspective of a doctor. The research included data obtained from the medical records of 240 deceased patients (mean age 76.9 years, 41.6% women). The research sample of medical doctors who commented on the decision-making about end-of-life care for these patients consisted of 369 physicians (mean age 35.9 years, 61% women). The results pointed to persistent deficiencies in the written recording of the care goals, prognosis, and possible decision to limit care. Medical doctors limit health care primarily based on consensus among physicians, the patient is usually not invited to the decision-making process. Patient preferences for the end-of-life period are in most cases not ascertained or this question is postponed. The institute of a previously stated wish did not appear in the examined group at all. It can be concluded that decisions about end-of-life care usually take place without knowledge of patients' values and preferences. The results indicate the need to improve the training of doctors and medical students, which should, in addition to building professional competencies, include training in effective communication with patients at the end of life.
The end of life care is recently regarded as a highly important research area in psychological disciplines such as medical psychology and thanatology. Psychosocial aspects, in addition to medical factors, also play a role in the care of dying patients and need to be better understood and taken into account in practice. The aim of this review was to explore psychosocial factors that influence the end of life care and decision-making process of physicians based on a literature review. Databases MEDLINE/Pubmed, Scopus a ProQuest Health and Medical Collection were systematically searched for a literature review. Considering selection criteria, the authors employed twenty-eight studies in English. Based on them, they identified the following physician-related psychosocial factors that affect processes: gender, age, professional experience and practice, spirituality, attitudes and beliefs, specialization, education and experience in end of life care, sociocultural and work environment. The authors then summarized the terminology of theoretical concepts used in the chosen studies and pointed out their heterogeneity. Research attention in this area and application of knowledge should lead to consideration of psychosocial factors affecting the end of life care and to improve the quality of life in patients, their family members, and health professionals as well. The findings can also serve as a valuable enrichment of the knowledge base for teaching undergraduate psychology students, participants in qualification course Psychologist in Health Care, and medical students.
