Korean Journal of Nephrology 2009;28(1):13-18.
Attitudes of Dialysis Unit Physicians with Regard to Withholding and Withdrawing Dialysis
Yeong Seop Yun, M.D., Soon Hyo Kwon, M.D., Jae Myun Jung, M.D. Jin Seok Jeon, M.D., Hyun Jin Noh, M.D. and Dong Cheol Han, M.D.
Division of Nephrology, Busan Paik Hospital, College of Medicine, Inje University
임상연구 : 투석 보류와 투석 중단의 결정에 대한 의사들의 태도
윤영섭, 권순효, 정재면, 전진석, 노현진, 한동철
인제대학교 의과대학 내과학교실
Abstract
Purpose: In many countries, patients and dialysis unit physicians attempt to address issues regarding withholding and withdrawing dialysis through advance directives and clinical guidelines for dialysis utilization. However, there are only a few reports of withholding and withdrawing dialysis in Korea. This study was developed to investigate the attitudes of dialysis unit physicians regarding withholding and withdrawing dialysis in Korea. Methods: A questionnaire survey was conducted among 45 dialysis unit physicians from January, 2006 to January, 2008. Physicians were asked about their decision making process to withhold and withdraw dialysis, and their opinions regarding the necessities of advance directives and guidelines for withholding and withdrawing dialysis. Results: Analysis of surveys revealed that physicians agreed more about whether to withhold and withdraw dialysis in vegetative patients compared to patients with dementia (p<0.001, p<0.001). There were more agreements about whether to withhold dialysis than whether to withdraw dialysis in patients with unimpaired cognition (p<0.037). However, there were no differences in agreements between withholding and withdrawing dialysis in patients with severe neurological impairments. There appeared to be a general consensus regarding the need for guidelines addressing withholding and withdrawing dialysis (84.4%). However, opinions supporting the necessity for advance directives were not strongly favored (33.3%). Conclusion: Conflicting opinions are present among dialysis unit physicians regarding whether to withhold and withdraw dialysis according to a patient's neurological impairments. However, most dialysis unit physicians were of one accord regarding the need of guidelines for withholding and withdrawing dialysis.
Key Words: Withholding dialysis, Withdrawing dialysis, Advance directives
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