투석 보류와 투석 중단의 결정에 대한 의사들의 태도 = Attitudes of Dialysis Unit Physicians with Regard to Withholding and Withdrawing Dialysis

다국어 초록 (Multilingual 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.

국문 초록 (Abstract)

목 적:국외의 경우 사전의사결정서와 투석 보류 및 중단 지침을 통해 환자와 의료진 모두 투석 중단에 대한 갈등과 고민을 최소화하고자 하고 있다. 그러나 아직 국내에서는 투석 중단에 대한 연구가 거의 없다. 이에 저자들은 신장내과 의사들의 투석 보류와 중단에 대한 태도를 알아보고자 본 연구를 시행하였다.
방 법:2006년 1월부터 2008년 1월까지 내과의원, 종합병원, 대학병원에서 투석환자를 진료하는 내과의사 45명을 대상으로 투석 보류와 중단에 대한 설문 조사를 시행하였다. 투석 보류와 중단에 대한 항목은 Likert식의 5점 척도로 구성되었고　투석 치료에 관한 사전의사결정서 작성과 투석중단 가이드라인 필요성에 대한 항목은 3점 척도로 구성되었다결 과:투석 보류와 중단 모두의 경우에서 치매 환자보다 식물상태 환자에서 더 강하게 동의하는 것으로 나타났다. 의식 상태가 명료한 말기 신질환 환자가 투석을 원하지 않을 경우 투석을 중단하는 것에 동의하는 것보다 시작을 보류하는 것에 더 강한 동의를 보였다. 하지만 치매나 식물상태의 경우에는 투석 보류와 중단 요구간에 대상자의 태도에는 의미 있는 차이가 없었다. 투석 시작 전 투석 중단에 관한 사전 의사 결정서에 대해서는 반대의견이 더 많았으나 투석 보류와 중단 가이드라인 제정에 대해서는 대부분 찬성하였다.
결 론:환자의 신경학적 이상에 따라 투석유보와 중단에 대해서 상반된 태도를 보였으나 투석 보류와 중단에 대한 지침의 필요성에서 대부분 찬성하였다.

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