Physicians’ approach to end of life care: comparison of two tertiary care university hospitals in Lebanon

Abstract Background The care of terminally ill patients is fraught with ethical and medical dilemmas carried by healthcare professionals. The present study aims to explore the approaches of Lebanese attending physicians towards palliative care, end of life (EOL) care, and patient management in two t...

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Autores principales:	George Dabar, Imad Bou Akl, Mirella Sader
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	End-of-life decisions Terminal care Physicians Attitude Medical culture Special aspects of education LC8-6691 Medicine R
Acceso en línea:	https://doaj.org/article/0e504f2e03a64336b5169d5dbbd42de2
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spelling	oai:doaj.org-article:0e504f2e03a64336b5169d5dbbd42de22021-11-28T12:40:56ZPhysicians’ approach to end of life care: comparison of two tertiary care university hospitals in Lebanon10.1186/s12909-021-03022-x1472-6920https://doaj.org/article/0e504f2e03a64336b5169d5dbbd42de22021-11-01T00:00:00Zhttps://doi.org/10.1186/s12909-021-03022-xhttps://doaj.org/toc/1472-6920Abstract Background The care of terminally ill patients is fraught with ethical and medical dilemmas carried by healthcare professionals. The present study aims to explore the approaches of Lebanese attending physicians towards palliative care, end of life (EOL) care, and patient management in two tertiary care university hospitals with distinct medical culture. Methods Four hundred attending physicians from the American University of Beirut Medical Center (AUBMC) and Hotel Dieu de France (HDF) were recruited. Participants were Medical Doctors in direct contact with adult patients that could be subject to EOL situations providing relevant demographic, educational, religious as well as personal, medical or patient-centric data. Results The majority of physicians in both establishments were previously exposed to life-limiting decisions but remains uncomfortable with the decision to stop or limit resuscitation. However, physicians with an American training (AUBMC) were significantly more likely to exhibit readiness to initiate and discuss DNR with patients (p<0.0001). While the paternalistic medicinal approach was prevalent in both groups, physicians with a European training (HDF) more often excluded patient involvement based on family preference (p<0.0001) or to spare them from a traumatic situation (p=0.003). The majority of respondents reported that previous directives from the patient were fundamental to life-limiting decisions. However, the influence of patient and medical factors (e.g. culture, religion, life expectancy, age, socioeconomic status) was evidenced in the HDF group. Conclusion Early physician-initiated EOL discussions remain challenged in Lebanon. Paternalistic attitudes limit shared decision making and are most evident in European-trained physicians. Establishing a sound and effective framework providing legal, ethical and religious guidance is thus needed in Lebanon.George DabarImad Bou AklMirella SaderBMCarticleEnd-of-life decisionsTerminal carePhysiciansAttitudeMedical cultureSpecial aspects of educationLC8-6691MedicineRENBMC Medical Education, Vol 21, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	End-of-life decisions Terminal care Physicians Attitude Medical culture Special aspects of education LC8-6691 Medicine R
spellingShingle	End-of-life decisions Terminal care Physicians Attitude Medical culture Special aspects of education LC8-6691 Medicine R George Dabar Imad Bou Akl Mirella Sader Physicians’ approach to end of life care: comparison of two tertiary care university hospitals in Lebanon
description	Abstract Background The care of terminally ill patients is fraught with ethical and medical dilemmas carried by healthcare professionals. The present study aims to explore the approaches of Lebanese attending physicians towards palliative care, end of life (EOL) care, and patient management in two tertiary care university hospitals with distinct medical culture. Methods Four hundred attending physicians from the American University of Beirut Medical Center (AUBMC) and Hotel Dieu de France (HDF) were recruited. Participants were Medical Doctors in direct contact with adult patients that could be subject to EOL situations providing relevant demographic, educational, religious as well as personal, medical or patient-centric data. Results The majority of physicians in both establishments were previously exposed to life-limiting decisions but remains uncomfortable with the decision to stop or limit resuscitation. However, physicians with an American training (AUBMC) were significantly more likely to exhibit readiness to initiate and discuss DNR with patients (p<0.0001). While the paternalistic medicinal approach was prevalent in both groups, physicians with a European training (HDF) more often excluded patient involvement based on family preference (p<0.0001) or to spare them from a traumatic situation (p=0.003). The majority of respondents reported that previous directives from the patient were fundamental to life-limiting decisions. However, the influence of patient and medical factors (e.g. culture, religion, life expectancy, age, socioeconomic status) was evidenced in the HDF group. Conclusion Early physician-initiated EOL discussions remain challenged in Lebanon. Paternalistic attitudes limit shared decision making and are most evident in European-trained physicians. Establishing a sound and effective framework providing legal, ethical and religious guidance is thus needed in Lebanon.
format	article
author	George Dabar Imad Bou Akl Mirella Sader
author_facet	George Dabar Imad Bou Akl Mirella Sader
author_sort	George Dabar
title	Physicians’ approach to end of life care: comparison of two tertiary care university hospitals in Lebanon
title_short	Physicians’ approach to end of life care: comparison of two tertiary care university hospitals in Lebanon
title_full	Physicians’ approach to end of life care: comparison of two tertiary care university hospitals in Lebanon
title_fullStr	Physicians’ approach to end of life care: comparison of two tertiary care university hospitals in Lebanon
title_full_unstemmed	Physicians’ approach to end of life care: comparison of two tertiary care university hospitals in Lebanon
title_sort	physicians’ approach to end of life care: comparison of two tertiary care university hospitals in lebanon
publisher	BMC
publishDate	2021
url	https://doaj.org/article/0e504f2e03a64336b5169d5dbbd42de2
work_keys_str_mv	AT georgedabar physiciansapproachtoendoflifecarecomparisonoftwotertiarycareuniversityhospitalsinlebanon AT imadbouakl physiciansapproachtoendoflifecarecomparisonoftwotertiarycareuniversityhospitalsinlebanon AT mirellasader physiciansapproachtoendoflifecarecomparisonoftwotertiarycareuniversityhospitalsinlebanon
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Physicians’ approach to end of life care: comparison of two tertiary care university hospitals in Lebanon

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