Attitudes of Dialysis Unit Physicians with Regard to Withholding and Withdrawing Dialysis

Yun, Yeong Seop; Kwon, Soon Hyo; Jung, Jae Myun; Jeon, Jin Seok; Noh, Hyun Jin; Han, Dong Cheol

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.