Obstinación terapéutica en pacientes geriátricos: estudio fenomenológico de experiencias de médicos en Jalisco, México

Abstract

ObjectiveTo understand the experiences of physicians with regard to therapeutic obstinacy in geriatric patients from Jalisco, Mexico. MethodA phenomenological research study of physicians of public and private second level hospitals from Jalisco, Mexico, during 2015. A purposive sample obtained by snowball technique was studied, obtaining seven participants with clinical experience in geriatric patients and therapeutic obstinacy cases. Semi-structured interviews were performed and recorded, manually transcribed and analysed with Atlas.ti©6 software, according to the phenomenological method proposed by Husserl. ResultsFive categories emerged: concept of therapeutic obstinacy, decision-making process, microsocial facilitators, macrosocial facilitators and the concept of dying well. The participants conceived therapeutic obstinacy as a negative and useless event. Decision-making around this phenomenon is influenced by microsocial facilitators as well as the wishes of the patients and their relatives, and by macrosocial facilitators such as the negative meaning of death as a consequence of medical tasks and as an indicator of hospital performance, and the lack of training for doctors to understand their patients and to communicate their ideas around dyingwell. Dying well was referred to as a natural process, linked to family, and entailed preventing pain during death. ConclusionsThe physicians who experienced therapeutic obstinacy with geriatric patients perceived this phenomenon as undesirable and recognised that it is facilitated by micro and macrosocial factors that interfere with dying well.