Influencia del nivel de estudios alcanzado en alumnos de Medicina sobre la percepción de la necesidad de tratamientos de soporte al final de la vida

ABSTRACT : Objectives: The limitation of therapeutic effort during end-of-life care has been object of an intense debate throughout the medical community. The aim of this study was to analyse the different perspectives of medical students regarding these topics and identify characteristics associated with them. Methods: Q methodology analysis was performed to find profiles. A chi-square test was used to compare proportions. Results: 143 students participated. We obtained three opinion profiles. The first of the profiles seeks to ensure quality of life and attaches great importance to the patient’s will; the second one puts life extension above anything else; and the third one advocates an equitable health system with no room for special cases. Those students who have religious beliefs are included in profile 2 in a greater proportion (48.8% vs 27.5%), while those who claim not to be religious or consider their beliefs do not influence their ethical principles are primarily included in profile 3 (48.5% vs 29.2%). Conclusion: Three profiles were identified on end-of-life care. Given the influence of beliefs and academic training on these viewpoints, the reinforcement of bioethics and health economics contents in medical schools’ curricula would contribute to developing more knowledge-based opinion profiles.RESUMEN : Objetivos: La limitación del esfuerzo terapéutico en el contexto de los tratamientos de soporte al final de la vida ha generado un intenso debate en la comunidad médica. El objetivo de este estudio fue analizar los diferentes puntos de vista de los estudiantes de medicina sobre estos temas, e identificar características asociadas con los mismos. Métodos: Se realizó un análisis con metodología Q para hallar perfiles. Para comparar proporciones se utilizó un test chi-cuadrado. Resultados: 143 estudiantes participaron. Se obtuvieron tres perfiles de opinión. El primero de ellos busca garantizar la calidad de vida y el respeto a la voluntad del paciente; el segundo valora la extensión de la vida por encima de todo; y el tercero aboga por un sistema de salud equitativo, sin espacio para casos especiales. Los estudiantes que tienen creencias religiosas se incluyen en el perfil 2 en una mayor proporción (48.8% vs 27.5%), mientras que aquellos que no son religiosos o consideran que sus creencias no influyen sus principios éticos pertenecen principalmente al perfil 3 (48.5% vs 29.2%). Conclusión: Tres perfiles con respecto a los tratamientos de soporte al final de la vida fueron identificados. Considerando la influencia de las creencias y la formación académica en estos puntos de vista, el refuerzo de los contenidos de bioética y economía sanitaria en las facultades de medicina contribuiría a desarrollar perfiles de opinión más basados en el conocimiento.Grado en Medicin

Perception of Medical Students on the Need for End-of-Life Care: A Q-Methodology Study

End-of-life care and the limitation of therapeutic effort are among the most controversial aspects of medical practice. Many subjective factors can influence decision-making regarding these issues. The Q methodology provides a scientific basis for the systematic study of subjectivity by identifying different thought patterns. This methodology was performed to find student profiles in 143 students at Cantabria University (Spain), who will soon deal with difficult situations related to this topic. A chi-square test was used to compare proportions. We obtained three profiles: the first seeks to ensure quality of life and attaches great importance to the patient's wishes; the second prioritizes life extension above anything else; the third incorporates the economic perspective into medical decision-making. Those who had religious beliefs were mostly included in profile 2 (48.8% vs. 7.3% in profile 1 and 43.9% in profile 3), and those who considered that their beliefs did not influence their ethical principles, were mainly included in profile 3 (48.5% vs. 24.7% in profile 1 and 26.8% in profile 2). The different profiles on end-of-life care amongst medical students are influenced by personal factors. Increasing the clinical experience of students with terminally ill patients would contribute to the development of knowledge-based opinion profiles and would avoid reliance on personal experiences.Funding: This research received a grant from the Spanish Minister of Education (Beca de colaboración