Artificial Nutrition and Hydration in Terminally Ill Patients with Advanced Dementia: Opinions and Correlates among Italian Physicians and Nurses

Valentini, Elisabetta; Giantin, Valter; Voci, Alberto; Iasevoli, Mario; Zurlo, Anna; Pengo, V.; Maggi, Stefania; Pegoraro, Renzo; Catarini, Massimo; Andrigo, Margherita; Storti, Matteo; Manzato, Enzo

doi:10.1089/jpm.2013.0616

Cited by 21 publications

(24 citation statements)

References 35 publications

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“…A new questionnaire was developed for the End of Life Decisions studY, and the Padua University Hospital ethical committee approved it. Previous publications reported findings on end‐of‐life decisions, communications between professionals, patients and families, and different opinions regarding artificial nutrition for advanced dementia patients …”

Section: Methodsmentioning

confidence: 99%

“…Previous publications reported findings on end-of-life decisions, 17 communications between professionals, patients and families, 18 and different opinions regarding artificial nutrition for advanced dementia patients. 19 The present study focuses on health professionals' opinions regarding AH, AT and AN for advanced dementia patients with different life expectancies. Though it is difficult to judge objectively the life expectancy in different patients and pathologies, we asked participants (in separate items) a subjective opinion whether they agreed that AT, AH or AN should be administered to patients with advanced dementia with a life expectancy more than 6 months, from 1 to 6 months or less than a month.…”

Section: Methodsmentioning

confidence: 99%

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Advanced dementia: opinions of physicians and nurses about antibiotic therapy, artificial hydration and nutrition in patients with different life expectancies

Pengo

Zurlo

Voci

et al. 2016

Geriatrics Gerontology Int

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Advanced dementia: opinions of physicians and nurses about antibiotic therapy, artificial hydration and nutrition in patients with different life expectancies

Pengo

Zurlo

Voci

et al. 2016

Geriatrics Gerontology Int

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“…Italian health care professionals seem to perceive artificial hydration as more of a basic care need than artificial nutrition. 36 However, it may well be possible that in many cases artificial hydration was implemented instead of tube feeding to minimize the family's anguish, for what Hoffer calls "cosmetic reasons". 37 However, the physicians stated they agreed with the decision.…”

Section: Typology Of Critical Decisionsmentioning

confidence: 99%

Critical Decisions for Older People With Advanced Dementia: A Prospective Study in Long-Term Institutions and District Home Care

Toscani¹,

Steen²,

Finetti³

et al. 2015

Journal of the American Medical Directors Association

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Objective. To describe and compare the decisions critical for survival or quality of life (CDs) made for patients with advanced dementia in nursing homes (NHs) and home care (HC) services.Design. Prospective cohort study with a follow-up of 6 months.Setting. Lombardy Region (NHs) and Reggio-Emilia and Modena Districts (HC), Italy.Participants. Patients (496 total; 315 in NHs and 181 in HC) with advanced dementia (Functional Assessment Staging Tool score >7) and expected survival >2 weeks.Measurements. At baseline, the patients' demographic data, date of admission and of dementia diagnosis, type of dementia, main co-morbidities, presence of pressure sores, ongoing treatments, and current prescriptions were abstracted from clinical records. At baseline and every 15 days thereafter, information regarding the patients' general condition and CDs (deemed critical by the doctor or team) was collected via interview with the doctor. For each CD, the physician reported the problem that led to the decision, the decision that was eventually made, the purpose of the decision, whether the decision had been discussed with and/or communicated to the family, who made the final decision, whether the decision was maintained after one week, whether it corresponded to what the doctor would have judged appropriate, and the expected survival of the patient (≤15 days).Results. For 267 of the 496 patients (53.8%; 60.3% in NHs and 42.5% at home), 644 CDs were made; for 95 patients, more than one CD was made. The problems that led to a CD were mainly infections (respiratory tract and other infections; 46.6%, 300/644 CDs); nutritional/hydration problems (20.6%; 133 CDs) and the worsening of a pre-existing disease (9.3%; 60 CDs). The most frequent type of decision concerned the prescription of antibiotics (overall 41.1%, 265/644; among NH patients 44.6%, 218/488; among HC patients, 30.2%, 47/156). The decision to hospitalize the patient was more frequently reported for HC than NH patients (25.5% vs. 3.1%). The most frequent purposes of the CDs in both settings were reducing symptoms or suffering (more so in NHs; 81.1 vs. 57.0% in HC) and prolonging survival (NH 27.5%; HC 23.1%; multiple purposes were possible). For 26 decisions (3.8%), the purpose was to ease death or not to prolong life. Conclusions.Decisions critical for the survival or quality of life of patients with advanced dementia were made for approximately half of the patients during a 6-month time frame, and such decisions were made more frequently in NHs than in HC. HC patients were more frequently hospitalized, and a sizeable minority of these patients were treated with the goal of prolonging survival. Italian patients with advanced dementia may benefit from the implementation of 5 palliative care principles, and HC patients may benefit from the implementation of measures to avoid hospitalizing patients near the end of life.

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“…27 Valentini ve ark.nın yaptığı çalışma sonucunda, insan onuruna saygının ihmal edilmesi ve yaşam sonu kararlara ilişkin etik sorunların yaşan-dığı saptanmıştır. 28 Diğer bir çalışma sonucunda ise insan onurunun ihlali, dürüstlüğün ihlali, kaynak yetersizliği, zaman yetersizliği, hekim ve hemşirelerin mesleki yetersizlikleri nedeni ile etik sorunların yaşandığı görülmüştür. 29 Robinson ve ark.…”

Section: çAlişmalardan Elde Edi̇len Bulgularunclassified

Ethical Problems in Palliative Care: A Systematic Review

Korhan¹,

Kırşan²,

Yıldırım³

et al. 2019

Turkiye Klinikleri J Med Ethics

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ünya Sağlık Örgütü'nün tanımına göre, palyatif bakım, yaşamı tehdit eden hastalığı olan ve bu hastalıklarla mücadele eden hasta ve hasta yakınlarının yaşam kalitelerini yükseltmeyi hedefleyen bir Palyatif Bakımda Etik Sorunlar: Bir Sistematik Derleme Ö ÖZ ZE ET T A Am ma aç ç: : Palyatif bakımda yaşanan etik sorunlara odaklanan mevcut literatürün gözden geçirilmesi ve çalışmalardan elde edilen verilerin sistematik biçimde incelenmesidir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışma

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Artificial Nutrition and Hydration in Terminally Ill Patients with Advanced Dementia: Opinions and Correlates among Italian Physicians and Nurses

Cited by 21 publications

References 35 publications

Advanced dementia: opinions of physicians and nurses about antibiotic therapy, artificial hydration and nutrition in patients with different life expectancies

Advanced dementia: opinions of physicians and nurses about antibiotic therapy, artificial hydration and nutrition in patients with different life expectancies

Critical Decisions for Older People With Advanced Dementia: A Prospective Study in Long-Term Institutions and District Home Care

Ethical Problems in Palliative Care: A Systematic Review

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