End of life treatment decisions in people with dementia: carers' views and the factors which influence them

Potkins, Dawn; Bradley, Sonia; Shrimanker, Jay; O’Brien, John T.; Swann, Alan; Ballard, Clive

doi:10.1002/1099-1166(200011)15:11<1005::aid-gps223>3.0.co;2-0

Cited by 24 publications

(15 citation statements)

References 9 publications

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“…Studies summarized in table 3 [28,32,38,39] investigated the attitudes of family members toward various life-sustaining interventions. The attitudes were similar to those of patients: antibiotics were the treatment that family members were least willing to forgo.…”

Section: Attitudes Of Familiesmentioning

confidence: 99%

Ethical Issues Relating to the Use of Antimicrobial Therapy in Older Adults

Marcus¹,

Clarfield

Moses

2001

CLIN INFECT DIS

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This article aims to review the literature relating to the ethics of antibiotic prescription decisions in older adults and to offer some suggestions as to how one might approach these difficult problems. According to many studies, most patients and their family members wish to receive antibiotics even when they are terminally ill or suffering from advanced dementia. Health care professionals are also frequently reluctant to deny the use of antibiotics in such situations. We suggest that the difficult decisions regarding whether one should withhold treatment can be based on consideration of the ethical principles of autonomy, beneficence, nonmaleficence, and justice. From the public health point of view, one should also take into account the need to avoid the emergence of antimicrobial resistance, keeping in mind the balance between the benefit to the specific patient and the cost to future patients. Infectious diseases consultants should actively participate in these ethical dilemmas.

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Section: Attitudes Of Familiesmentioning

confidence: 99%

Ethical Issues Relating to the Use of Antimicrobial Therapy in Older Adults

Marcus¹,

Clarfield

Moses

2001

CLIN INFECT DIS

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“…7 Research to date has focused on end-of-life (EOL) decision making in the setting of dementia and delirium. 8,9 However, less severe cognitive impairment that frequently accompanies late-stage cancer often goes unrecognized by physicians. 10 The impact of such common yet subtle degrees of cognitive impairment on decisions and care at the EOL has remained largely unexplored.…”

Section: Introductionmentioning

confidence: 99%

Minor Cognitive Impairments in Cancer Patients Magnify the Effect of Caregiver Preferences on End-of-Life Care

Gào

Prigerson

Diamond

et al. 2013

Journal of Pain and Symptom Management

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Context Cognitive impairment commonly affects cancer patients. Objectives To examine whether minor cognitive impairment in patients with advanced cancer is associated with the intensity of end-of-life (EOL) care or modifies the influence of patient and caregiver preferences on the intensiveness of EOL care. Methods Data were derived from structured interviews with 221 advanced cancer patient-caregiver dyads in the Coping with Cancer Study, a multi-site, longitudinal cohort study. Deficits in patients’ cognitive function were identified using the Short Portable Mental Status Questionnaire (SPMSQ). Patients and caregivers reported preferences regarding life-extending versus symptom-directed care. Information regarding EOL care was obtained from post-mortem interviews with caregivers. Logistic regression analyses modeled main and interactive effects of patients’ cognitive impairment and patients’ and caregivers’ treatment preferences on intensive EOL care. Results Cognitive impairment was associated with less intensive EOL care (OR=0.56; 95% CI, 0.34–0.91). Patients and caregivers had poor agreement regarding preferences for lifeextending versus symptom-directed care (Φ=0.10; χ2=2.32, df=1, P=0.13). Patient preference for life-extending care predicted intensive EOL care irrespective of cognitive status (AOR=2.11; 95% CI, 1.04–4.28). For patients with no errors on the SPMSQ, caregiver preference for life-extending care was unrelated to intensive EOL care (AOR=0.40; 95% CI, 0.09–1.77). However, the association between caregiver preference for life-extending care and intensive EOL care increased by nearly a factor of seven for every error on the SPMSQ (interaction AOR=6.90; 95% CI, 1.40–34.12). Conclusion Cognitive impairment in patients with advanced cancer is associated with less intensive EOL care. Caregivers’ influence on intensive EOL care dramatically increases with minor declines in patients’ cognitive function.

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“…Limitations of this earlier work include the utilization of hypothetical scenarios to investigate surrogate decision-making8, 9, retrospective study designs6 and small sample sizes 8. The types of decisions actually confronted by surrogates of NH residents in the final end-stages of dementia and the quality of the decision-making process have never been rigorously described.…”

Section: Introductionmentioning

confidence: 99%

Healthcare Proxies of Nursing Home Residents with Advanced Dementia: Decisions They Confront and Their Satisfaction with Decision‐Making

Givens

Kiely

Carey

et al. 2009

J American Geriatrics Society

101

125

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Objectives-To describe the medical decisions confronting health care proxies (HCPs) of nursing home (NH) residents with advanced dementia and identify factors associated with greater decisionmaking satisfaction.Design-Prospective cohort study. Setting-22Boston-area NHs. Participants-323 NH residents with advanced dementia and their HCPs.Measurements-Decisions made by HCPs over 18-months were ascertained quarterly. After making a decision, HCPs completed the Decision Satisfaction Inventory (DSI) (range 0-100). Independent variables included HCP and resident sociodemographics, health status, and advance care planning. Multivariable linear regression identified factors associated with higher DSI scores (greater satisfaction).Results-Of 323 HCPs, 123 (38.1%) recalled making at least one medical decision. A total of 232 decisions were made, concerning feeding problems (27.2%), infections (20.7%), pain (12.9%), dyspnea (8.2%), behavior problems (6.9%), hospitalizations (3.9%), cancer (3.0%) and other complications (17.2%). The mean DSI score was 78.4 ± 19.5 (SD), indicating high overall satisfaction. NH provider involvement in shared decision-making was the area of least satisfaction. In adjusted analysis, greater decision-making satisfaction was associated with the resident living on a special care dementia unit (p=0.002), greater resident comfort (p=0.004), and the HCP not being the resident's child (p=0.02).Conclusion-HCPs of NH patients with advanced dementia can most commonly expect to encounter medical decisions relating to feeding problems, infections and pain. Inadequate support

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End of life treatment decisions in people with dementia: carers' views and the factors which influence them

Cited by 24 publications

References 9 publications

Ethical Issues Relating to the Use of Antimicrobial Therapy in Older Adults

Ethical Issues Relating to the Use of Antimicrobial Therapy in Older Adults

Minor Cognitive Impairments in Cancer Patients Magnify the Effect of Caregiver Preferences on End-of-Life Care

Healthcare Proxies of Nursing Home Residents with Advanced Dementia: Decisions They Confront and Their Satisfaction with Decision‐Making

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