Practice of end-of-life care for patients with advanced dementia by hospital physicians and nurses: Comparison between medical and surgical wards.
Practice of end-of-life care for patients with advanced dementia by hospital physicians and nurses: Comparison between medical and surgical wards.
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DOI：
10.1177/14713012221077533
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发表时间：
2022-05
影响因子：
2.4
通讯作者：
Dekeyser-Ganz, Freda
中科院分区：
文献类型：
--
作者：
Erel, Meira;Marcus, Esther-Lee;Dekeyser-Ganz, Freda
晚期痴呆患者通常在急性护理病房住院，但有关向这一人群提供的临终（EOL）护理的数据有限。该研究的目的是检查由医生和护士报告的在急性病房住院的晚期痴呆患者的EOL护理。参加者是以色列两所三级医院内科和外科病房的医生和护士。参与者完成了一份自我报告问卷，评估老年痴呆症患者的终末期护理经验，知识，表现，评估，沟通和感知徒劳的护理。315名供应商填写了问卷。有190名内科病房的受访者和125名来自普通外科病房。其中，48.6%的人认为痴呆症是一种绝症，而26.0%的参与者报告说，他们知道不到10%的患者的临终偏好。在提供者中，53.3%的人报告说，临终病房的讨论只发生在有生命威胁的情况下，11.1%-16.5%的人从来没有从事临终沟通有关EOL患者的喜好，为患者指定律师，疾病轨迹或姑息治疗的本质，与患者或其代表。只有17.1%的人报告说“从不”为晚期痴呆患者提供他们认为无效的护理。控制性别，年龄，角色，职位（高级/初级），并暴露于晚期痴呆患者，外科病房受访者报告说，在姑息治疗的几乎所有方面，比内科病房受访者进行更少的EOL护理。尽管越来越多的关注，一个显着的一部分工作人员在急性护理病房没有报告应用EOL护理晚期痴呆患者在临床实践中，特别是外科病房的工作人员。
Patients with advanced dementia are commonly hospitalized in acute care wards, yet there is limited data regarding the end-of-life (EOL) care delivered to this population. The aim of the study was to examine EOL care delivered to patients with advanced dementia hospitalized on acute wards as reported by physicians and nurses. Participants were physicians and nurses from medical and surgical wards of two tertiary hospitals in Israel. Participants completed a self-report questionnaire evaluating EOL care experiences, knowledge, performance, assessment, communication, and perceived futile care regarding patients with dementia. The questionnaire was completed by 315 providers. There were 190 medical ward respondents and 125 from general surgical wards. Of them, 48.6% recognized dementia as a terminal disease, while 26.0% of the participants reported that they knew the end-of-life preferences for less than 10% of their patients. Among the providers, 53.3% reported that end-of-life ward discussions took place only when there was a life-threatening situation and 11.1%–16.5% never engaged in end-of-life communication regarding EOL patient’s preferences, appointing an attorney for the patient, disease trajectory or the essence of palliative care, with patients or their representatives. Only 17.1% reported “never” performing care they considered to be futile for patients with advanced dementia. Controlling for gender, age, role, position (senior/junior), and exposure to patients with advanced dementia, surgical ward respondents reported performing less EOL care than medical ward respondents in almost all aspects of palliative care. Despite growing attention, a significant portion of staff in acute care wards do not report applying EOL care to patients with advanced dementia in clinical practice, especially surgical ward staff.
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DOI：
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