Attitudes of physicians, nurses and relatives towards end-of-life decisions concerning nursing home patients with dementia
Attitudes of physicians, nurses and relatives towards end-of-life decisions concerning nursing home patients with dementia
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DOI：
10.1016/j.pec.2005.04.016
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发表时间：
2006-06-01
影响因子：
3.5
通讯作者：
van der Wal, G
中科院分区：
文献类型：
--
作者：
Rurup, ML;Onwuteaka-Philipsen, BD;van der Wal, G
目的：对于许多处于痴呆症晚期的疗养院患者来说，必须在他们生命的末期做出开始或放弃治疗的决定。对于参与这种决策的所有人来说，就哪一项决定最符合患者的利益达成一致，这是非常重要的。因此，有必要调查医生、护士和亲属对痴呆患者的临终医疗决策的态度，以便调整养老院的政策，以促进各方之间的对话和理解。方法：向医生、护士和养老院的痴呆患者家属提交关于人工营养和水合(ANH)、提前指令、加速死亡、自决和安乐死以及养老院政策的15份声明。然而，在一些问题上，决策的结果可能会有所不同。亲属比医生更重视提前指示，对加速死亡的态度更宽容。结论：虽然医生、护士和亲属都以患者的最大利益为指导，但宗教信仰、患者视角和责任的不同似乎会导致对临终决定的不同态度。实践启示：医生应该更公开地讨论临终决定。医生应该意识到对态度的影响，并将其纳入到关于临终决定的沟通中。(C)2005爱思唯尔爱尔兰有限公司。保留所有权利。
Objective: For many nursing home patients in the advanced stages of dementia, a decision to start or forgo treatment has to be taken at the end of their life. It is very important for the peace of mind of all involved in such decision-making that there is agreement on which decision is in the best interest of the patient. It is thus important to investigate the attitude of physicians, nurses and relatives towards medical end-of-life decisions concerning patients with dementia, so that the policy in nursing homes can be tuned to stimulate dialogue and understanding between all parties.Methods: Fifteen statements about artificial nutrition and hydration (ANH), advance directives, hastening death, self-determination and euthanasia, and nursing home policy were presented to physicians, nurses and relatives of nursing home patients suffering from dementia.Results: In general, physicians, nurses and relatives agree on many aspects of end-of-life decision-making for nursing home patients with dementia. However, on some issues the outcomes of the decision-making may differ. Relatives attach more importance to advance directives than physicians, and have more permissive attitudes towards hastening death.Conclusion: Although physicians, nurses and relatives are all guided by the best interest of the patient, it seems that differences in religious beliefs, perspective of the patient, and responsibility can lead to different attitudes towards end-of-life decisions.Practice implications: Physicians should discuss end-of-life decisions more openly. Physicians should be aware of the influences on attitudes and incorporate them into communication about end-of-life decisions. (c) 2005 Elsevier Ireland Ltd. All rights reserved.