Rurup Mette L, Onwuteaka-Philipsen Bregje D, Pasman H Roeline W, Ribbe Miel W, van der Wal Gerrit
VU University Medical Center, Institute for Research in Extramural Medicine, Department of Public and Occupational Health, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
Patient Educ Couns. 2006 Jun;61(3):372-80. doi: 10.1016/j.pec.2005.04.016. Epub 2005 Jun 21.
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.
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.
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.
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.
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.
对于许多处于痴呆晚期的养老院患者而言，在其生命末期必须做出开始或放弃治疗的决定。对于所有参与此类决策的人来说，就哪项决策最符合患者的最大利益达成一致，对于他们内心的平静非常重要。因此，调查医生、护士和亲属对痴呆患者医疗临终决策的态度很重要，这样养老院的政策才能进行调整，以促进各方之间的对话和理解。
向患有痴呆症的养老院患者的医生、护士和亲属提出了15条关于人工营养和水分补充（ANH）、预立医疗指示、加速死亡、自主决定权和安乐死以及养老院政策的陈述。
总体而言，医生、护士和亲属在痴呆养老院患者临终决策的许多方面达成了一致。然而，在一些问题上，决策结果可能会有所不同。亲属比医生更重视预立医疗指示，并且对加速死亡持更宽容的态度。
尽管医生、护士和亲属都以患者的最大利益为指导，但宗教信仰、患者视角和责任的差异似乎会导致对临终决策的不同态度。
医生应该更公开地讨论临终决策。医生应该意识到这些态度的影响，并将其纳入关于临终决策的沟通中。
