School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Psychology, Maastricht University Medical Centre (MUMC+), The Netherlands.
Patient Educ Couns. 2012 Apr;87(1):43-8. doi: 10.1016/j.pec.2011.07.023. Epub 2011 Sep 1.
To gain caregivers' insights into the decision-making process in dementia patients with regard to treatment and care.
Four focus group interviews (n=29).
The decision-making process consists of three elementary components: (1) identifying an individual's needs; (2) exploring options; and (3) making a choice. The most important phase is the exploration phase as it is crucial for the acceptance of the disease. Furthermore, the decision is experienced more as an emotional choice than a rational one. It is influenced by personal preferences whereas practical aspects do not seem to play a substantial role.
Several aspects make decision-making in dementia different from decision-making in the context of other chronic diseases: (1) the difficulty accepting dementia; (2) the progressive nature of dementia; (3) patient's reliance on surrogate decision-making; and (4) strong emotions. Due to these aspects, the decision-making process is very time-consuming, especially the crucial exploration phase.
A more active role is required of both the caregiver and the health care professional especially in the exploration phase, enabling easier acceptance and adjustment to the disease. Acceptance is an important condition for reducing anxiety and resistance to care that may offer significant benefits in the future.
了解照料者在痴呆症患者的治疗和护理方面的决策过程。
4 次焦点小组访谈（n=29）。
决策过程由三个基本组成部分组成：（1）确定个人需求；（2）探索选择；（3）做出选择。最重要的阶段是探索阶段，因为它对疾病的接受至关重要。此外，决策更多地被体验为一种情感选择，而不是理性选择。它受到个人偏好的影响，而实际方面似乎没有起到重要作用。
与其他慢性疾病背景下的决策相比，痴呆症的决策有几个方面不同：（1）难以接受痴呆症；（2）痴呆症的进展性；（3）患者依赖替代决策；（4）强烈的情绪。由于这些方面，决策过程非常耗时，特别是关键的探索阶段。
护理人员和医疗保健专业人员都需要发挥更积极的作用，尤其是在探索阶段，这可以使患者更容易接受和适应疾病。接受是减轻焦虑和对护理的抵制的重要条件，这可能会在未来带来重大收益。
