German Reference Centre for Ethics in the Life Sciences (DRZE), Bonn, Germany.
Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
PLoS One. 2018 May 24;13(5):e0197229. doi: 10.1371/journal.pone.0197229. eCollection 2018.
To investigate whether life-sustaining measures in medical emergency situations are less accepted for an anticipated own future of living with dementia, and to test whether a resource-oriented, in contrast to a deficit-oriented video about the same demented person, would increase the acceptance of such life-saving measures.
Experimental study conducted between September 2012 and February 2013.
Community dwelling female volunteers living in the region of Bonn, Germany.
278 women aged 19 to 89 (mean age 53.4 years).
Presentation of a video on dementia care focusing either on the deficits of a demented woman (negative framing), or focusing on the remaining resources (positive framing) of the same patient.
Approval of life-sustaining treatments in five critical medical scenarios under the assumption of having comorbid dementia, before and after the presentation of the brief videos on care.
At baseline, the acceptance of life-sustaining measures in critical medical situations was significantly lower in subjects anticipating their own future life with dementia. Participants watching the resource-oriented film on living with dementia had significantly higher post-film acceptance rates compared to those watching the deficit-oriented negatively framed film. This effect particularly emerges if brief and efficient life-saving interventions with a high likelihood of physical recovery are available (eg, antibiotic treatment for pneumonia).
Anticipated decisions regarding life-sustaining measures are negatively influenced by the subjective imagination of living with dementia, which might be shaped by common, unquestioned stereotypes. This bias can be reduced by providing audio-visual information on living with dementia which is not only centred around cognitive and functional losses but also focuses on remaining resources and the apparent quality of life. This is particularly true if the medical threat can be treated efficiently. These findings have implications for the practice of formulating, revising, and supporting advance directives.
调查在医疗紧急情况下，对于预期自己未来患有痴呆症的生活，是否会较少接受维持生命的措施，并测试相对于关注同一痴呆症患者缺陷的资源导向型视频，是否会增加对这些救生措施的接受度。
2012 年 9 月至 2013 年 2 月期间进行的实验研究。
德国波恩地区的社区居住女性志愿者。
278 名年龄在 19 至 89 岁之间的女性（平均年龄 53.4 岁）。
呈现关于痴呆症护理的视频，重点关注痴呆症女性的缺陷（负面框架），或关注同一患者的剩余资源（积极框架）。
在假设患有共病痴呆症的情况下，在观看简短的护理视频前后，对五种关键医疗情况下的维持生命的治疗方法的批准情况。
在基线时，对于自己未来患有痴呆症的生活，预期接受维持生命措施的患者明显减少。观看以资源为导向的痴呆症生活电影的参与者，在观看影片后的接受率明显高于观看以缺陷为导向的负面框架电影的参与者。如果有简短且高效的救生干预措施，且患者有较高的身体恢复可能性（例如，肺炎的抗生素治疗），则这种效果更为明显。
对维持生命措施的预期决策受到对患有痴呆症的主观想象的负面影响，这种偏见可能受到常见的、未经质疑的刻板印象的影响。通过提供不仅关注认知和功能丧失，而且还关注剩余资源和明显生活质量的关于痴呆症生活的视听信息，可以减少这种偏见。如果医疗威胁可以得到有效治疗，那么这种效果更为显著。这些发现对制定、修订和支持预先指示的实践具有重要意义。
