Erel Meira, Marcus Esther-Lee, Dekeyser-Ganz Freda
Henrietta Szold Hadassah-Hebrew University School of Nursing, Kiryat Hadassah, POB 1200, 9112001, Jerusalem, Israel.
Faculty of Medicine, Hadassah-Hebrew University, Jerusalem, Israel.
Health Care Anal. 2022 Mar;30(1):57-72. doi: 10.1007/s10728-021-00429-x. Epub 2021 Mar 30.
Patients with advanced dementia are less likely than those with other terminal illnesses to receive palliative care. Due to the nature and course of dementia, there may be a failure to recognize the terminal stage of the disease. A possible and under-investigated explanation for this healthcare disparity is the healthcare practitioner who plays a primary role in end-of-life decision-making. Two potential areas that might impact provider decision-making are cognitive biases and moral considerations. In this analysis, we demonstrate how the cognitive biases and moral considerations of practitioners related to clinical decision-making are inherent in clinical practice and may impact on providers' accuracy related to diagnostic and treatment related decision-making associated with patients with advanced dementia. Anchoring, default, availability, representativeness and framing biases are cognitive biases based on the "Two System Model" that relate to decision-making in end-of-life care. In patients with advanced dementia, those biases may result in a tendency to adhere to traditional mandatory care, involving an aggressive approach to care, which values saving lives at all costs, without taking into account the possible suffering and long-term consequences. Aspects such as moral sensitivity and moral courage play an important role in ethical decision-making related to advanced dementia. Investigations of clinical decision-making that include the cognitive biases and ethical considerations of practitioners might advance the comprehensive understanding of the clinical decision-making process related to care of patients with advanced dementia and promote the quality of care given to this population.
与患有其他晚期疾病的患者相比，晚期痴呆症患者接受姑息治疗的可能性更小。由于痴呆症的性质和病程，可能无法识别该疾病的终末期。对于这种医疗保健差异，一个可能且未得到充分研究的解释是在临终决策中起主要作用的医疗从业者。可能影响提供者决策的两个潜在领域是认知偏差和道德考量。在本分析中，我们展示了从业者与临床决策相关的认知偏差和道德考量如何在临床实践中是固有的，并且可能影响提供者在与晚期痴呆症患者相关的诊断和治疗决策方面的准确性。锚定偏差、默认偏差、可得性偏差、代表性偏差和框架偏差是基于“双系统模型”的认知偏差，与临终护理中的决策相关。在晚期痴呆症患者中，这些偏差可能导致倾向于坚持传统的强制治疗，包括积极的治疗方法，这种方法不惜一切代价重视挽救生命，而不考虑可能的痛苦和长期后果。道德敏感性和道德勇气等方面在与晚期痴呆症相关的伦理决策中起着重要作用。对临床决策的调查，包括从业者的认知偏差和伦理考量，可能会促进对与晚期痴呆症患者护理相关的临床决策过程的全面理解，并提高给予这一人群的护理质量。
