Henrietta Szold School of Nursing, Hadassah Hebrew University, Jerusalem 9112102, Israel.
Herzog-Medical Center, Department of Geriatrics, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9103702, Israel.
Int J Environ Res Public Health. 2022 Aug 17;19(16):10236. doi: 10.3390/ijerph191610236.
Decision analysis regarding emergency medical treatment in patients with advanced dementia has seldom been investigated. We aimed to examine the preferred medical treatment in emergency situations for patients with advanced dementia and its association with perceptions of palliative care. We conducted a survey of 159 physicians and 156 nurses from medical and surgical wards in two tertiary hospitals. The questionnaire included two case scenarios of patients with advanced dementia presenting gastrointestinal bleeding (scenario I) or pneumonia (scenario II) with a list of possible interventions and 11 items probing perceptions towards palliative care. Low burden interventions such as laboratory tests and intravenous administration of antibiotics/blood were preferred. Palliative measures such as analgesia/sedation were chosen by about half of the participants and invasive intervention by 41.6% (gastroscopy in scenario I) and 37.1% (intubation/mechanical ventilation in scenario II). Medical ward staff had a more palliative approach than surgical ward staff in scenario I, and senior staff had a more palliative approach than junior staff in scenario II. Most participants (90.4%) agreed that palliative care was appropriate for patients with advanced dementia. Stress in caring for patients with advanced dementia was reported by 24.5% of participants; 33.1% admitted fear of lawsuit, 33.8% were concerned about senior-level responses, and 69.7% were apprehensive of family members' reaction to palliative care. Perceptions of health care workers towards palliative care were associated with preferred treatment choice for patients with advanced dementia, mainly in scenario II. Attitudes and apprehensions regarding palliative care in these situations may explain the gap between positive attitudes towards palliative care and the chosen treatment approach. Acquainting emergency care practitioners with the benefits of palliative care may impact their decisions when treating this population.
针对晚期痴呆患者的紧急医疗处理的决策分析很少被研究。我们旨在研究晚期痴呆患者在紧急情况下的首选医疗处理方法及其与姑息治疗观念的关系。我们对两家三级医院的内科和外科病房的 159 名医生和 156 名护士进行了一项调查。问卷包括两个晚期痴呆患者出现胃肠道出血（场景 I）或肺炎（场景 II）的病例场景，列出了可能的干预措施和 11 个探查姑息治疗观念的项目。倾向于选择低负担的干预措施，如实验室检查和静脉给予抗生素/血液。大约一半的参与者选择了姑息治疗措施，如止痛/镇静，41.6%（场景 I 中的胃镜检查）和 37.1%（场景 II 中的插管/机械通气）选择了侵入性干预。在场景 I 中，内科病房工作人员比外科病房工作人员更倾向于姑息治疗，在场景 II 中，高级工作人员比初级工作人员更倾向于姑息治疗。大多数参与者（90.4%）认为姑息治疗适合晚期痴呆患者。24.5%的参与者报告在照顾晚期痴呆患者时感到压力；33.1%承认害怕诉讼，33.8%担心高层的反应，69.7%担心家属对姑息治疗的反应。医疗保健工作者对姑息治疗的看法与为晚期痴呆患者选择的治疗方法有关，主要是在场景 II 中。这些情况下对姑息治疗的态度和担忧可能解释了对姑息治疗的积极态度与所选治疗方法之间的差距。让急救护理从业者了解姑息治疗的好处可能会影响他们在治疗这一人群时的决策。
