Punchik Boris, Kaidash Nikolay, Geva Robinson Shahar, Meged-Book Tehilah, Semionov Valentina, Freud Tamar, Press Yan
Unit for Community Geriatrics, The Haim Doron Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Home Care Unit, Clalit Healthcare Services, Beer‑Sheva, Israel.
Clin Interv Aging. 2025 Aug 31;20:1417-1427. doi: 10.2147/CIA.S528602. eCollection 2025.
Providing essential end-of-life care for patients with advanced dementia depends on physicians' ability to identify eligible individuals and refer them to hospice services. In practice, however, such referrals are often delayed-or not made at all. This study aimed to examine the factors associated with physicians' knowledge and attitudes toward referring patients with advanced dementia to home hospice care, and to compare characteristics of those who refer with those who do not.
This cross-sectional study assessed physicians' knowledge and attitudes regarding hospice services for patients with advanced dementia. A dedicated questionnaire was developed for the purpose of the study, based on a representative clinical case involving a patient with advanced dementia.
A total of 200 physicians participated in the study. While 84.3% had treated at least one patient with advanced dementia in the past six months, only 88 physicians (44.2%) reported referring to home hospice care such patients during that time. Moreover, only 6% of physicians correctly answered all four knowledge questions on the topic. No significant differences were observed between referring and non-referring physicians in terms of participation in dedicated training, knowledge level, or attitudes. Higher professional status (board certification) and the number of advanced dementia patients treated in the previous six months were the only independent predictors of referral.
This study revealed substantial gaps in the recognition of advanced dementia and in the timely referral of affected patients to hospice care among community-based family physicians and hospital-based internists. Targeted training in hospice care for all relevant physicians, coupled with structured exposure to end-stage dementia patients and hospice services during residency, may improve clinical awareness and increase the likelihood of appropriate and timely referrals.
The study received an exemption from the Meir Hospital Helsinki Committee.
为晚期痴呆患者提供基本的临终关怀取决于医生识别符合条件的个体并将他们转介至临终关怀服务机构的能力。然而在实际操作中，此类转介往往会延迟——或者根本就不会进行。本研究旨在探讨与医生将晚期痴呆患者转介至居家临终关怀护理的知识和态度相关的因素，并比较转介者与未转介者的特征。
这项横断面研究评估了医生对晚期痴呆患者临终关怀服务的知识和态度。基于一个涉及晚期痴呆患者的代表性临床病例，为该研究专门设计了一份问卷。
共有200名医生参与了该研究。虽然84.3%的医生在过去六个月中至少治疗过一名晚期痴呆患者，但在此期间只有88名医生（44.2%）报告将此类患者转介至居家临终关怀护理。此外，只有6%的医生正确回答了关于该主题的所有四个知识问题。在参与专门培训、知识水平或态度方面，转介医生与未转介医生之间未观察到显著差异。较高的专业地位（获得委员会认证）以及前六个月治疗的晚期痴呆患者数量是转介的唯一独立预测因素。
本研究揭示了社区家庭医生和医院内科医生在识别晚期痴呆以及及时将受影响患者转介至临终关怀护理方面存在重大差距。对所有相关医生进行有针对性的临终关怀培训，以及在住院实习期间安排与晚期痴呆患者和临终关怀服务的结构化接触，可能会提高临床意识，并增加适当及时转介的可能性。
该研究获得了梅尔医院赫尔辛基委员会的豁免。
