Saila Haapasalmi1,2,3, Reetta P Piili4,5, Riina Metsänoja6, Pirkko-Liisa I Kellokumpu-Lehtinen4,7, Juho T Lehto4,5. 1. Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. saila.haapasalmi@fimnet.fi. 2. Palliative Care Centre and Department of Geriatrics, Tampere University Hospital, Tampere, Finland. saila.haapasalmi@fimnet.fi. 3. Tays Hatanpää Hospital, Hatanpäänkatu 24, T-Building, 4th floor, 33900, Tampere, Finland. saila.haapasalmi@fimnet.fi. 4. Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. 5. Palliative Care Centre and Tays Cancer Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland. 6. Faculty of Social Sciences, Tampere University, Tampere, Finland. 7. Tays Cancer Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland.
Abstract
BACKGROUND: Physicians' decision-making for seriously ill patients with advanced dementia is of high importance, especially as the prevalence of dementia is rising rapidly, and includes many challenging ethical, medical and juridical aspects. We assessed the change in this decision-making over 16 years (from 1999 to 2015) and several background factors influencing physicians' decision. METHODS: A postal survey including a hypothetical patient-scenario representing a patient with an advanced dementia and a life-threatening gastrointestinal bleeding was sent to 1182 and 1258 Finnish physicians in 1999 and 2015, respectively. The target groups were general practitioners (GPs), surgeons, internists and oncologists. The respondents were asked to choose between several life-prolonging and palliative care approaches. The influence of physicians' background factors and attitudes on their decision were assessed. RESULTS: The response rate was 56%. A palliative care approach was chosen by 57 and 50% of the physicians in 1999 and 2015, respectively (p = 0.01). This change was statistically significant among GPs (50 vs 40%, p = 0.018) and oncologists (77 vs 56%, p = 0.011). GPs chose a palliative care approach less often than other responders in both years (50 vs. 63% in 1999 and 40 vs. 56% in 2015, p < 0.001). In logistic regression analysis, responding in 2015 and being a GP remained explanatory factors for a lower tendency to choose palliative care. The impact of family's benefit on the decision-making decreased, whereas the influence of the patient's benefit and ethical values as well as the patient's or physician's legal protection increased from 1999 to 2015. CONCLUSIONS: Physicians chose a palliative care approach for a patient with advanced dementia and life-threatening bleeding less often in 2015 than in 1999. Specialty, attitudes and other background factors influenced significantly physician decision-making. Education on the identification and palliative care of the patients with late-stage dementia are needed to make these decisions more consistent.
BACKGROUND: Physicians' decision-making for seriously ill patients with advanced dementia is of high importance, especially as the prevalence of dementia is rising rapidly, and includes many challenging ethical, medical and juridical aspects. We assessed the change in this decision-making over 16 years (from 1999 to 2015) and several background factors influencing physicians' decision. METHODS: A postal survey including a hypothetical patient-scenario representing a patient with an advanced dementia and a life-threatening gastrointestinal bleeding was sent to 1182 and 1258 Finnish physicians in 1999 and 2015, respectively. The target groups were general practitioners (GPs), surgeons, internists and oncologists. The respondents were asked to choose between several life-prolonging and palliative care approaches. The influence of physicians' background factors and attitudes on their decision were assessed. RESULTS: The response rate was 56%. A palliative care approach was chosen by 57 and 50% of the physicians in 1999 and 2015, respectively (p = 0.01). This change was statistically significant among GPs (50 vs 40%, p = 0.018) and oncologists (77 vs 56%, p = 0.011). GPs chose a palliative care approach less often than other responders in both years (50 vs. 63% in 1999 and 40 vs. 56% in 2015, p < 0.001). In logistic regression analysis, responding in 2015 and being a GP remained explanatory factors for a lower tendency to choose palliative care. The impact of family's benefit on the decision-making decreased, whereas the influence of the patient's benefit and ethical values as well as the patient's or physician's legal protection increased from 1999 to 2015. CONCLUSIONS: Physicians chose a palliative care approach for a patient with advanced dementia and life-threatening bleeding less often in 2015 than in 1999. Specialty, attitudes and other background factors influenced significantly physician decision-making. Education on the identification and palliative care of the patients with late-stage dementia are needed to make these decisions more consistent.
Authors: Jen-Hau Chen; Ding-Cheng Derrick Chan; Dan K Kiely; John N Morris; Susan L Mitchell Journal: J Gerontol A Biol Sci Med Sci Date: 2007-05 Impact factor: 6.053
Authors: Adam E Singer; Joy R Goebel; Yan S Kim; Sydney M Dy; Sangeeta C Ahluwalia; Megan Clifford; Elizabeth Dzeng; Claire E O'Hanlon; Aneesa Motala; Anne M Walling; Jaime Goldberg; Daniella Meeker; Claudia Ochotorena; Roberta Shanman; Mike Cui; Karl A Lorenz Journal: J Palliat Med Date: 2016-08-17 Impact factor: 2.947
Authors: Supriya G Mohile; William Dale; Mark R Somerfield; Mara A Schonberg; Cynthia M Boyd; Peggy S Burhenn; Beverly Canin; Harvey Jay Cohen; Holly M Holmes; Judith O Hopkins; Michelle C Janelsins; Alok A Khorana; Heidi D Klepin; Stuart M Lichtman; Karen M Mustian; William P Tew; Arti Hurria Journal: J Clin Oncol Date: 2018-05-21 Impact factor: 44.544
Authors: Reetta P Piili; Juho T Lehto; Riina Metsänoja; Heikki Hinkka; Pirkko-Liisa I Kellokumpu-Lehtinen Journal: BMJ Support Palliat Care Date: 2019-08-08 Impact factor: 3.568
Authors: C Kenis; L Decoster; J Flamaing; P R Debruyne; I De Groof; C Focan; F Cornélis; V Verschaeve; C Bachmann; D Bron; S Luce; G Debugne; H Van den Bulck; J-C Goeminne; D Schrijvers; K Geboers; B Petit; C Langenaeken; R Van Rijswijk; P Specenier; G Jerusalem; J-P Praet; K Vandenborre; J-P Lobelle; M Lycke; K Milisen; H Wildiers Journal: Ann Oncol Date: 2018-09-01 Impact factor: 32.976
Authors: Bertrand Guidet; Hans Flaatten; Ariane Boumendil; Alessandro Morandi; Finn H Andersen; Antonio Artigas; Guido Bertolini; Maurizio Cecconi; Steffen Christensen; Loredana Faraldi; Jesper Fjølner; Christian Jung; Brian Marsh; Rui Moreno; Sandra Oeyen; Christina Agwald Öhman; Bernardo Bollen Pinto; Ivo W Soliman; Wojciech Szczeklik; Andreas Valentin; Ximena Watson; Tilemachos Zafeiridis; Dylan W De Lange Journal: Intensive Care Med Date: 2018-05-17 Impact factor: 17.440
Authors: Hans Wildiers; Pieter Heeren; Martine Puts; Eva Topinkova; Maryska L G Janssen-Heijnen; Martine Extermann; Claire Falandry; Andrew Artz; Etienne Brain; Giuseppe Colloca; Johan Flamaing; Theodora Karnakis; Cindy Kenis; Riccardo A Audisio; Supriya Mohile; Lazzaro Repetto; Barbara Van Leeuwen; Koen Milisen; Arti Hurria Journal: J Clin Oncol Date: 2014-08-20 Impact factor: 44.544
Authors: Meira Erel; Esther-Lee Marcus; Samuel N Heyman; Freda DeKeyser Ganz Journal: Int J Environ Res Public Health Date: 2022-08-17 Impact factor: 4.614