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Do Perceptions about Palliative Care Affect Emergency Decisions of Health Personnel for Patients with Advanced Dementia?

Author

Listed:
  • Meira Erel

    (Henrietta Szold School of Nursing, Hadassah Hebrew University, Jerusalem 9112102, Israel
    M.E. and E.-L.M. provided equal contribution as first authors.)

  • Esther-Lee Marcus

    (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
    M.E. and E.-L.M. provided equal contribution as first authors.)

  • Samuel N. Heyman

    (Herzog-Medical Center, Department of Geriatrics, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9103702, Israel
    Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem 9765422, Israel)

  • Freda DeKeyser Ganz

    (Henrietta Szold School of Nursing, Hadassah Hebrew University, Jerusalem 9112102, Israel
    Faculty of Health and Life Sciences, Jerusalem College of Technology, Jerusalem 9372115, Israel)

Abstract

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.

Suggested Citation

  • Meira Erel & Esther-Lee Marcus & Samuel N. Heyman & Freda DeKeyser Ganz, 2022. "Do Perceptions about Palliative Care Affect Emergency Decisions of Health Personnel for Patients with Advanced Dementia?," IJERPH, MDPI, vol. 19(16), pages 1-15, August.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:16:p:10236-:d:890910
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    References listed on IDEAS

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    1. I‐Hui Chen & Kuan‐Yu Lin & Sophia H Hu & Yeu‐Hui Chuang & Carol O Long & Chia‐Chi Chang & Megan F Liu, 2018. "Palliative care for advanced dementia: Knowledge and attitudes of long‐term care staff," Journal of Clinical Nursing, John Wiley & Sons, vol. 27(3-4), pages 848-858, February.
    2. Eliza Lai-Yi Wong & Nicole Kiang & Roger Yat-Nork Chung & Janice Lau & Patsy Yuen-Kwan Chau & Samuel Yeung-Shan Wong & Jean Woo & Emily Ying-Yang Chan & Eng-Kiong Yeoh, 2020. "Quality of Palliative and End-Of-Life Care in Hong Kong: Perspectives of Healthcare Providers," IJERPH, MDPI, vol. 17(14), pages 1-14, July.
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