Attitudinal patterns determining decision-making in the treatment of the elderly: a comparison between physicians and nurses in Germany and Sweden

Richter, Joachim; Eisemann, Martin

doi:10.1007/s001340000602

Cited by 17 publications

(24 citation statements)

References 29 publications

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“…The majority of physicians in this survey chose both to withhold tube feeding and to withdraw tube feeding after 3 months without improvement.The confounding influences of patient and family wishes have been noted in previous studies [5][6][7]10,15,24 and physicians often override the advance directives of patients. 7,14 Even patients recognize that their families may not agree with their advance directives, and some prefer for their families' wishes to supersede their own.…”

Section: Discussionmentioning

confidence: 93%

“…27 The patient and institutional factors associated with actual tube feeding in nursing homes demonstrated considerable overlap in importance for both physician decision groups.Given previous literature, 10,14 physicians who withheld or withdrew tube feeding might have been expected to value advanced dementia, bedridden status, or prognosis less than 6 months more, but differences were not seen between the decision groups.Several factors were less important to physicians than we expected from the literature, such as anticipated short duration of tube feeding and younger patient age. 10,20 Subgroup 2 analysis revealed differences between younger and older physicians in the importance of younger patient age (65-74 years), the presence of advanced dementia, nursing and administrative cooperation and cost.…”

Section: Discussionmentioning

confidence: 99%

“…10,14,15 Physician ethnicity was associated with tube feeding decisions, 16 and patient and institutional factors associated with tube feeding in nursing home patients have been identified in previous observational studies. [17][18][19][20] However, the physicians' perception of the importance of these factors in tube-feeding decision-making has not been examined.…”

Section: Introductionmentioning

confidence: 96%

“…Physicians' end of life treatment preferences have been associated with physician ethnicity, religion, age, and personality style, [5][6][7][8][9][10][11][12][13] while other studies have found associations between treatment decisions and patient or institutional factors. 10,14,15 Physician ethnicity was associated with tube feeding decisions, 16 and patient and institutional factors associated with tube feeding in nursing home patients have been identified in previous observational studies.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with Physician Decision-Making in Starting Tube Feeding

Bell

Somogyi-Zalud

Masaki

et al. 2008

Journal of Palliative Medicine

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Background:Because tube-feeding decisions are sometimes difficult, we examined physician, institutional, and patient factors associated with these decisions.Methods: Primary care physicians (n ‫؍‬ 388) likely to manage nursing home patients in Hawaii were surveyed. Respondents indicated the factors of great importance in tube feeding decisions based on a vignette of a poststroke patient failing to thrive and family disagreement with advance directives. 2 and multiple logistic regression analyses were used to examine associations between physician demographics and factors of importance to physicians and their decisions based on the vignette. Conclusions: The decision to start or withhold tube feeding is associated with the individual physician's perception of the importance of patient wishes versus family wishes and liability concerns. Physician awareness of the influence of these factors on medical decisions may improve the decision-making process.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Factors Associated with Physician Decision-Making in Starting Tube Feeding

Bell

Somogyi-Zalud

Masaki

et al. 2008

Journal of Palliative Medicine

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“…In Italy, DNR decision is consulted with a competent patient in only 10% of the cases. This represents only a small percentage of cases in comparison with the Netherlands, where 84% of patients make the decision together with their physician [13,14].…”

Section: Situationsmentioning

confidence: 99%

DNR declaration — emergency medical system nurses’ opinions

et al. 2012

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AbstractAdvance directive and other declarations of will made by patients in a case of mental illness still raise ethical and legal issues. In Poland there is no legal regulation, neither research about code of conduct in situation of do not attempt resuscitation. There are also not enough studies regarding Healthcare workers’ opinion about DNAR declaration (Do Not Attempt Resuscitation). The study is aimed at finding out emergency medical system nurses opinion on the subject of enforcing do not attempt resuscitation in situation of circulatory and respiratory arrest. Methods: The research was conducted by means of the diagnostic survey method applying a self — constructed questionnaire. The study was carried out among 82 (100%) nurses, from September to December 2011. Obtained information were analyzed statistically, Chi-square of independence with assumed p ≤ 0.05. level of significance was used for statistical analysis. Results: The study of the respondents’ opinion shows that 67% Healthcare employees think that DNAR declaration should be obligatory in Poland. Contrary opinion has 7.3% of respondents. In their opinion the decision to refrain from resuscitating should be made by attending physician − 46.3% and medical board − 29.3%. Information enclosed within DNAR declaration, in most of respondents’ opinion − 59.5%, should be only passed on in written form. Conclusions: Majority of respondents agree that patients have a right to refrain from resuscitating as a self − determination act. Respondents concur the introduction of DNAR declaration in Polish Healthcare system. In respondents’ opinion that decision should be required in written form and an attending physician should decide about its implementation, what violates the existing rule. The execution of living will declaration raises ethical issues. Additionally, it also appears as public/social problem. The last stage of incurable disease is given as justifiable circumstances of DNAR.

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Implementatie van niet-reanimeerbeleid op afdelingen acute geriatrie van Vlaamse ziekenhuizen in 2002 nog niet voltooid

Gendt

Bilsen²,

Stichele³

et al. 2007

GEEG

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This study describes the historical development and status of a do-not-resuscitate (DNR) policy on acute geriatric wards in Flanders, Belgium. In 2002 (the year Belgium voted a law on euthanasia), a structured mail questionnaire was sent to all head geriatricians of acute geriatric wards in Flanders (N=94). Respondents were asked about the existence, development, and implementation of the DNR policy (guidelines and order forms). The response was 76.6%. Development of DNR policy began in 1985, with a step-up in 1997 and 200l. In 2002, a DNR policy was available in 86.1% of geriatric wards, predominantly with institutional DNR guidelines and individual, patient-specific DNR order forms. The policy was initiated and developed predominantly from an institutional perspective by the hospital. The forms were not standardized and generally lacked room to document patient involvement in the decision making process. Implementation of institutional DNR guidelines and individual DNR order forms on geriatric wards in Flanders lagged behind that of other countries and was still incomplete in 2002. DNR policies varied in content and scope and were predominantly an expression of institutional defensive attitudes rather than a tool to promote patient involvement in DNR and other end-of-life decisions.

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Attitudinal patterns determining decision-making in the treatment of the elderly: a comparison between physicians and nurses in Germany and Sweden

Cited by 17 publications

References 29 publications

Factors Associated with Physician Decision-Making in Starting Tube Feeding

Factors Associated with Physician Decision-Making in Starting Tube Feeding

DNR declaration — emergency medical system nurses’ opinions

Implementatie van niet-reanimeerbeleid op afdelingen acute geriatrie van Vlaamse ziekenhuizen in 2002 nog niet voltooid

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