Systematic Review for the Quality of End-of-Life Care for Patients With Dementia in the Hospital Setting

Moon, Felicity; McDermott, Fiona; Kissane, David W.

doi:10.1177/1049909118776985

Cited by 16 publications

(18 citation statements)

References 46 publications

(171 reference statements)

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“…The uniqueness of this study is in its description of the clinical basis of palliative and EOL care for patients in the advanced stage of dementia ( Mitchell et al, 2009 ). Most of the studies conducted in the context of EOL care for patients with dementia in acute settings, as summarized in the review by Moon et al, (2018) refer to only one of the parameters that we examined.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that up to 50% of healthcare providers in nursing homes fail to recognize dementia as a terminal illness ( Robinson et al, 2014 ), especially at its end stage ( Mitchell et al, 2009 ). In a systematic review, Moon et al (2018) found that those providing acute care to patients with dementia are increasingly aware of the terminal nature of end stage dementia; however, provision of EOL care was inconsistent. Healthcare professionals on acute hospital wards are usually trained to provide a quick diagnosis, cure disease, and save lives at any cost ( Dewing & Dijk, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

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Practice of end-of-life care for patients with advanced dementia by hospital physicians and nurses: Comparison between medical and surgical wards

2022

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Background Patients with advanced dementia are commonly hospitalized in acute care wards, yet there is limited data regarding the end-of-life (EOL) care delivered to this population. The aim of the study was to examine EOL care delivered to patients with advanced dementia hospitalized on acute wards as reported by physicians and nurses. Methods Participants were physicians and nurses from medical and surgical wards of two tertiary hospitals in Israel. Participants completed a self-report questionnaire evaluating EOL care experiences, knowledge, performance, assessment, communication, and perceived futile care regarding patients with dementia. Results The questionnaire was completed by 315 providers. There were 190 medical ward respondents and 125 from general surgical wards. Of them, 48.6% recognized dementia as a terminal disease, while 26.0% of the participants reported that they knew the end-of-life preferences for less than 10% of their patients. Among the providers, 53.3% reported that end-of-life ward discussions took place only when there was a life-threatening situation and 11.1%–16.5% never engaged in end-of-life communication regarding EOL patient’s preferences, appointing an attorney for the patient, disease trajectory or the essence of palliative care, with patients or their representatives. Only 17.1% reported “never” performing care they considered to be futile for patients with advanced dementia. Controlling for gender, age, role, position (senior/junior), and exposure to patients with advanced dementia, surgical ward respondents reported performing less EOL care than medical ward respondents in almost all aspects of palliative care. Conclusions Despite growing attention, a significant portion of staff in acute care wards do not report applying EOL care to patients with advanced dementia in clinical practice, especially surgical ward staff.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Practice of end-of-life care for patients with advanced dementia by hospital physicians and nurses: Comparison between medical and surgical wards

2022

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“…As the number of people dying with or from dementia continues to increase, the need for high quality, person-centred end-of-life care is a recognised priority [11]. However, guidelines for care and treatment are still primarily consensus-based, and suboptimal care continues to be reported across a range of end-of-life areas [12][13][14][15][16][17]. While people with dementia may be less likely to receive aggressive care at the end of life, provision of palliative care interventions and symptom management remains inconsistent [13].…”

Section: Introductionmentioning

confidence: 99%

Junior medical doctors’ decision making when using advance care directives to guide treatment for people with dementia: a cross-sectional vignette study

et al. 2022

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Background Junior medical doctors have a key role in discussions and decisions about treatment and end-of-life care for people with dementia in hospital. Little is known about junior doctors’ decision-making processes when treating people with dementia who have advance care directives (ACDs), or the factors that influence their decisions. To describe among junior doctors in relation to two hypothetical vignettes involving patients with dementia: (1) their legal compliance and decision-making process related to treatment decisions; (2) the factors influencing their clinical decision-making; and (3) the factors associated with accurate responses to one hypothetical vignette. Method A cross-sectional survey of junior doctors, including trainees, interns, registrars and residents, on clinical rotation in five public hospitals located in one Australian state. The anonymous, investigator-developed survey was conducted between August 2018 and June 2019. Two hypothetical vignettes describing patients with dementia presenting to hospital with an ACD and either: (1) bacterial pneumonia; or (2) suspected stroke were presented in the survey. Participants were asked to indicate whether they would commence treatment, given the ACD instructions described in each vignette. Results Overall, 116 junior doctors responded (35% consent rate). In Vignette 1, 58% of respondents (n = 67/116) selected the legally compliant option (i.e. not commence treatment). Participants who chose the legally compliant option perceived ‘following patient wishes’ (n = 32/67; 48%) and ‘legal requirements to follow ACDs’ (n = 32/67; 48%) as equally important reasons for complying with the ACD. The most common reason for not selecting the legally compliant option in Vignette 1 was the ‘ACD is relevant in my decision-making process, but other factors are more relevant’ (n = 14/37; 38%). In Vignette 2, 72% of respondents (n = 83/116) indicated they would commence treatment (i.e. not follow the ACD) and 18% (n = 21/116) selected they would not commence treatment. (i.e. follow the ACD). Similar reasons influenced participant decision-making in Vignette 2, a less legally certain scenario. Conclusions There are critical gaps in junior doctors’ compliance with the law as it relates to the implementation of ACDs. Despite there being differences in relation to the legal answer and its certainty, clinical and ethical factors guided decision-making over and above the law in both vignettes. More education and training to guide junior doctors’ clinical decision-making and ensure compliance with the law is required.

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“…1 Whilst family members may understand a dying person’s prognosis, 2 family members are often not prepared for death, 2,3 with inadequate information, emotional and bereavement support impacting family preparedness. 4 Family members of dying patients want expert, respectful and compassionate care, 5 anticipatory guidance 6 and to be supported in their distress. 7 When death is imminent, family members prefer to stay close to the dying person, 8 say goodbyes, 9 and to be supported in following their cultural rites and family traditions.…”

Section: Introductionmentioning

confidence: 99%

Facilitating family needs and support at the end of life in hospital: A descriptive study

et al. 2021

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Background: Caring for family members of dying patients is a vital component of end-of-life care, yet family members’ needs at the end of life may be unmet. Aim: To explore hospital clinician assessment and facilitation of family needs and practices to support families at the end of life. Design: Descriptive study utilising a retrospective medical record audit. Setting and Sample: Undertaken in a large public hospital, the sample included 200 deceased patients from four specialities; general medicine ( n = 50), intensive care ( n = 50), inpatient palliative care ( n = 50) and aged rehabilitation ( n = 50). Data were analysed according to age; under 65-years and 65-years or over. Results: Deceased patients’ mean age was 75-years, 60% were Christian and Next-of-Kin were documented in 96% of cases. 79% spoke English, yet interpreters were used in only 6% of cases. Formal family meetings were held in 64% of cases. An assessment of family needs was undertaken in 52% of cases, and more likely for those under 65-years ( p = 0.027). Cultural/religious practices were supported/facilitated in only 6% of all cases. Specialist palliative care involvement was more likely for those aged 65-years or over ( p = 0.040) and social work involvement more likely for those under 65-years ( p = 0.002). Pastoral care and bereavement support was low across the whole sample. Conclusions: Prioritising family needs should be core to end-of-life care. Anticipation of death should trigger routine referral to support personnel/services to ensure practice is guided by family needs. More research is needed to evaluate how family needs assessment can inform end-of-life care, supported by policy.

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Systematic Review for the Quality of End-of-Life Care for Patients With Dementia in the Hospital Setting

Abstract: Although patients with dementia appear to receive less aggressive treatment at the end of life, the provision of palliative care and symptom management may be inadequate.

Cited by 16 publications

References 46 publications

Practice of end-of-life care for patients with advanced dementia by hospital physicians and nurses: Comparison between medical and surgical wards

Practice of end-of-life care for patients with advanced dementia by hospital physicians and nurses: Comparison between medical and surgical wards

Junior medical doctors’ decision making when using advance care directives to guide treatment for people with dementia: a cross-sectional vignette study

Facilitating family needs and support at the end of life in hospital: A descriptive study

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