Document Detail


A cross-cultural study of physician treatment decisions for demented nursing home patients who develop pneumonia.
MedLine Citation:
PMID:  16735523     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: We wanted to explore factors that influence Dutch and US physician treatment decisions when nursing home patients with dementia become acutely ill with pneumonia.
METHODS: Using a qualitative semistructured interview study design, we collected data from 12 physicians in the Netherlands and 12 physicians in North Carolina who care for nursing home patients. Our main outcome measures were perceptions of influential factors that determine physician treatment decisions regarding care of demented patients who develop pneumonia.
RESULTS: Several themes emerged from the study. First, physicians viewed their patient care roles differently. Dutch physicians assumed active, primary responsibility for treatment decisions, whereas US physicians were more passive and deferential to family preferences, even in cases when they considered families' wishes for care as inappropriate. These family wishes were a second theme. US physicians reported a perceived sense of threat from families as influencing the decision to treat more aggressively, whereas Dutch physicians revealed a predisposition to treat based on what they perceived was in the best interest of the patient. The third theme was the process of decision making whereby Dutch physicians based decisions on an intimate knowledge of the patient, and American physicians reported limited knowledge of their nursing home patients as a result of lack of contact time.
CONCLUSION: Physician-perceived care roles regarding treatment decisions are influenced by contextual differences in physician training and health care delivery in the United States and the Netherlands. These results are relevant to the debate about optimal care for patients with poor quality of life who lack decision-making capacity.
Authors:
Margaret R Helton; Jenny T van der Steen; Timothy P Daaleman; George R Gamble; Miel W Ribbe
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of family medicine     Volume:  4     ISSN:  1544-1717     ISO Abbreviation:  Ann Fam Med     Publication Date:    2006 May-Jun
Date Detail:
Created Date:  2006-05-31     Completed Date:  2006-06-19     Revised Date:  2013-06-07    
Medline Journal Info:
Nlm Unique ID:  101167762     Medline TA:  Ann Fam Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  221-7     Citation Subset:  IM    
Affiliation:
Department of Family Medicine, University of North Carolina, Chapel Hill, NC 27599-7595, USA. margaret_helton@med.unc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cross-Cultural Comparison
Decision Making*
Dementia*
Family Health
Humans
Middle Aged
Netherlands
Nursing Homes
Palliative Care*
Physician's Role*
Pneumonia / therapy*
United States
Grant Support
ID/Acronym/Agency:
AG01033/AG/NIA NIH HHS; K23 AG001033-04/AG/NIA NIH HHS
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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