Initiating advance care planning on end-of-life issues in dementia: Ambiguity among UK and Dutch physicians |
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| Affiliation: | 1. Leiden University Medical Center, Department of Public Health and Primary Care, Hippocratespad 21, Gebouw 3, P.O. Box 9600, 2300 RC Leiden, The Netherlands;2. Radboud university medical center, Department of Primary and Community Care, Nijmegen, The Netherlands;3. School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, United Kingdom;1. Brigham and Woman''s Hospital, Center for Surgery and Public Health, Boston, Massachusetts, USA;2. Department of Surgery, Brigham and Woman''s Hospital, Boston, Massachusetts, USA;3. Division of Palliative Medicine, Department of Medicine, Brigham and Women''s Hospital, Boston, Massachusetts, USA;4. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA;5. Hebrew SeniorLife Arthur and Hinda Marcus Institute for Aging Research, Boston, Massachusetts, USA;6. Department of Anesthesia, Brigham and Woman''s Hospital, Boston, Massachusetts, USA;7. Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts, USA;8. VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, Massachusetts, USA;9. Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA;1. Department of IQ Healthcare, Radboud University Medical Centre Nijmegen, the Netherlands;2. Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands;3. Radboudumc Alzheimer Centre, Nijmegen, the Netherlands;4. Joachim en Anna, Centre for Specialized Geriatric Care, Nijmegen, the Netherlands;5. Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands;6. Research Group Innovating with Older Adults, Windesheim University of Applied Sciences, Zwolle, the Netherlands;7. Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands;8. Department of Geriatric Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands;1. Program Development Center, Center of Expertise for Chronic Organ Failure (CIRO+), Horn, The Netherlands;2. Respiratory Medicine, Maastricht UMC+, Maastricht, The Netherlands;3. Center of Expertise for Palliative Care, Maastricht UMC+, Maastricht, The Netherlands;1. Section of Palliative Care, Division of Primary Care and Population Health, Department of Medicine, Stanford School of Medicine, Palo Alto, California, USA;2. Health Education, Engagement and Promotion, Department of Patient Experience, Stanford Health Care, Palo Alto, California, USA;1. Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA;2. San Francisco Veterans Affairs Medical Center, San Francisco, California, USA;3. VA Eastern Colorado Geriatrics Research Education and Clinical Center (GRECC), Denver, Colorado, USA;4. Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA;5. Department of Medicine, McMaster University, Hamilton, Ontario, Canada;6. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada;7. Division of Geriatric Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA;8. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA;9. Palliative Care Program, Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, California, USA;10. Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands;11. Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA;12. Division of Gerontology and Geriatrics, University of Washington, Seattle, Washington, USA;13. Coalition for Compassionate Care of California, Sacramento, California, USA;14. Department of Critical Care Medicine, Queen''s University; Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada |
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| Abstract: | BackgroundIn dementia, advance care planning (ACP) of end-of-life issues may start as early as possible in view of the patient’s decreasing ability to participate in decision making. We aimed to assess whether practicing physicians in the Netherlands and the United Kingdom who provide most of the end-of-life care, differ in finding that ACP in dementia should start at diagnosis.MethodsIn a cross-sectional study, we surveyed 188 Dutch elderly care physicians who are on the staff of nursing homes and 133 general practitioners from Northern Ireland. We compared difference by country in the outcome (perception of ACP timing), rated on a 1–5 agreement scale. Regression analyses examined whether a country difference can be explained by contrasts in demographics, presence, exposure and role perceptions.ResultsThere was wide variability in agreement with the initiation of ACP at dementia diagnosis, in particular in the UK but also in the Netherlands (60.8% agreed, 25.3% disagreed and 14.0% neither agreed, nor disagreed). Large differences in physician characteristics (Dutch physicians being more present, exposed and adopting a stronger role perception) hardly explained the modest country difference. The perception that the physician should take the initiative was independently associated with agreeing with ACP at diagnosis.ConclusionsThere is considerable ambiguity about initiating ACP in dementia at diagnosis among physicians practicing in two different European health care systems and caring for different patient populations. ACP strategies should accommodate not only variations in readiness to engage in ACP early among patient and families, but also among physicians. |
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| Keywords: | Advance care planning Dementia End of life Palliative care |
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