title: Reaching consensus: the process of recommending treatment decisions for Alzheimer's patients.
abstract: Observational and interview data obtained from nurse caregivers and family members of patients with late-stage Alzheimer's disease were analyzed to explicate the nursing role in advance proxy planning. A four-phase model, Achieving Consensus: Decision Making to Determine Treatment Options for Patients with Alzheimer's Disease, was developed. Patient decline, family coping, professional development of nursing staff, and nursing unit philosophy were community characteristics found to be important antecedents to the process of reaching consensus. Achieving consensus constructs included interactive process components of patient, family, and staff adjustment, caring, and knowing. Timing and trust were influential catalysts to family and staff readiness factors for achieving consensus. Outcomes were the advice provided by staff and the family conference where treatment options were determined. Consequences included the advance proxy plan and patient care.
authors.affiliation: Geriatric Research Education and Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Hurley
authors.forename: L
authors.initials: L
authors.lastname: Volicer
authors.forename: V F
authors.initials: VF
authors.lastname: Rempusheski
authors.forename: S T
authors.initials: ST
authors.lastname: Fry
mesh_terms: D000223:Adaptation, Psychological; D032722:Advance Care Planning; D000544:Alzheimer Disease / Q000451:nursing*; D032921:Consensus; D003657:Decision Making; D005190:Family / Q000523:psychology; D006304:Health Status; D006801:Humans; D007872:Legal Guardians; D016294:Models, Nursing; D024802:Nurse's Role; D009730:Nursing Assessment; D010687:Philosophy, Nursing; D036301:Qualitative Research; D012106:Research; D013192:Staff Development; D013727:Terminal Care; D013997:Time Factors; D035502:Trust; D028761:Withholding Treatment