[Whether or not to treat pneumonia curatively in (demented) psychogeriatric patients: evaluation of a guideline for nursing home physicians].
A guideline was developed to support decision-making about whether or not to treat pneumonia curatively in psychogeriatric (demented) nursing home patients. This guideline was developed as a 'checklist of considerations', primarily of the ethical and legal aspects of decision-making. Nursing home physicians used and evaluated the list. The list's acceptance was assessed by measuring the frequency of the list's use, and judgements of the list's contents and 'usefulness'. The list was used in 50 out of 58 participating nursing homes, in 47% of the 489 psychogeriatric patients in whom pneumonia occurred. The list was found somewhat to very useful to support decision-making in 47% of 107 individual patients. For the targeted patient category as a whole, 85% of 48 physicians who were asked retrospectively (one physician per home) found the list somewhat to very useful. The content of the list was judged favourably. In conclusion, the nursing home physicians accepted the considerations of the checklist as a basis for decision-making on whether or not to treat pneumonia curatively in psychogeriatric patients. In the future, the format of the list can be adapted for use in diverse clinical situations. Suggestions are provided to increase user friendliness and usefulness.
van der Steen
Jenny
J
Instituut voor Extramuraal Geneeskundig Onderzoek (EMGO-instituut), Vrije Universiteit medisch centrum (VUmc), Amsterdam. jt.van_der_steen.emgo@med.vu.nl
Ooms
Marcel
M
Muller
Martien
M
van der Wal
Gerrit
G
Ribbe
Miel
M
D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making / Q000941:ethics; D020000:Decision Support Systems, Clinical / Q000941:ethics / Q000458:organization & administration; D003704:Dementia / Q000150:complications* / Q000628:therapy; D026690:Ethics, Clinical; D005260:Female; D005852:Geriatric Psychiatry / Q000941:ethics; D006304:Health Status; D006801:Humans; D008297:Male; D009426:Netherlands; D009735:Nursing Homes / Q000941:ethics; D018579:Patient Selection; D011014:Pneumonia / Q000150:complications / Q000628:therapy*; D017410:Practice Guidelines as Topic; D013727:Terminal Care / Q000941:ethics*; D028761:Withholding Treatment