Attitudes of physicians, nurses and relatives towards end-of-life decisions concerning nursing home patients with dementia.
OBJECTIVE
For many nursing home patients in the advanced stages of dementia, a decision to start or forgo treatment has to be taken at the end of their life. It is very important for the peace of mind of all involved in such decision-making that there is agreement on which decision is in the best interest of the patient. It is thus important to investigate the attitude of physicians, nurses and relatives towards medical end-of-life decisions concerning patients with dementia, so that the policy in nursing homes can be tuned to stimulate dialogue and understanding between all parties.


METHODS
Fifteen statements about artificial nutrition and hydration (ANH), advance directives, hastening death, self-determination and euthanasia, and nursing home policy were presented to physicians, nurses and relatives of nursing home patients suffering from dementia.


RESULTS
In general, physicians, nurses and relatives agree on many aspects of end-of-life decision-making for nursing home patients with dementia. However, on some issues the outcomes of the decision-making may differ. Relatives attach more importance to advance directives than physicians, and have more permissive attitudes towards hastening death.


CONCLUSIONS
Although physicians, nurses and relatives are all guided by the best interest of the patient, it seems that differences in religious beliefs, perspective of the patient, and responsibility can lead to different attitudes towards end-of-life decisions.


CONCLUSIONS
Physicians should discuss end-of-life decisions more openly. Physicians should be aware of the influences on attitudes and incorporate them into communication about end-of-life decisions.
VU University Medical Center, Institute for Research in Extramural Medicine, Department of Public and Occupational Health, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. m.rurup@vumc.nl
Mette L
ML
Rurup
Bregje D
BD
Onwuteaka-Philipsen
H Roeline W
HR
Pasman
Miel W
MW
Ribbe
Gerrit
G
van der Wal
D000328:Adult; D016223:Advance Directives / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D001294:Attitude to Health; D003142:Communication; D003657:Decision Making; D003704:Dementia / Q000628:therapy*; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008503:Medical Staff / Q000523:psychology; D008875:Middle Aged; D009426:Netherlands; D009735:Nursing Homes / Q000458:organization & administration; D009740:Nursing Staff / Q000523:psychology; D018529:Nutritional Support; D016134:Organizational Policy; D010819:Physician's Role / Q000523:psychology; D012069:Religion and Psychology; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000458:organization & administration / Q000523:psychology*