Prognosis is important in decisionmaking in Dutch nursing home patients with dementia and pneumonia.
OBJECTIVE
To explore how physicians treating nursing home residents with dementia and pneumonia in the Netherlands consider prognosis in their treatment decision.


METHODS
Survey study with data collected between July 2006 and March 2008. Physicians (n = 69) from 54 nursing homes in the Netherlands completed a questionnaire on symptoms, treatment, and prognosis for their next dementia patient newly diagnosed with pneumonia. They were also asked a general question regarding withholding antibiotic treatment and prognosis. Outcome was assessed at least two months afterwards. Two-week mortality risk if treated with antibiotics was calculated with a validated prognostic score.


RESULTS
The patients not treated with antibiotics had high (92%) actual 2-week mortality while only 12% of patients treated with antibiotics died. Physicians believed that mortality risk was high in the untreated group and would have been only slightly lower if treated with antibiotics (mean estimated risk 73%), which was higher than predicted from the risk score (42%). In general, three-quarters of physicians considered withholding antibiotics appropriate for mortality risks between 75% and 90%.


CONCLUSIONS
Prognosis is an important consideration when Dutch nursing home physicians make antibiotic treatment decisions for patients with dementia and pneumonia. This suggests they prefer not to treat with antibiotics when to do so is probably futile. Physicians in other countries may hold different views on futility, which should be addressed in larger, cross-national comparative studies.
van der Steen
Jenny T
JT
EMGO Institute, VU University Medical Center, 1081 BT Amsterdam, The Netherlands. j.vandersteen@vumc.nl
Helton
Margaret R
MR
Ribbe
Miel W
MW
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003657:Decision Making / Q000941:ethics*; D003704:Dementia / Q000150:complications* / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes; D010166:Palliative Care / Q000941:ethics; D011014:Pneumonia / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D010818:Practice Patterns, Physicians' / Q000941:ethics; D011379:Prognosis; D028761:Withholding Treatment / Q000941:ethics*
D000900:Anti-Bacterial Agents