title: Recognition of and intent to use gastrostomy or ventilator treatments in older patients with advanced dementia: differences between laypeople and healthcare professionals in Japan.
abstract: OBJECTIVE
  We compared differences between laypeople and healthcare professionals in the recognition of and intent to use gastrostomy and ventilator treatments in older patients with dementia.
  
  
  METHODS
  Between November 2011 and January 2012, a questionnaire survey was carried out. People who underwent a general health check-up at Nomura Hospital Preventive Medical Center were recruited as the laypeople group. Physicians and nurses working in Mitaka, Tokyo, Japan, were recruited as the healthcare professional group. We assessed the recognition rate of ventilator and gastrostomy treatments. Then we provided two scenarios for participants to determine whether these methods represented life-sustaining treatments that will simply delay an inevitable death. Intentions were compared between cases with and without advance directives.
  
  
  RESULTS
  Approximately 60% of laypeople did not know what gastrostomy is. Healthcare professionals were more likely to recognize a ventilator as a life-sustaining treatment; in contrast, there were no significant differences in judgments regarding gastrostomy. Both groups were more likely to have intent to use a gastrostomy and a ventilator for family members than themselves. Furthermore, healthcare professionals were more likely to want to use these items for patients than their family members. Advance directive for withholding life-sustaining treatment reduced the intention to use these treatments.
  
  
  CONCLUSIONS
  It is necessary to increase our understanding regarding knowledge of end-of-life care options of both laypeople and healthcare professionals.
authors.affiliation: Division of Clinical Epidemiology, Research Center for Medical Science, Jikei University School of Medicine, Tokyo, Japan; Nomura Hospital, Tokyo, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Kawasaki
authors.forename: Masato
authors.initials: M
authors.lastname: Matsushima
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Miura
authors.forename: Takamasa
authors.initials: T
authors.lastname: Watanabe
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Tominaga
authors.forename: Takuya
authors.initials: T
authors.lastname: Nagata
authors.forename: Yoko
authors.initials: Y
authors.lastname: Hirayama
authors.forename: Akinari
authors.initials: A
authors.lastname: Moriya
authors.forename: Kouji
authors.initials: K
authors.lastname: Nomura
mesh_terms: D016223:Advance Directives; D000368:Aged; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003657:Decision Making; D003704:Dementia / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005774:Gastrostomy / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007564:Japan; D008297:Male; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods / Q000706:statistics & numerical data*
keywords: advance directives; end-of-life care; gastrostomy; ventilator; withholding treatment