Nursing home directors' attitude toward medical decision-making and medical care for elderly people with dementia

Background We intend to examine whether the COVID-19 outbreak influences medical decision-making (MDM) among Non-COVID patients. Method We recruit 287 patients who admit to ER department due to cardiovascular complaints. Anxiety level was measured using three questionnaires (GAD-7, Beck Inventory, and the cardiac anxiety questionnaire). A fourth survey was designed to assess MDM considerations. Results 64% of patients were male (median age 54). Almost half of the patients were found to have moderate to severe levels of anxiety.79.3% of patients reported that the outbreak influenced their MDM. 44.5% of patients sought medical care 2-3 from the onset of symptoms. Coronary artery disease was found in only 26 patients (9.1%). Almost half of the patients stated that they would have gone earlier if not for the current pandemic. Conclusion Non-COVID patients seeking medical care had a high anxiety level that directly affected decision-making and put them at unnecessary risk.

Download Full-text

Medical Decision-Making in the Nursing Home: A Comparison of Physician and Nurse Perspectives

Journal of Gerontological Nursing ◽

10.3928/00989134-20061201-03 ◽

2006 ◽

Vol 32 (12) ◽

pp. 14-21 ◽

Cited By ~ 8

Author(s):

Jiska Cohen-Mansfield ◽

Steven Lipson ◽

Debra Horton

Keyword(s):

Decision Making ◽

Nursing Home ◽

Medical Decision Making ◽

Medical Decision

Download Full-text

An Investigation of Medical Decision Making BIAS Using Patient Penal Status

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/154193120504901101 ◽

2005 ◽

Vol 49 (11) ◽

pp. 1004-1008

Author(s):

Stephane Timothee ◽

Marc L Resnick

Keyword(s):

Decision Making ◽

Medical Care ◽

Prescription Drugs ◽

Medical Decision Making ◽

Information Sources ◽

Medical Decision ◽

Decision Making Process ◽

The Us ◽

Patient Variables ◽

To Receive

When providing medical care, doctors are constantly required to make complex decisions based on a wide variety of information sources. As the US health care system becomes more complex with managed care, new regulations for prescription drugs, and other factors, it will become easier for bias to be introduced into the decision making process. This study investigates medical treatment decisions and seeks to identify paths through which bias can be introduced. Patient penal status was used as a proxy for patient variables that in theory should not affect care decisions but in practice often do. The results of the study show that penal patients are less likely to receive required and recommended treatments and that these differences are not due to differences in race, age, or gender of the prisoner population. Additional research is needed to identify the organizational or contextual factors that lead to differences in the provision of medical care.

Download Full-text

SYSTEM CHANGES TO SUPPORT RESIDENT-CENTERED MEDICAL DECISION MAKING FOR FRAIL NURSING HOME RESIDENTS

The Gerontologist ◽

10.1093/geront/gnw162.2747 ◽

2016 ◽

Vol 56 (Suppl_3) ◽

pp. 675-675

Keyword(s):

Decision Making ◽

Nursing Home ◽

Medical Decision Making ◽

Nursing Home Residents ◽

Medical Decision ◽

System Changes

Download Full-text

Advance directives in dementia: issues of validity and effectiveness

International Psychogeriatrics ◽

10.1017/s1041610209990706 ◽

2009 ◽

Vol 22 (2) ◽

pp. 201-208 ◽

Cited By ~ 40

Author(s):

Marike E. de Boer ◽

Cees M. P. M. Hertogh ◽

Rose-Marie Dröes ◽

Cees Jonker ◽

Jan A. Eefsting

Keyword(s):

Decision Making ◽

Empirical Research ◽

Advance Directives ◽

Medical Decision Making ◽

Dementia Care ◽

Medical Decision ◽

Special Focus ◽

Ethical Debate ◽

People With Dementia ◽

Insight Into

ABSTRACTBackground: Although advance directives may seem useful instruments in decision-making regarding incompetent patients, their validity in cases of dementia has been a much debated subject and little is known about their effectiveness in practice. This paper assesses the contribution of advance directives to decision-making in the care of people with dementia, with a special focus on non-treatment directives and directives for euthanasia.Methods: The relevant problems from the ethical debate on advance directives in cases of dementia are summarized and we discuss how these relate to what is known from empirical research on the validity and effectiveness of advance directives in the clinical practice of dementia care.Results: The ethical debate focuses essentially on how to respond to the current wishes of a patient with dementia if these contradict the patient's wishes contained in an advance directive. The (very limited) empirical data show that the main factors in medical decision-making in such cases is not the patient's perspective but the medical judgment of the physician and the influence of relatives. Insight into the experiences and wishes of people with dementia regarding advance directives is totally lacking in empirical research.Conclusions: Ethics and actual practice are two “different worlds” when it comes to approaching advance directives in cases of dementia. It is clear, however, that the use of advance directives in practice remains problematic, above all in cases of advance euthanasia directives, but to a lesser extent also when non-treatment directives are involved. Although generally considered valid, their effectiveness seems marginal. Further empirical research into the (potential) value of advance directives in dementia care is recommended.

Download Full-text

Communication about Advance Directives: Are Patients Sharing Information with Physicians?

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180100006575 ◽

1992 ◽

Vol 1 (4) ◽

pp. 377-387 ◽

Cited By ~ 4

Author(s):

Suzanne B. Yellen ◽

Laurel A. Burton ◽

Ellen Elpern

Keyword(s):

Decision Making ◽

Medical Care ◽

Advance Directives ◽

Patient Participation ◽

Medical Decision Making ◽

Treatment Plan ◽

Treatment Decision ◽

Treatment Decisions ◽

Medical Decision

Historically, patients have deferred to physicians′ judgments about appropriate medical care, thereby limiting patient participation in treatment decisions. In this model of medical decision making, physicians typically decided upon the treatment plan. Communication with patients focused on securing their cooperation in accepting a treatment decision that essentially had already been made.

Download Full-text

Design and implementation of the system to support making medical decisions aid to the population

E3S Web of Conferences ◽

10.1051/e3sconf/202124411015 ◽

2021 ◽

Vol 244 ◽

pp. 11015

Author(s):

Ekaterina Stodelova ◽

Galina Korableva

Keyword(s):

Decision Making ◽

Medical Care ◽

Medical Decision Making ◽

Database Management System ◽

Automated System ◽

Medical Decision ◽

City Hospital ◽

Medical Decisions ◽

Software Product ◽

Rabies Prevention

The publication discusses the issues and results of designing an automated system for supporting medical decision-making on issues of antirabic prevention and aid to the population. The need to provide medical care in the framework of preventing deaths from rabies infection and carrying out preventive measures to prevent such infections is relevant not only in the Russian Federation, but also in many countries of the world. Algorithms for providing medical care and carrying out rabies vaccination are complex, requiring certain professional skills from medical professionals, as well as care and accuracy from patients. Therefore, in manual mode, they are time-consuming both in terms of registering information about the treatment performed, and in terms of the speed of forming medical decisions when providing medical care or when correcting violations of previously defined algorithms. For computer support of these processes, an automated system for supporting medical decision-making has been developed using the tools of the Clarion 10 relational database management system. For various categories of patients and citizens undergoing rabies prevention, experts have developed and entered into the database templates of treatment courses, which are assigned by the system after analyzing the clinical data of patients and the initial or repeated fact of their request for help. These templates and algorithms for analyzing the possibilities of their application are similar to products that allow you to link assumptions and conclusions when making decisions. The automated medical decision support system allows you to register patients and persons undergoing rabies prevention, assign them treatment courses and vaccination schemes, adjust treatment and prevention methods in case of violations of previously prescribed ones, and generate statistical reports. The developed software product received the author’s certificate no. 2018663452 dated 26.10.2018 from the Federal service for intellectual property (Rospatent). The software product has been tested in first aid rooms in Moscow, in the practice of the polyclinic department of the First City hospital named after N. I. Pirogov.

Download Full-text

Medical Decision-Making around the Time of Death of Cognitively Impaired Nursing Home Residents: A Pilot Study

OMEGA - Journal of Death and Dying ◽

10.2190/4j17-px0v-wq03-cgda ◽

2004 ◽

Vol 48 (2) ◽

pp. 103-114 ◽

Cited By ~ 3

Author(s):

Jiska Cohen-Mansfield ◽

Steven Lipson

Keyword(s):

Decision Making ◽

Nursing Home ◽

Medical Decision Making ◽

Nursing Home Residents ◽

Medical Decision ◽

Cognitively Impaired ◽

Decision Making Process ◽

Status Change ◽

Comfort Care ◽

Change Event

The purpose of this article is to describe the end-of-life process in the nursing home for three groups of cognitively–impaired nursing home residents: those who died with a medical decision-making process prior to death; those who died without such a decision-making process; and those who had a status–change event and a medical decision-making process, and did not die prior to data collection. Residents had experienced a medical status–change event within the 24 hours prior to data collection, and were unable to make their own decisions due to cognitive impairment. Data on the decision-making process during the event, including the type of event, the considerations used in making the decisions, and who was involved in making these decisions were collected from the residents' charts and through interviews with their physicians or nurse practitioners. When there was no decision-making process immediately prior to death, a decision-making process was usually reported to have occurred previously, with most decisions calling either for comfort care or limitation of care. When comparing those events leading to death with other status–change events, those who died were more likely to have suffered from troubled breathing than those who remained alive. Hospitalization was used only among those who survived, whereas diagnostic tests and comfort care were used more often with those who died. Those who died had more treatments considered and chosen than did those who remained alive. For half of those who died, physicians felt that they would have preferred less treatment for themselves if they were in the place of the decedents. The results represent preliminary data concerning decision-making processes surrounding death of the cognitively–impaired in the nursing home. Additional research is needed to elucidate the trends uncovered in this study.

Download Full-text