How do nursing home doctors involve patients and next of kin in end-of-life decisions? A qualitative study from Norway
Tóm tắt
Ethically challenging critical events and decisions are common in nursing homes. This paper presents nursing home doctors’ descriptions of how they include the patient and next of kin in end-of-life decisions. We performed ten focus groups with 30 nursing home doctors. Advance care planning; aspects of decisions on life-prolonging treatment, and conflict with next of kin were subject to in-depth analysis and condensation. The doctors described large variations in attitudes and practices in all aspects of end-of-life decisions. In conflict situations, many doctors were more concerned about the opinion of next of kin than ensuring the patient’s best interest. Many end-of-life decisions appear arbitrary or influenced by factors independent of the individual patient’s values and interests and are not based on systematic ethical reflections. To protect patient autonomy in nursing homes, stronger emphasis on legal and ethical knowledge among nursing home doctors is needed.
Tài liệu tham khảo
Causes of death, Norway. Norwegian Institute of Public Health. 2014. http://statistikkbank.fhi.no/dar/. Accessed 16 Apr 2015.
Bergh S, Holmen J, Saltvedt I, Tambs K, Selbaek G. Dementia and neuropsychiatric symptoms in nursing-home patients in Nord-Trøndelag County. J Norw Med Assoc. 2012;132:1956–9.
Pleie- og omsorgstjenesten i kommunene: tjenestemottakere, hjelpebehov og tilbud. Report in Norwegian. Norwegian Board of Health Supervision. 2003. https://www.helsetilsynet.no/upload/Publikasjoner/Rapporter2003/pleie_omsorgstjenesten_kommunene_rapport_102003.pdf. Accessed 16 Apr 2015.
Selbaek G, Kirkevold Ø, Engedal K. (2007). The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes. Int J Geriatr Psychiatry. 2007;22:843–9.
Graverholt B, Riise T, Jamtvedt G, Ranhoff AH, Kruger K, Nortvedt MW. Acute hospital admissions among nursing home residents: a population-based observational study. BMC Health Serv Res. 2011;11:126.
The Patients’ Rights Act. The Norwegian Directorate of Health. 2004. English translation: http://www.ub.uio.no/ujur/ulovdata/lov-19990702-063-eng.pdf. Accessed 16 Apr 2015.
Menezes B, Tadros G. Implementing the Mental Capacity Act in nursing homes: between obligation and application. Int J Geriatr Psychiatry. 2008;23:334–5.
Gjerberg E, Forde R, Bjorndal A. Staff and family relationships in end-of-life nursing home care. Nurs Ethics. 2011;18:42–53.
Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24:105–12.
Friis P, Forde R. Advance care planning discussions with geriatric patients. J Norw Med Assoc. 2015;135:233–5.
Dreyer A, Forde R, Nortvedt P. Autonomy at the end of life: life-prolonging treatment in nursing homes-relatives’ role in the decision-making process. J Med Ethics. 2009;35:672–7.
Sharp T, Moran E, Kuhn I, Barclay S. Do the elderly have a voice? Advance care planning discussions with frail and older individuals: a systematic literature review and narrative synthesis. Br J Gen Pract. 2013;63:657–68.
Gjerberg E, Lillemoen L, Forde R, Pedersen R. End-of-life care communications and shared decision-making in Norwegian nursing homes - experiences and perspectives of patients and relatives. BMC Geriatrics. 2015;15:103.
Parker SM, Clayton JM, Hancock K, Walder S, Butow PN, Carrick S, et al. A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: patient/caregiver preferences for the content, style, and timing of information. J Pain Symptom Manage. 2007;34:81–93.
Hancock K, Clayton JM, Parker SM, Walder S, Butow PN, Carrick S, et al. Discrepant perceptions about end-of-life communication: a systematic review. J Pain Symptom Manage. 2007;34:190–200.
Sharp T, Moran E, Kuhn I, Barclay S. Do the elderly have a voice? Advance care planning discussions with frail and older individuals: a systematic literature review and narrative synthesis. Br J Gen Pract. 2013. doi:10.3399/bjgp13X673667.
Beck ER, McIlfatrick S, Hasson F, Leavey G. Health care professionals’ perspectives of advance care planning for people with dementia living in long-term care settings: A narrative review of the literature. Dementia. 2015. doi:10.1177/1471301215604997.