A Short Decision Support Tool to Help you Decide about Antibiotic and Artificial Hydration Use in Advanced Dementia

01 November 2018

Dr Andrea Loizeau is a researcher and psychologist working in the field of palliative care and dementia at the Center for Gerontology, University of Zurich, Switzerland and the Institute for Ageing Research, Harvard Medical School Affiliate, United States. Dr Loizeau and her colleagues conducted a study to improve medical decision-making for patients dying with advanced dementia, and pneumonia or insufficient fluid intake.

Dementia is a terminal condition that affects more than 50 million people worldwide. Offering appropriate end-of-life care to affected patients is a public health priority. In the last months of their lives, patients with advanced dementia commonly experience burdensome medical interventions such as antibiotic misuse or artificial hydration. These interventions may be of limited benefit and do not promote comfort.

Family decision-makers (or formally designated professional guardians) along with physicians make medical decisions on behalf of advanced dementia patients but lack adequate support in the decision process. When families are given decision-support tools or are asked about the goals of care, patients experience less burdensome interventions in their last months of life.

Fact Boxes are helpful and short decision support tools that can easily be understood by a variety of decision-makers. Based at the University of Zurich and in collaboration with researchers from Germany, the Netherlands and the United States, we developed two short Fact Box decision support tools on antibiotics for pneumonia and artificial hydration in advanced dementia. See what our Fact Boxes look like.

Can our newly developed Fact Box positively impact the decisional conflict of decision-makers? Can they result in greater knowledge about treatments? Do they change the decision-makers’ preferences about the use of antibiotics and artificial hydration in advanced dementia, e.g. toward less aggressive treatment decisions?

To answer these questions, we tested our Fact Box decision support tools among 64 physicians, 100 relatives of dementia patients, and 68 professional guardians in the Swiss-German region of Switzerland. Participants were mailed questionnaires assessing treatment preferences with respect to hypothetical scenarios of patients with advanced dementia, and pneumonia or insufficient fluid intake.

The findings revealed that the Fact Boxes considerably reduced the decisional conflict of physicians, relatives, and professional guardians about the use of antibiotics for pneumonia and artificial hydration in advanced dementia. They resulted in greater knowledge about the use of these treatments and promoted preferences to forego antibiotics in advanced dementia. All but one physician stated that they would use the Fact Boxes as a communication tool.

Fact Boxes have the potential to aid a variety of decision-makers, including physicians, in making end-of-life treatment decisions on behalf of patients with advanced dementia. They constitute a promising option for real-life care settings because they are brief and inexpensive compared to other decision support tools.


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