Treatment decision making involving patients with dementia in acute care: A scoping review.
Kristen E Pecanac, Mary Wyman, Amy J H Kind and 1 others
PMID 29980337WHAT IT FOUND
In acute care, treatment decisions for patients with dementia are driven by whether caregivers and clinicians truly know the patient's values.
Advance directives are frequently ignored due to family conflict or religious beliefs, and caregivers often feel excluded from the process.
Key findings
01Caregivers and nurses prioritize knowing the patient's baseline and values to guide decisions, but advance directives are often not followed due to family discord, religious beliefs, or caregiver burden.
02Caregivers frequently report feeling excluded from decision-making and unsupported, with only 63% of caregivers in one study feeling included in the process.
03Palliative care involvement yields mixed results; while some interventions reduced feeding tube placement or length of stay, others failed to increase consultations or were delayed until after discharge.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included only four databases, which may have missed some relevant studies. Most included studies focused on advanced dementia and surrogate decision-making, leaving little insight into how patients with mild-to-moderate dementia participate in acute care decisions. Findings may not be generalizable across countries due to differing healthcare systems, legal frameworks, and cultural attitudes toward end-of-life care. The consultation focus group included only healthcare practitioners, not patients or caregivers, potentially missing their direct perspectives on the findings.
Declared interests
No specific conflicts of interest or funding sources are detailed in the provided text beyond the publication types indicating non-U.S. government support.
The easy way to misread this
Do not assume that the presence of an advance directive guarantees it will be followed. The review shows that directives are frequently ignored due to family conflict, religious beliefs, or caregiver burden, so clinicians must still engage deeply with the family's current understanding and values.