A Cross-Cultural Study of Physician Treatment Decisions for Demented Nursing Home Patients Who Develop Pneumonia

The Article in Brief

A Cross-Cultural Study of Physician Treatment Decisions for Demented Nursing Home Patients Who Develop Pneumonia

Margaret R. Helton, MD, and colleagues

Background There are many differences between US and Dutch approaches to care of nursing home patients. In this study, US and Dutch physicians were interviewed about factors that are important in their treatment decisions for nursing home patients with dementia who develop pneumonia.

What This Study Found Physicians view their patient care roles differently, with Dutch physicians taking active responsibility for treatment decisions and US physicians deferring to family wishes. Dutch physicians base decisions on an intimate knowledge of the patient; American physicians report more limited knowledge of their nursing home patients as a result of limited time with them.

Implications

• Physicians are shaped by broad social factors. For American doctors, these factors include technological medical training, a lack of emphasis on care of nursing home patients, a high value of personal autonomy, and fear of lawsuits. Dutch doctors are influenced by the Netherlands' public discussion about end-of-life care, a strong national focus on and training in nursing home care, and less emphasis on technology in medicine.
• Efforts to improve care of nursing home patients with dementia and pneumonia must consider social values, physician training, and processes by which physicians determine and negotiate patient and family preferences regarding care.
• These study findings should be considered in debates about how to best care for patients with poor quality of life who lack decision-making capacity.