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Do‐Not‐Hospitalize Orders for Individuals with Advanced Dementia: Healthcare Proxies' Perspectives
Author(s) -
Mann Elizabeth,
Goff Sarah L.,
ColonCartagena Wanda,
Bellantonio Sandra,
Rothberg Michael B.
Publication year - 2013
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12406
Subject(s) - medicine , dementia , psychological intervention , minimum data set , distress , health care , nursing , medline , family medicine , qualitative research , nursing homes , clinical psychology , disease , social science , pathology , sociology , political science , law , economics , economic growth
Objectives To determine how well healthcare proxies ( HCP s) understand do‐not‐hospitalize ( DNH ) orders and why they may or may not initiate them. Design Semistructured qualitative interviews. Setting Two nursing homes in western Massachusetts. Participants HCPs of nursing home residents with advanced dementia. Measurement In‐depth interviews were audiotaped and transcribed verbatim. Data were qualitatively analyzed in an iterative process, and emergent concepts were conceptually ordered into explanatory categories. Pertinent demographic and clinical information was collected from the M inimum D ata S et ( MDS ) and patient charts. Results Sixteen of 31 eligible HCP s were interviewed. Major findings included barriers to and facilitators of initiating DNH orders. Barriers included a perceived lack of physician involvement in decision‐making and limited understanding of DNH orders and the resident's prognosis. Facilitators included a HCP s' personal experience in health care, understanding the prognosis of advanced dementia, and a desire to limit resident distress. Conclusion The potential barriers to and facilitators of HCP s initiating DNH orders identified in this study suggest that HCP s may benefit from more in‐depth discussions with healthcare providers when making this decision. Interventions to address these barriers may improve the capacity of HCP s to make informed decisions about DNH orders that reflect individuals' values and wishes.