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People were about 19 percentage points less likely to recommend life-sustaining treatment for a seriously ill patient with dementia than for a patient without dementia, even when an advance directive requested life-sustaining care, according to new research from the University of Colorado Anschutz.
The study, published in JAMA Network Open, surveyed nearly 6,000 U.S. adults to examine how a patient's dementia status, advance directive, physician recommendations and a surrogate decision-maker's own preferences influenced recommendations about end-of-life care.
The findings showed that dementia status played an important role in participants' recommendations. The difference in recommendations for life-sustaining treatment persisted even when the patient's documented wishes called for that treatment.
"People's assumptions about what life is like with dementia appear to play an important role in how they think about treatment decisions," said Lauren Hersch Nicholas, Ph.D., MPP, professor of medicine in the division of geriatric medicine at the University of Colorado Anschutz School of Medicine and the study's lead author.
"That's important because a patient's wishes may not be reflected in the care they ultimately receive if the person making decisions for them has a different view of what quality of life means."
In the randomized online survey experiment, participants reviewed scenarios involving seriously ill, hospitalized older adults. Researchers varied several factors, including whether the patient had dementia, whether an advance directive requested life-sustaining or comfort-focused care and whether a physician recommended treatment.
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