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Attitudes toward withholding antibiotics from people with dementia lacking decisional capacity : findings from a survey of Canadian stakeholders

Gina Bravo, Lieve Van den Block (UGent) , Jocelyn Downie, Marcel Arcand and Lise Trottier
(2021) BMC MEDICAL ETHICS. 22(1).
Author
Organization
Abstract
Background Healthcare professionals and surrogate decision-makers often face the difficult decision of whether to initiate or withhold antibiotics from people with dementia who have developed a life-threatening infection after losing decisional capacity. Methods We conducted a vignette-based survey among 1050 Quebec stakeholders (senior citizens, family caregivers, nurses and physicians; response rate 49.4%) to (1) assess their attitudes toward withholding antibiotics from people with dementia lacking decisional capacity; (2) compare attitudes between dementia stages and stakeholder groups; and (3) investigate other correlates of attitudes, including support for continuous deep sedation (CDS) and medical assistance in dying (MAID). The vignettes feature a woman moving along the dementia trajectory, who has refused in writing all life-prolonging interventions and explicitly requested that a doctor end her life when she no longer recognizes her loved ones. Two stages were considered after she had lost capacity: the advanced stage, where she likely has several more years to live, and the terminal stage, where she is close to death. Results Support for withholding antibiotics ranged from 75% among seniors and caregivers at the advanced stage, to 98% among physicians at the terminal stage. Using the generalized estimating equation approach, we found stakeholder group, religiosity, and support for CDS and MAID, to be associated with attitudes toward antibiotics. Conclusions Findings underscore the importance for healthcare professionals of discussing underlying values and treatment goals with people at an early stage of dementia and their relatives, to help them anticipate future care decisions and better prepare surrogates for their role. Findings also have implications for the scope of MAID laws, in particular in Canada where the extension of MAID to persons lacking decisional capacity is currently being considered.
Keywords
NURSING-HOME RESIDENTS, AFFECTING PHYSICIANS DECISIONS, LIFE-SUSTAINING, TREATMENTS, CONTINUOUS DEEP SEDATION, ANTIMICROBIAL USE, FAMILY BOOKLET, UNTIL DEATH, END, CARE, PNEUMONIA, Dementia, Decisional incapacity, Advance directive, Infection, Antibiotics, Continuous deep sedation, Euthanasia, Medical assistance in, dying (MAID), Survey, Canada

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MLA
Bravo, Gina, et al. “Attitudes toward Withholding Antibiotics from People with Dementia Lacking Decisional Capacity : Findings from a Survey of Canadian Stakeholders.” BMC MEDICAL ETHICS, vol. 22, no. 1, 2021, doi:10.1186/s12910-021-00689-1.
APA
Bravo, G., Van den Block, L., Downie, J., Arcand, M., & Trottier, L. (2021). Attitudes toward withholding antibiotics from people with dementia lacking decisional capacity : findings from a survey of Canadian stakeholders. BMC MEDICAL ETHICS, 22(1). https://doi.org/10.1186/s12910-021-00689-1
Chicago author-date
Bravo, Gina, Lieve Van den Block, Jocelyn Downie, Marcel Arcand, and Lise Trottier. 2021. “Attitudes toward Withholding Antibiotics from People with Dementia Lacking Decisional Capacity : Findings from a Survey of Canadian Stakeholders.” BMC MEDICAL ETHICS 22 (1). https://doi.org/10.1186/s12910-021-00689-1.
Chicago author-date (all authors)
Bravo, Gina, Lieve Van den Block, Jocelyn Downie, Marcel Arcand, and Lise Trottier. 2021. “Attitudes toward Withholding Antibiotics from People with Dementia Lacking Decisional Capacity : Findings from a Survey of Canadian Stakeholders.” BMC MEDICAL ETHICS 22 (1). doi:10.1186/s12910-021-00689-1.
Vancouver
1.
Bravo G, Van den Block L, Downie J, Arcand M, Trottier L. Attitudes toward withholding antibiotics from people with dementia lacking decisional capacity : findings from a survey of Canadian stakeholders. BMC MEDICAL ETHICS. 2021;22(1).
IEEE
[1]
G. Bravo, L. Van den Block, J. Downie, M. Arcand, and L. Trottier, “Attitudes toward withholding antibiotics from people with dementia lacking decisional capacity : findings from a survey of Canadian stakeholders,” BMC MEDICAL ETHICS, vol. 22, no. 1, 2021.
@article{8744032,
  abstract     = {{Background Healthcare professionals and surrogate decision-makers often face the difficult decision of whether to initiate or withhold antibiotics from people with dementia who have developed a life-threatening infection after losing decisional capacity. Methods We conducted a vignette-based survey among 1050 Quebec stakeholders (senior citizens, family caregivers, nurses and physicians; response rate 49.4%) to (1) assess their attitudes toward withholding antibiotics from people with dementia lacking decisional capacity; (2) compare attitudes between dementia stages and stakeholder groups; and (3) investigate other correlates of attitudes, including support for continuous deep sedation (CDS) and medical assistance in dying (MAID). The vignettes feature a woman moving along the dementia trajectory, who has refused in writing all life-prolonging interventions and explicitly requested that a doctor end her life when she no longer recognizes her loved ones. Two stages were considered after she had lost capacity: the advanced stage, where she likely has several more years to live, and the terminal stage, where she is close to death. Results Support for withholding antibiotics ranged from 75% among seniors and caregivers at the advanced stage, to 98% among physicians at the terminal stage. Using the generalized estimating equation approach, we found stakeholder group, religiosity, and support for CDS and MAID, to be associated with attitudes toward antibiotics. Conclusions Findings underscore the importance for healthcare professionals of discussing underlying values and treatment goals with people at an early stage of dementia and their relatives, to help them anticipate future care decisions and better prepare surrogates for their role. Findings also have implications for the scope of MAID laws, in particular in Canada where the extension of MAID to persons lacking decisional capacity is currently being considered.}},
  articleno    = {{119}},
  author       = {{Bravo, Gina and Van den Block, Lieve and Downie, Jocelyn and Arcand, Marcel and Trottier, Lise}},
  issn         = {{1472-6939}},
  journal      = {{BMC MEDICAL ETHICS}},
  keywords     = {{NURSING-HOME RESIDENTS,AFFECTING PHYSICIANS DECISIONS,LIFE-SUSTAINING,TREATMENTS,CONTINUOUS DEEP SEDATION,ANTIMICROBIAL USE,FAMILY BOOKLET,UNTIL DEATH,END,CARE,PNEUMONIA,Dementia,Decisional incapacity,Advance directive,Infection,Antibiotics,Continuous deep sedation,Euthanasia,Medical assistance in,dying (MAID),Survey,Canada}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{11}},
  title        = {{Attitudes toward withholding antibiotics from people with dementia lacking decisional capacity : findings from a survey of Canadian stakeholders}},
  url          = {{http://doi.org/10.1186/s12910-021-00689-1}},
  volume       = {{22}},
  year         = {{2021}},
}
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