Introduction to Research & Evidence-Based Practice

Introduction to Healthcare Decision Making

Dementia is a neurological disorder that is made up of a wide range of medical conditions. These groups of condition are generally referred to as Alzheimer’s disease (Livingston, 2017). Dementia can bring about changes in the brain in an abnormal pattern. It can bring about a change in thinking status of the person, hamper with his skill set and can also bring about alterations in the cognitive ability of the person. This can be observed to have a direct impact on the person’s activities of daily living as well hindering with the independent status of living. The behavioral display of the person also alters with the changes, impacting upon the feelings and relationships of the person affected. There are many countries that have laws, allowing people to make their individual decisions regarding their healthcare. People suffering with dementia are often presumed to be incapable of the decision-making, as soon as they are diagnosed with the condition (Lavazza, 2018). However, these individuals might still possess certain cognitive capabilities that might help them in making prudent judgement pertaining to their own health status.

Being able to make a sound decision can be deemed as the person having a good capacity. This might get affected with dementia, as multiple parts of the brains are involved in the mechanism of the disease. Dementia can very well hamper with the process of collecting information, remembering the facts and processing that information to be put to good use. Capacity of the person may also vary with specific time and individual limitations (Mariani, 2017). A person having dementia, may be able to make good decision now, but might lack this ability in his later stages of life. As the condition of dementia is progressive, the overall capacity of the patient might reduce over the due course of time. It can also vary with the rate of disease spread and the type of dementia the person is having. There is a dire need of good understanding of the person in respect with his or her environment, to make sure the best possible support can be provided to them (Hung, 2019). It is also important to make sure that the individual get the opportunity to make sound decisions as long as possible by them. The main statement of this paper will be analyzing the decision-making capacity in people suffering from dementia.

Critical Analysis

Shared clinical decision-making process can be recognized as an important element, ensuring person-centered care in dementia patients. Studies have reflected upon the fact that even with cognitive impairments, people suffering from dementia have offered a request to be a part of the decision-making process (Kirkendall, 2017). This includes the minute details of taking part in their activities of daily living as well. The staff working in various healthcare facilities or extended care settings, such as elderly accommodation, tend to review the patient from a clinical aspect (Daly, 2018). The stigma attached with dementia, pertaining to the inability of the person in sound judgement delivery, hampers them to look at the emotional aspect of the scenario. However, clinical set-ups that work on the basis of shared decision-making process for the patient have been shown to have a higher percentage of quality of care enabled to the patients. With additional guidance of the staff members, improvement can be attained in terms of both quality of life as well as clinical decision-making for the benefit of the patient.

Shared decision-making process, especially with people with dementia is quite possible and it may require an adaptive method. The process includes being constantly engaged in the continuity of care of the patient. It is also crucial to know the individual experience of the patient, so that the case scenario can be analyzed from an individual perspective (Groen, 2017). Shared decision-making also helps in focusing from initial preferences to the experienced preferences, best suitable for the patient. Professionals engaged in the care of the patient on a personal basis, can be quite helpful for ensuring smooth facilitation of healthcare services. As highlighted, capacity to make one’s own healthcare related decision enables a patient to have certain autonomy in the process. It might however, vary with the functional capacity of the patient. There are four key components that can be attached with this process. This can include understanding, communicating, appreciating and analysing the situation from a critical reasoning point of view (Hegde, 2016). The complexities might increase with impaired capacity of the individual. However, it is duty of the healthcare professional to maintain a balance, ensuring the best interest of the patient and preserving their autonomy.

End-of-life care in patients suffering from dementia, can give rise of certain ethical and legal considerations in the clinical decision-making for the patient. These situations can no doubt be quite complex and challenging. Multiple components may be attached to this specific situation. However, by working in close coordination with the patient, the situation can be simplified, with assurance of delivery of high-quality care to the patient (Dening, 2017). The decision-making should be carried out, keeping a close consideration for past, present and future of the patient’s capabilities as well as limitations. The role of family in the decision-making process should also be verified from the valid sources. In patients, who might not be able to make decision on their own anad can take help of their family members. The healthcare professionals can also work along with the family, in facilitating care for the patients. The family or next of kin can serve as the best advocates for the medical rights and demands of the patient (Miller, 2016). This will also ensure a good decision-making, through a collaborative approach.

Communication is another major element that can be taken into due consideration, while making informed decision-making for the patient. The patients suffering from dementia are generally experiencing various emotional risks, judging their won capabilities. This might hinder with the process of sound decision-making (Stevenson, 2019). Communication can however, help in addressing this issue and enabling robust and equal involvement of the patient in the process. Effective communication using problem solving models can be deemed as the best possible approach to deal with the underlying emotional stressors, patient might be experiencing. Few people suffering from dementia might also require advanced care planning to deal with their condition. This scenario is generally faced by the healthcare professionals in a long-term care setting. There might be certain communication challenges attached to this method of delivery of care to the dementia patients (Beck, 2017). This can only be attained through two main approaches.

The primary approach can include being continuously included in the process of enhancing the channels of communication. And the secondary method can be, inculcating various planning and educational strategies to improve on the shortcomings. There have been incidences, with patients suffering from dementia, having multiple other clinical comorbidities. The decision-making process can raise quite a few ethical concerns in such given case scenario. The decision should however, be modulated as per the situational analysis of the overall assessment of the patient (Griffiths, 2020). This method can also be deemed as quite flexible and might render the additional emotional comfort required by the patient, to deal with such strenuous clinical scenarios. There is also a dire need of an extended hand of support for such patients, ensuring the support in a continuous manner. The role of professional conceptualization, is to be taken into due consideration while making decision for patient suffering from dementia. Various factors determine and influence this process. These elements might include, advocating for the rights of the patient, advocating the working through relational practices, capacity assessment for patient suffering from dementia and the supporting force standing aside the patient. These factors are all interlinked in terms of interpretating the professional indifferences, which might hinder with eth decision making process (Sinclair, 2019). Doing so adequate support can be rendered to the patient, as per their individual health care needs and requirements.

A study was conducted by Hogsnes in 2016 to analyze the concept of end of life care in dementia. The study undertook various parameters for evaluating the same. These categories included decision-making, participation, communication and healthcare staff. The study concluded that while managing care for dementia patient during their end of life, a holistic view should be considered from the patient’s perspective (Hogsnes, 2016). All kinds of needs, including physical, emotion and psychosocial, should be taken into due consideration, while going through the process of decision-making.

Conclusion on Healthcare Decision Making

It is vital for a person to make their own individual choice, defining how they may want to live. The assessment of one’s capacity should completely rely upon the given scenario and the medical limitations observed in the patient. It is the duty of the healthcare professional to assess the optimal level of the person’s functioning status. This is crucial for getting to acknowledge their capability to make a decision. The evaluation of the patient should be done from a legal perspective as well. The decision- making capacity should not overlap with the ethical and legal considerations of the healthcare system. The patients having less cognitive issues might be aware of their rights and responsibilities. The same might not stand true, when the disease progresses in the patient, leaving behind multiple impairments. This can overlap with the clinical decision-making, best suitable for the patient.

References for Healthcare Decision Making

Beck, E. R., McIlfatrick, S., Hasson, F., & Leavey, G. (2017). Health care professionals’ perspectives of advance care planning for people with dementia living in long-term care settings: A narrative review of the literature. Dementia16(4), 486-512. https://doi.org/10.1177%2F1471301215604997

Daly, R. L., Bunn, F., & Goodman, C. (2018). Shared decision-making for people living with dementia in extended care settings: A systematic review. British Medical Journal Open8(6). http://dx.doi.org/10.1136/bmjopen-2017-018977

Dening, K. H., King, M., Jones, L., & Sampson, E. L. (2017). Healthcare decision-making: Past present and future, in light of a diagnosis of dementia. International Journal of Palliative Nursing23(1), 4-11. https://doi.org/10.12968/ijpn.2017.23.1.4

Griffiths, A. W., Ashley, L., Kelley, R., Cowdell, F., Collinson, M., Mason, E., ... & Surr, C. (2020). Decision‐making in cancer care for people living with dementia. Psycho‐Oncology29(8), 1347-1354. https://doi.org/10.1002/pon.5448.

Groen-van de Ven, L., Smits, C., de Graaff, F., Span, M., Eefsting, J., Jukema, J., & Vernooij-Dassen, M. (2017). Involvement of people with dementia in making decisions about their lives: A qualitative study that appraises shared decision-making concerning daycare. British Medical Journal Open7(11), 83-97. http://dx.doi.org/10.1136/bmjopen-2017-018337

Hegde, S., & Ellajosyula, R. (2016). Capacity issues and decision-making in dementia. Annals of Indian Academy of Neurology19(1), 34–39. https://doi.org/10.4103/0972-2327.192890

Høgsnes, L., Danielson, E., Norbergh, K. G., & Melin‐Johansson, C. (2016). Healthcare professionals' documentation in nursing homes when caring for patients with dementia in end of life–a retrospective records review. Journal of Clinical Nursing25(11-12), 1663-1673.

Hung, L., Phinney, A., Chaudhury, H., Rodney, P., Tabamo, J., & Bohl, D. (2017). “Little things matter!” Exploring the perspectives of patients with dementia about the hospital environment. International Journal of Older People Nursing12(3), 121-153. DOI https://doi.org/10.1111/opn.12153

Kirkendall, A., Linton, K., & Farris, S. (2017). Intellectual disabilities and decision making at end of life: a literature review. Journal of Applied Research in Intellectual Disabilities30(6), 982-994. DOI https://doi.org/10.1111/jar.12270

Lavazza, A., & Reichlin, M. (2018). Of meatballs, autonomy, and human dignity: Neuroethics and the boundaries of decision making among persons with dementia. AJOB Neuroscience9(2), 88-95. DOI https://doi.org/10.1080/21507740.2018.1459930

Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D., ... & Cooper, C. (2017). Dementia prevention, intervention, and care. The Lancet390(10113), 2673-2734. https://doi.org/10.1016/S0140-6736(17)31363-6

Mariani, E., Vernooij-Dassen, M., Koopmans, R., Engels, Y., & Chattat, R. (2017). Shared decision-making in dementia care planning: Barriers and facilitators in two European countries. Aging & Mental Health21(1), 31-39. https://doi.org/10.1080/13607863.2016.1255715

Miller, L. M., Whitlatch, C. J., & Lyons, K. S. (2016). Shared decision-making in dementia: a review of patient and family carer involvement. Dementia15(5), 1141-1157. https://doi.org/10.1177%2F1471301214555542

Sinclair, C., Bajic-Smith, J., Gresham, M., Blake, M., Bucks, R. S., Field, S., Clayton, J. M., Radoslovich, H., Agar, M., & Kurrle, S. (2019). Professionals’ views and experiences in supporting decision-making involvement for people living with dementia. Dementia. https://doi.org/10.1177/1471301219864849

Stevenson, M., Savage, B., & Taylor, B. J. (2019). Perception and communication of risk in decision making by persons with dementia. Dementia18(3), 1108-1127. https://doi.org/10.1177%2F1471301217704119

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