Discordance between the perceptions of clinicians and families about end-of-life trajectories in hospitalized dementia patients.

摘要: BACKGROUND Due to the unpredictable dementia trajectory, it is challenging recognize illness progression and appropriateness of a palliative approach. Further confusion occurs during hospitalization where presence comorbid conditions complicates prognostication. This research examined clinicians families' perceptions as terminal condition in relation end-of-life admissions. CONTEXT The study was based General Medicine units one Australian public hospital. Medical, nursing, social work were recruited reflect multidisciplinary perspectives. Bereaved caregivers deceased patients with interviewed 3 months following death. METHODS Qualitative underpinned by constructionist epistemology framed through complex systems theory. Semi-structured interviews generated data that illuminated deterioration observed toward end life. RESULTS Although participants anticipated general cognitive physical associated dementia, emergence made difficult predict onset During hospital admission, attributed life advanced outcomes whereas families described new medical crises. End-of-life admissions intersections between comorbidities rather than progression. In contrast perception people lose awareness at life, drew attention evidence their loved present dying phase. SIGNIFICANCE OF Our findings challenge dominant understanding trajectories. Bifurcations views demonstrate difficulties recognizing transitions. Implications for integration care are considered.