FAMILY DECISION-MAKING FOR ADVANCED ALZHEIMER PATIENTS.
Contributors: Boston College.
Published: 1992
Number of pages: 324
Subjects: Gerontology.; Health Sciences, Nursing.; Sociology, Individual and Family Studies.
Description: This qualitative research employed grounded theory methodology to describe the process of decision making about the use of life-sustaining interventions by the wives of patients with dementia of the Alzheimer type (DAT). In the pilot study, a retrospective record review revealed that the patients were physically healthy, although extremely impaired cognitively and functionally, necessitating decision making by surrogates. When the patients' preferences for less aggressive intervention were known, a palliative approach to care was often selected. Two patient variables, lost speech ability and lack of cooperation emerged in a stepwise multiple regression equation to account for 23% of the decisional variance. When examined independently, other correlates of the decision were impaired social contact, decreased communication ability, and diminished functional and interactive capability.

In the next phase, the wives were interviewed before and after the Family Conferences where the decisions about interventions were made. Through participant observation, the conference proceedings and the wives' interactions with the members of the interdisciplinary team were recorded. The data from the preconference interviews revealed the wives' personal experience with DAT and the decisions made in response to the progressive dementia. They responded to their many losses with expressions of grief, and demonstrated how they cognitively process their decisions, which were often made in crisis situations.

The decisions made by the wives during the Family Conferences were qualitatively different. From the postconference interview data, these decisions about life-sustaining medical interventions were not made in response to a situational crisis, but in the context of open communication with the interdisciplinary team, and trust that their husbands' needs would be met.

Four dynamics characterized the family conferences: interest, interpretation, interagency, and intervention. The complex interplay between the contextual theme of DAT progression, the pervasive themes of grief and cognitive style, and the importance of relationships influenced the decisions about life-sustaining interventions made by the wives.

This research increases understanding of the process of surrogate decision making and the role of the interdisciplinary team, and has clinical utility as more surrogates are appointed through the Patient Self-Determination Act.
Notes: Source: Dissertation Abstracts International, Volume: 53-09, Section: A, page: 3330.

Thesis (PH.D.)--BOSTON COLLEGE, 1992.

School code: 0016.