EMS providers face diagnosis, language, directive challenges to dementia care
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Key takeaways:
- A content analysis of EMS treatment in 81 critically ill patients with dementia yielded three major themes.
- Future research should include boarder interviews with EMS personnel and patient surrogates.
PHILADELPHIA — Emergency medical service providers face challenges such as diagnosis, proper intervention and surrogate decision-making in treating critically ill individuals with dementia who require urgent medical intervention, according to a poster.
“The goal was to try and better understand decision-making about advanced life support for people with advanced dementia during time-pressured clinical situations like 911 calls,” Lauren R. Pollack, MD, MS, clinical research instructor in the division of pulmonary, critical care and sleep medicine at the University of Washington, told Healio at the Alzheimer’s Association International Conference.
Prior research established the need for comfort-based care for those diagnosed with Alzheimer’s disease and related dementias near the end of life, considering the possibility of required mechanical ventilation. Obstacles such as timing and location as well as end-of-life document completion and location presented challenges to rapid and compassionate care in emergency situations.
As such, Pollack and colleagues aimed to identify major themes in the emergency medical service (EMS) decision-making process regarding intubation for individuals living with dementia before hospital admittance.
The researchers conducted a qualitative content analysis of EMS treatment narratives derived from 911 calls. The analysis included data from the UW Medicine electronic health record on 81 patients (mean age, 80 years; 42% women; 48% nursing home residents) with a dementia diagnosis who were assessed by EMS and admitted to a hospital between 2011 and 2021.
According to the results, the largest proportion of narratives of interest (31%) was the diagnosis of dementia itself, followed by discussions of advanced directives (22%), then the presence of a surrogate decision-maker (21%) for the patient.
The researchers identified three major themes: disagreement about prognosis or treatment goals between the patient and their surrogate, language barriers between patient/surrogate and those who would administer treatment, and disagreements over the nature of advanced health directives.
Pollack and colleagues acknowledged limitations of their study, such as the analysis being conducted in a single health care system, a focus on written documentation and the omission of those who decided against hospitalization. They noted that more qualitative interviews would be necessary within the same care provider population to broaden the body of knowledge surrounding 911 response situations.
“Our emergency medical services system has gotten much less attention compared with hospital settings and outpatient clinic practices when it comes to this concept of goal-concordant care,” Pollack told Healio. “I think we need to give it equal focus.”