Patient autonomy in dementia: Effects of supported advance care decision-making

Retaining autonomy in medical decision-making is challenging for people with dementia as decision-making capacity becomes increasingly impaired. Advance directives can help preserve autonomous treatment decisions, and approaches such as advance care planning and supported decision-making may facilitate the completion of such documents. This study examined supported decision-making within an advance care planning approach adapted for people with dementia, referred to as supported advance care decision-making (sACD). The effects of a sACD intervention were examined in memory clinic patients using a comparative, non-randomized design with a baseline phase (n = 154) and an intervention phase (n = 135). Results indicated that the sACD intervention was associated with a higher proportion of advance directives meeting the informed consent standard, but not with overall advance directive status. Effects on patient-reported satisfaction were uncertain due to missing data and ceiling effects. Given the study design, causal inferences are limited. Overall, the findings suggest that supported decision-making has the potential to promote patient autonomy in advance care planning for people with dementia.