Physicians' Tendency to Choose Palliative Care for an Advanced Dementia Patient Increases Concomitantly With Clinical...

ObjectiveThe benefits of palliative care (PC) education are recognized, but the effects of physicians' attitudes, values and growing experience on end-of-life (EOL) decision-making remain unclear. This study aimed to evaluate whether graduating medical students' EOL decision-making regarding an advanced dementia patient with critical gastrointestinal (GI) bleeding has changed after 6 years' working experience.MethodsA questionnaire presenting a case scenario of a patient with advanced dementia and critical GI bleeding, together with additional questions on attitudes and background factors, was offered to all Finnish final-year medical students in 2015 (n = 639). Respondents were asked to choose between PC and active life-prolonging procedures. The same questionnaire was sent to the previous respondents (n = 402) at the end of 2021.ResultsThe proportion of the respondents (n = 227) choosing PC for a dementia patient increased from 37% (n = 84) in 2015 to 50% (n = 114) in 2021 (P = .002). During the study, 60 respondents changed their option from active care (AC) to PC and 30 from PC to AC. However, attitudes behind the decisions remained largely unchanged. The respondents choosing PC prioritized patient benefit and ethics, while those choosing AC regarded physician's legal protection as more influential.ConclusionPhysicians were more likely to choose PC for an advanced dementia patient after 6 years of clinical experience, though decision-making still varied. The attitudes influencing these decisions may primarily have developed during medical school. The findings underscore the importance of education on PC and ethical aspects of the EOL decision-making in dementia in all levels of medical training.