Attitudinal patterns determining decision making in the treatment of the elderly: a comparison between physicians and nurses in Germany and Sweden

Objective: Do-not-resuscitate orders (DNR orders) and advance directives (AD) have been developed and their use by patients is increasing. The objective of the study was to evaluate the compliance with patient's wishes and doctors' and nurses' agreement on decision-making in the treatment of elderly patients from a cross-cultural perspective. Design and participants: One hundred and four Swedish physicians and 122 nurses as well as 192 German physicians and 182 nurses from teaching and university hospitals were surveyed by a questionnaire based on a case-vignette with three scenarios of available information about patient's wishes for treatment. Results: A relationship between the perceived level of help and the chosen treatment option was established for all four samples, especially for the scenario in which an AD was available. Two patterns of closely related determinants appeared: (a) patient's wishes','ethical concerns', and 'family wishes'; and (b) 'patient's age','level of dementia', and 'hospital costs'. Conclusions: An intensive and continuous education of physicians and nurses in medical ethics is required to promote patient autonomy in clinical practice. The ethical implications of patient's age and level of dementia in relation to hospital costs should constitute important topics of these educational programs.