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Practitioner Bias as an Explanation for Low Rates of Palliative Care Among Patients with Advanced Dementia

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Abstract

Patients with advanced dementia are less likely than those with other terminal illnesses to receive palliative care. Due to the nature and course of dementia, there may be a failure to recognize the terminal stage of the disease. A possible and under-investigated explanation for this healthcare disparity is the healthcare practitioner who plays a primary role in end-of-life decision-making. Two potential areas that might impact provider decision-making are cognitive biases and moral considerations. In this analysis, we demonstrate how the cognitive biases and moral considerations of practitioners related to clinical decision-making are inherent in clinical practice and may impact on providers’ accuracy related to diagnostic and treatment related decision-making associated with patients with advanced dementia. Anchoring, default, availability, representativeness and framing biases are cognitive biases based on the "Two System Model" that relate to decision-making in end-of-life care. In patients with advanced dementia, those biases may result in a tendency to adhere to traditional mandatory care, involving an aggressive approach to care, which values saving lives at all costs, without taking into account the possible suffering and long-term consequences. Aspects such as moral sensitivity and moral courage play an important role in ethical decision-making related to advanced dementia. Investigations of clinical decision-making that include the cognitive biases and ethical considerations of practitioners might advance the comprehensive understanding of the clinical decision-making process related to care of patients with advanced dementia and promote the quality of care given to this population.

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  1. Henrietta Szold Hadassah-Hebrew University School of Nursing, Kiryat Hadassah, POB 1200, 9112001, Jerusalem, Israel

    Meira Erel, Esther-Lee Marcus & Freda Dekeyser-Ganz

  2. Faculty of Medicine, Hadassah-Hebrew University, Jerusalem, Israel

    Meira Erel & Esther-Lee Marcus

  3. Geriatric Division, Herzog Medical Center, Givat Shaul Street, POB 3900, 9103702, Jerusalem, Israel

    Esther-Lee Marcus

  4. Jerusalem College of Technology, 11 Beit-Hadfus, Jerusalem, 9548311, Israel

    Freda Dekeyser-Ganz

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Erel, M., Marcus, EL. & Dekeyser-Ganz, F. Practitioner Bias as an Explanation for Low Rates of Palliative Care Among Patients with Advanced Dementia. Health Care Anal 30, 57–72 (2022). https://doi.org/10.1007/s10728-021-00429-x

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