Advance directives for future dementia can be modified by a brief video presentation on dementia care: An experimental study

Abstract

Objectives: To investigate whether life-sustaining measures in medical emergency situations are less accepted for an anticipated own future of living with dementia, and to test whether a resource-oriented, in contrast to a deficit-oriented video about the same demented person, would increase the acceptance of such life-saving measures.

Design: Experimental study conducted between September 2012 and February 2013.

Setting: Community dwelling female volunteers living in the region of Bonn, Germany.

Participants: 278 women aged 19 to 89 (mean age 53.4 years).

Intervention: Presentation of a video on dementia care focusing either on the deficits of a demented woman (negative framing), or focusing on the remaining resources (positive framing) of the same patient.

Main outcome measures: Approval of life-sustaining treatments in five critical medical scenarios under the assumption of having comorbid dementia, before and after the presentation of the brief videos on care.

Results: At baseline, the acceptance of life-sustaining measures in critical medical situations was significantly lower in subjects anticipating their own future life with dementia. Participants watching the resource-oriented film on living with dementia had significantly higher post-film acceptance rates compared to those watching the deficit-oriented negatively framed film. This effect particularly emerges if brief and efficient life-saving interventions with a high likelihood of physical recovery are available (eg, antibiotic treatment for pneumonia).

Conclusions: Anticipated decisions regarding life-sustaining measures are negatively influenced by the subjective imagination of living with dementia, which might be shaped by common, unquestioned stereotypes. This bias can be reduced by providing audio-visual information on living with dementia which is not only centred around cognitive and functional losses but also focuses on remaining resources and the apparent quality of life. This is particularly true if the medical threat can be treated efficiently. These findings have implications for the practice of formulating, revising, and supporting advance directives.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Two-step experimental design.

DCV: Dementia Case Vignette; CCV: Control Case Vignette; DCV+: Dementia Case Vignette after seing a resource-oriented film on living with dementia ("positive film"); DCV-: Dementia Case Vignette after seeing a deficit-oriented film on living with dementia ("negative film").

Fig 2. Difference in the acceptance of life- extending measures overall and according to each scenario at baseline.

Labels on the X-Axis are paraphrases of the original Likert-Scale response categories. DCV: Dementia Case Vignette, CCV: Control Case Vignette. * Significant difference between groups (p

Fig 3. Difference in the acceptance of life-extending measures in the Dementia Case Vignette (DCV) groups after presentation of two alternative films conveying either a positive or negative image of living with dementia.

Labels on the X-Axis are paraphrases of the original Likert-Scale response categories. DCV: Dementia Case Vignette, CCV: Control Case Vignette. * Significant difference between groups (p