Decisions to treat or not to treat pneumonia in demented psychogeriatric nursing home patients: Evaluation of a guideline

We evaluated a new guideline, in the form of a "checklist of considerations ," to support end-of-life decision making in the treatment of demented pati ents with pneumonia. Questionnaires were sent to nursing home physicians (N HPs) in The Netherlands at three times: before implementation of the checkl ist (concerning 91 individual patients), during use of the checklist (conce rning another 107 individual patients), and after data collection (concerni ng the targeted patient category of demented nursing home patients with pne umonia as a whole). In the last questionnaire, one NHP from each nursing ho me (n = 55 NHPs) gave his or her general opinion about the checklist. We me asured the usefulness of the checklist in supporting decision making and it s frequency of actual use. The NHPs accepted the contents of the checklist for use in the targeted patient category. It was used in 46% of the inciden t cases of pneumonia. The checklist was considered more useful in supportin g decision making for the targeted patient category (85% of the NHPs) than for the individual patient (47%). Possible explanations for this discrepanc y in "usefulness" include the difference in the nature of the outcome measu res and the fact that the checklist was used more frequently for the "easie r cases." Information on individual patient level, patient category level, and nursing home and NHP characteristics is used to suggest checklist impro vements.