Medical Staff's Decision-Making Process in the Nursing Home

BACKGROUND: This paper describes the medical decision-making process at the time of status change events in the nursing home. METHODS: Six male physicians and 3 female nurse practitioners completed questionnaires that described the medical decision-making process for 70 residents of a large nonprofit nursing home. RESULTS: Hospitalization was the most frequently cited treatment considered and chosen; family members were involved in 39% of decisions, and nurses were involved in 34%. The most important considerations in making a decision were reported to be the resident's quality of life, the relative effectiveness of the treatment options, and the family's wishes. The levels of importance ascribed to the considerations were related to the physician's identity, specific resident characteristics (such as estimated life expectancy), and communication between the physician and resident (such as sharing knowledge of family wishes). CONCLUSIONS: The decision at the time of a status change event involves multiple conditions, multiple considerations, and multiple treatment options, and tends to result in either an active route, such as hospitalization, or a passive one, such as comfort care. The impact of the individual physician and the physician-resident relationship on this process deserves further investigation.