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

• Published in: Health care analysis 2022-03, Vol.30 (1), p.57-72
• Main Authors: Erel, Meira, Marcus, Esther-Lee, Dekeyser-Ganz, Freda
• Format: Article
• Language: English
• Subjects: Anchoring; Bravery; Clinical decision making; Clinical medicine; Cognitive bias; Dementia; End of life decisions; Ethical dilemmas; Ethics; Health disparities; Health Informatics; Hospice care; Medicine; Medicine & Public Health; Original Article; Palliative care; Philosophy of Medicine; Public Health; Quality of care; Representativeness; Terminal illnesses
• ISSN: 1065-3058; 1573-3394
• DOI: 10.1007/s10728-021-00429-x

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.