This study protocol addresses treatment decision-making concerning acute life threatening complications occurring in Alzheimer’s Disease patients at the end of life. Decisions about the best treatment pathway and whether to treat or not to treat are largely ethical questions which, under British law, are difficult to express (let alone investigate systematically).
This multi-centre study of clinical cases across 67 health centres in the east of France looks at the “card sorting” technique as a means of facilitating (and investigating) difficult decisions. It involved a set of 36 cards, each labelled with a consideration about treatment decision-making. Participant clinicians were each given the card game to assist them in gathering their thoughts. They were required to select fewer than ten cards and rank these according to the importance they attached to each. The selected cards were put on the table anonymously, ranked by order of importance in each pile.
The “card sorting” method was adopted readily by professionals as a tool to assist with end-of-life discussions beyond the context of this study.
Please note (quotation):
“The role of caregivers (healthcare professionals and family) in the decision-making process must be understood before designing a research protocol on this topic. Their role depends on socio-cultural aspects, organisational aspects, professional guidelines and legislation.
In France, if a patient is in an advanced or terminal phase of a severe and incurable disease, or if a patient receives only artificial life-sustaining treatment, French law (Code of Public Health, Law No. 2005-370 of 22 April 2005 on patients’ rights and end of life) allows the clinician caring for the patient to limit or stop unnecessary or disproportionate treatment”.
Pazart, L. Vidal, C. [and] Chalon, DF. [et al] (2011). “Card sorting”: a tool for research in ethics on treatment decision-making at the end of life in Alzheimer patients with a life threatening complication. BMC Palliative Care, March 3rd 2011, Vol.10(3), pp.1-6.
(Click here to view the PubMed abstract).