Junior doctors and limitation-of-care orders: perspectives, experiences and the challenge of dealing with persons with dementia.

Abstract

Globally, junior doctors play a central role in completing limitation of care orders (LCOs). This study aims to guide improvement of LCO utility by ascertaining junior doctor perspectives, LCO experiences and identifying challenges encountered in LCOs for patients with dementia, a particularly complex patient group. Qualitative data were collected through semi-structured interviews. Participants were registered medical practitioners who had graduated within the previous 3 years and were practicing in a hospital in Victoria, Australia. Nineteen junior doctors were interviewed between December 2013 and January 2015. Junior doctors were frequently involved in discussion and decision-making around treatment limitations and end-of-life care. Participants described inconsistent support, a lack of preparedness, a vague understanding of related hospital policies and inadequate knowledge and experience when it came to completing LCOs. Although participants acknowledged the additional nuances of capacity and prognosis assessment for patients with dementia, they did not feel that the processes for completing LCOs were significantly different for these persons. Many also recognised that decisions were often made without adequate consultation with the relevant stakeholders in this patient group. The junior doctors in this study highlighted global challenges in providing appropriate end-of-life care, particularly when they are responsible for this role. To improve patient care and ensure the wellbeing of junior doctors, hospitals need to address gaps in training needs and supervision with respect to end-of-life care, as well as to implement policies that support consistent and informed use of LCOs.