Objective: To explore the relationships between personality characteristics, underlying attitudes, and treatment decisions for severely ill elderly patients in a sample of Russian doctors.
Design: Survey.
Setting: Group sessions during meetings or individual presentations of questionnaire.
Subjects: A convenience sample of 231 physicians from the Archangelsk region in northern Russia who frequently encounter treatment situations with incompetent elderly patients.
Measurements: Temperament and Character Inventory (Cloninger et al, 1994) for assessing personality dimensions. The questionnaire on decision-making is based on the original developed by Molloy and coworkers from McMaster University in Canada. In a case-vignette, the condition of an 82-year-old man with acute gastrointestinal bleeding is described comprehensively in combination with 3 different levels of information about the patient wishes (no information, DNR order, advance directive). Questions about importance of legal concerns, patient and family wishes, hospital costs, patient's age and level of dementia, and physician's religion for the doctor's decision-making are added.
Main results: No significant relationship was found between chosen treatment options and personality traits in any of the 3 situations. However, personality characteristics such as self-directedness, cooperativeness, and self-transcendence, in particular, show significant relationships with attitudes underlying these decisions.
Conclusions: Physicians should be trained to improve their cooperative abilities in the treatment of severely ill elderly patients to be better prepared for their decision-making and coping concerning end-of-life decisions and the use of do-not-resuscitate orders and advance directives. Ethical values in clinical practice, especially patient autonomy, should be addressed during the early stage of the medical curriculum.