Design
To serve the study’s aims, a cross-sectional descriptive e-survey was designed for data collection. Ethical approval was obtained from the Lebanese University institutional review board (IRB). For confidentiality reasons, all collected data (logged, analysed) were kept in a concealed place and reviewed only by the principal investigator.
Participants and selection criteria
It is noteworthy that there is a major deficit in the number of physicians specialized in geriatrics in Lebanon12. Moreover, Lebanese geriatricians who are members of the Lebanese Society for Geriatric Medicine (LSGM), constituted the target population of this study. Only geriatricians who worked with patients having AD either clinically or through research and practicing within Lebanese territories were invited to participate in this study (Figure 1).
Procedure
Google Forms platform was utilized to create an e-survey to collect the geriatricians’ data. Furthermore, contact information about geriatricians, members of the LSGM, was requested and obtained from the Lebanese Order of Physicians in Beirut.
Each member of the Society was approached via a phone call, where study-specific information was delivered. Those who accepted to participate received a link to the study’s survey via e-mail. Moreover, follow-up phone calls were conducted twice a week, over a whole month, to make sure that the geriatricians completed the survey. Geriatricians’ implied consent was obtained with the completion of the survey. It is noteworthy, that geriatricians’ participation was fully voluntary and they had the freedom to withdraw from the survey whenever they wanted to.
The survey started with a brief introduction to the study. The introduction described the current situation regarding aging and the increased prevalence of dementia among the elderly. It also drew attention to the ethical issues that might arise in treating patients with AD, or by including them as potential participants in research studies. The aim of the study was followed in the next part. The remaining section of the survey included: (a) section one, socio-demographic data; (b) section two, autonomy; (c) and section three, decision-making capacity.
Section one: socio-demographic data.
This section intended to collect socio-demographic data related to the geriatricians, such as their years of experience, their gender, and their area(s) of practice [(a) academic, (b) research, (c) clinical, (d) administrative, or (e) consultation]. The last question was related to the clinical/research practice setting (s) [(a) university-hospital, (b) private clinic, (c) or specialized geriatric center].
Section two: autonomy.
This section was designed to capture the geriatricians’ understanding of the ethical concept of autonomy (Table 1).
Section three: decision-making capacity.
At the beginning of this section, a clear distinction between both of the concepts of capacity and competency was provided. The term “capacity” was defined as “a person’s performance on measures of decision-making abilities”2. Capacity was also defined as “a person's ability to make a particular decision at a specific time or in a specific situation”10. The term “competency” was defined as being “the judgment that a person’s capacity is adequate to make the decision in question”2, and by “a legal capacity that is determined by a judge in a court, where it is a threshold requirement imposed by society for an individual to retain decision-making power in a particular activity or set of activities”.
Three questions were designed to investigate the geriatricians’ standpoint regarding the DMC’s assessment in this section (Table 2). If the geriatrician answered “No” on the first question (Table 2), he/she was systematically directed to submit their answers and finish the survey.
Statistical Analysis
Data were analyzed using the Statistical Package for the Social Sciences (SPSS) Version 21.0 for Windows. Descriptive statistics (mean, standard deviation, proportions) were calculated for the geriatricians’ answers on the sections of (a) socio-demographic, (b) autonomy, (c) and DMC.