The impact of history of depression and access to weapons on suicide risk assessment: a comparison of ChatGPT-3.5 and ChatGPT-4.

The aim of this study was to evaluate the effectiveness of ChatGPT-3.5 and ChatGPT-4 in incorporating critical risk factors, namely history of depression and access to weapons, into suicide risk assessments. Both models assessed suicide risk using scenarios that featured individuals with and without a history of depression and access to weapons. The models estimated the likelihood of suicidal thoughts, suicide attempts, serious suicide attempts, and suicide-related mortality on a Likert scale. A multivariate three-way ANOVA analysis with Bonferroni post hoc tests was conducted to examine the impact of the forementioned independent factors (history of depression and access to weapons) on these outcome variables. Both models identified history of depression as a significant suicide risk factor. ChatGPT-4 demonstrated a more nuanced understanding of the relationship between depression, access to weapons, and suicide risk. In contrast, ChatGPT-3.5 displayed limited insight into this complex relationship. ChatGPT-4 consistently assigned higher severity ratings to suicide-related variables than did ChatGPT-3.5. The study highlights the potential of these two models, particularly ChatGPT-4, to enhance suicide risk assessment by considering complex risk factors.

Assessing prognosis in depression: comparing perspectives of AI models, mental health professionals and the general public.

BACKGROUND: Artificial intelligence (AI) has rapidly permeated various sectors, including healthcare, highlighting its potential to facilitate mental health assessments. This study explores the underexplored domain of AI's role in evaluating prognosis and long-term outcomes in depressive disorders, offering insights into how AI large language models (LLMs) compare with human perspectives. METHODS: Using case vignettes, we conducted a comparative analysis involving different LLMs (ChatGPT-3.5, ChatGPT-4, Claude and Bard), mental health professionals (general practitioners, psychiatrists, clinical psychologists and mental health nurses), and the general public that reported previously. We evaluate the LLMs ability to generate prognosis, anticipated outcomes with and without professional intervention, and envisioned long-term positive and negative consequences for individuals with depression. RESULTS: In most of the examined cases, the four LLMs consistently identified depression as the primary diagnosis and recommended a combined treatment of psychotherapy and antidepressant medication. ChatGPT-3.5 exhibited a significantly pessimistic prognosis distinct from other LLMs, professionals and the public. ChatGPT-4, Claude and Bard aligned closely with mental health professionals and the general public perspectives, all of whom anticipated no improvement or worsening without professional help. Regarding long-term outcomes, ChatGPT 3.5, Claude and Bard consistently projected significantly fewer negative long-term consequences of treatment than ChatGPT-4. CONCLUSIONS: This study underscores the potential of AI to complement the expertise of mental health professionals and promote a collaborative paradigm in mental healthcare. The observation that three of the four LLMs closely mirrored the anticipations of mental health experts in scenarios involving treatment underscores the technology's prospective value in offering professional clinical forecasts. The pessimistic outlook presented by ChatGPT 3.5 is concerning, as it could potentially diminish patients' drive to initiate or continue depression therapy. In summary, although LLMs show potential in enhancing healthcare services, their utilisation requires thorough verification and a seamless integration with human judgement and skills.

The influence of emotional reactions and compliance with Ministry of Health guidelines during the COVID-19 pandemic in Israel: a longitudinal study of gender differences.

This study sought to examine gender differences in emotional reactions and compliance with Ministry of Health (MOH) guidelines during the COVID-19 pandemic in Israel, with the goal of gaining a deeper understanding of these gender-related variations throughout the lockdown periods. A longitudinal study comprising 2509 participants was conducted during two of Israel's lockdowns: 1424 participants completed a questionnaire during the first lockdown (23 April-5 May 2020); of these, 1085 completed a follow-up questionnaire during the second lockdown (September 30-October 10, 2020). Participants exhibited higher levels of compliance with MOH guidelines (e.g., wearing face masks, maintaining social distancing) and knowledge about COVID-19 during the second lockdown, whereas they exhibited more negative emotional reactions during the first lockdown. Female participants scored higher than male participants on all measures. Multiple regression results showed that about 21% of the variance in compliance with MOH guidelines was explained by lockdown type (i.e., first or second), gender, and age, while knowledge and negative emotional reactions added another 19% to the explained variance. The results suggest that the impact of the pandemic on emotional reactions decreased over time, with people exhibiting greater compliance with MOH guidelines and more knowledge about COVID-19. Moreover, the behavioral and psychological impact of the pandemic was greater on women than on men. The results suggest that healthcare professionals should pay more attention to mental health issues during a pandemic. Moreover, policymakers should focus on women as a vulnerable group and suggest appropriate solutions to reduce their emotional distress. Furthermore, governments and employers should provide greater flexibility and support for single mothers during the pandemic. In addition, gender inequality during lockdowns may place women at greater risk of psychological distress.

Interventions that may increase control at the end of life in persons with dementia: the cross-cultural CONT-END acceptability study protocol and pilot-testing.

BACKGROUND: Interventions such as advance care planning (ACP), technology, or access to euthanasia may increase the sense of control over the end of life. In people with advanced dementia, the loss of cognitive and physical function limits the ability to control care. To date, little is known about the acceptability of these interventions from the perspective of persons with dementia and others involved. This study will examine the cross-cultural acceptability, and factors associated with acceptability, of four end-of-life interventions in dementia which contain an element of striving for control. Also, we report on the development and pilot testing of animation video vignettes that explain the interventions in a standardized manner. METHODS: Cross-sectional mixed-methods vignette study. We assess acceptability of two ACP approaches, technology use at the end of life and euthanasia in persons with dementia, their family caregivers and physicians in six countries (Netherlands, Japan, Israel, USA, Germany, Switzerland). We aim to include 80 participants per country, 50 physicians, 15 persons with dementia, and 15 family caregivers. After viewing each animation video, participants are interviewed about acceptability of the intervention. We will examine differences in acceptability between group and country and explore other potentially associated factors including variables indicating life view, personality, view on dementia and demographics. In the pilot study, participants commented on the understandability and clarity of the vignettes and instruments. Based on their feedback, the scripts of the animation videos were clarified, simplified and adapted to being less slanted in a specific direction. DISCUSSION: In the pilot study, the persons with dementia, their family caregivers and other older adults found the adapted animation videos and instruments understandable, acceptable, feasible, and not burdensome. The CONT-END acceptability study will provide insight into cross-cultural acceptability of interventions in dementia care from the perspective of important stakeholders. This can help to better align interventions with preferences. The study will also result in a more fundamental understanding as to how and when having control at the end of life in dementia is perceived as beneficial or perhaps harmful. TRIAL REGISTRATION: The CONT-END acceptability study was originally registered at the Netherlands Trial Register (NL7985) at 31 August, 2019, and can be found on the International Clinical Trials Registry Platform.

Depression and Medicine Use among Older Adults during the COVID-19 Pandemic: The Role of Psychosocial Resources and COVID-19 Perceived Susceptibility.

A relationship was found between the COVID-19 pandemic and depression among older adults and between depressed mood and increased use of antidepressant medication among older adults during the pandemic. With the aim of broadening the understanding of these relationships, the study examined whether COVID-19 perceived susceptibility mediates the relationship between psychosocial resources (optimism and perceived social support) and depressive symptoms and medication use. Participants included 383 older adults (M = 71.75, SD = 6.77) reporting on socio-demographics, health characteristics, depression, optimism, social support, and COVID-19 perceived susceptibility. Medication use was retrieved from participants medical files. Lower optimism, lower social support, and higher COVID-19 perceived susceptibility were associated with greater depression, related with higher medication use. The findings emphasize the buffering effect of psychosocial resources on the adverse effects of depression affecting older adults during the COVID-19 pandemic, and consequently, the increased use of medication in this population. Practitioners should focus interventions on enhancing optimism and expanding social support among older adults. Moreover, interventions focused on alleviating depression among older adults should aim at improving perceptions of perceived susceptibility in the older population.

Self-management After Bariatric Surgery: a Comparison Between Support Group Participants and Patients Receiving Individual Dietary Follow-Up.

PURPOSE: This study aimed to compare self-management after bariatric surgery between support group participants (the study group) and patients receiving only individual follow-up by a dietitian (the comparison group), and to examine the differences between the two groups regarding the associations of cognitive and emotional factors with self-management. MATERIALS AND METHODS: This cross-sectional comparative study was conducted among bariatric patients who either participated in bariatric support groups during the years 2018-2020 or received only individual follow-up with a dietitian since their surgery. The structured questionnaire included a self-management questionnaire, cognitive variables (eating self-efficacy, eating awareness as independent variables, weight control motivation) and emotional variables (positive and negative affect, emotional eating), and background control variables. RESULTS: The level of self-management was better in the study group than in the comparison group. The hierarchical regression model showed that in the study group, the control variables contributed negligibly to self-management (step 1), while all independent variables contributed the most (27%) to the explained variance (31%) in self-management (step 2). In the comparison group, the contribution of the control variables was 11.5% of the explained variance, with only lower duration of time since surgery being related to higher self-management (step 1). The independent variables contributed significantly - an additional 14.5% to the explained variance (step 2). Emotional eating was the sole variable related to self-management. CONCLUSION: The findings emphasize the importance of encouraging patients after bariatric surgery to participate in support groups, as the skills acquired in these groups strengthen the capacity to manage self-care.

Factors associated with work-family enrichment among working Israeli parents during COVID-19 lockdowns.

This study examined work-family enrichment, protective resources and psychological implications among working Israeli parents during COVID-19. In this cross-sectional study, 409 working parents were recruited during Israel's third lockdown. Levels of FWC/WFC and resilience were moderate, psychological distress and fear of COVID-19 were low, and perceived social support was high. All the study variables showed significant associations with each other. A multivariate regression analysis explained 30% of the WFC and FWC variance. We found differences in FWC/WFC based upon children's age but not on parents' gender. FWC/WFC mediated the effect of perceived social support and resilience on fear of COVID-19 and psychological distress. The findings explain the importance of personal resources during the pandemic in buffering the negative effects of parents' work- and family-related burdens and have important implications for helping families with young children cope during challenging times.

Participating in Bariatric Support Groups: the Effects on Self-management Changes.

BACKGROUND: This study focused on changes in self-management as the main outcome of participation in bariatric psychoeducational support groups. We assessed the contribution of changes in cognitive and emotional variables to improved self-management among 155 participants. METHOD: Data for this longitudinal study were collected at the beginning (time 1) and at the end (time 2) of the support groups' 10-session program. The structured questionnaire included self-management (the Bariatric Surgery Self-Management Behaviors Questionnaire), cognitive variables (eating self-efficacy, eating awareness, weight control motivation), and emotional variables (positive and negative affect, emotional eating), as well as background variables. RESULTS: Significant improvements in self-management and in eating self-efficacy, eating awareness, and emotional eating were found at time 2. The hierarchical regression model showed that the improvements in eating self-efficacy, and in positive and negative affect, contributed significantly to improved self-management. Additionally, a modification effect of negative affect was found. CONCLUSION: We conclude that participation in psychoeducational bariatric support groups is beneficial to improving one's self-management.

Factors Associated with Pro-Environmental Behaviors in Israel: A Comparison between Participants with and without a Chronic Disease.

This study examined differences regarding climate change pro-environmental behaviors (PEBs), comparing between individuals with chronic diseases and those without. A cross-sectional survey was conducted among 402 adults, of whom 25% had a chronic disease. Participants completed measures for PEBs, climate change exposure (i.e., exposure to its effects), climate change risk appraisal, environmental self-efficacy, collective efficacy, and sociodemographic variables. Results revealed a significant difference between participants with and without chronic diseases in climate change risk appraisal. Having a chronic disease was associated with higher climate change risk appraisal (ß = 0.16, p < 0.001), which in turn was associated with higher collective efficacy (ß = 0.29, p < 0.001). The latter was associated with more PEBs (ß = 0.10, p = 0.049). Furthermore, higher climate change exposure was associated with higher climate change risk appraisal (ß = 0.49, p < 0.001), which in turn was associated with collective efficacy (ß = 0.29, p < 0.001). The latter was associated with more PEBs (ß = 0.10, p = 0.049). In addition, higher climate change exposure was directly associated with both self-efficacy (ß = 0.33, p < 0.001) and collective efficacy (ß = 0.10, p = 0.049), which in turn were associated with more PEBs (ß = 0.28, p < 0.001 and ß = 0.10, p = 0.049, respectively). This study highlights the need to provide efficacy-enhancing information in climate change messaging for PEBs in general. A threat component in environment-relevant messages for people with chronic diseases, specifically, should also be adopted.

Cervical cancer survivors: The experiences of the journey.

OBJECTIVE: Cervical cancer affects survivors' overall coping. Yet, specifically emotional and behavioral expression patterns among cervical cancer survivors have barely been examined. In addition, no study has focused on survivors' experiences of sequences related to coping. Understanding these perceptions can help provide a tailored response and improve psycho-social interventions. The aim of this study was to gain a better understanding of the emotional and behavioral motives involved in coping with cervical cancer recovery. METHODS: Qualitative interviews were conducted with 15 survivors of cervical cancer (stages I and II), using a semi-structured in-depth questionnaire. The interviews were recorded, transcribed, and analyzed by three researchers using thematic analysis. RESULTS: Six main themes emerged: (i) Reasons and benefits for keeping the disease a secret or sharing it with others; (ii) "When you get used to despair, there's also room for hope": Despair alongside hope; (iii) Self-guilt following the disease, but also knowing how to forgive yourself; (iv) Deep loneliness alongside a significant need for support; (v) Finding the way from passivity to activity; and (vi) When meaning in life is missing, and the importance of meaning when it is present. There was a balance between negative emotions and behaviors (despair, confidentiality, guilt, loneliness, passivity, lack of meaning) and positive emotions and behaviors (hope, openness, forgiveness, significant support, activity, meaning). SIGNIFICANCE OF THE RESULTS: The study revealed that in some cases cervical cancer coping during the recovery period moves across sequences. The women's narratives portray past difficulties as the reason for present psychological health, and their experience of a healthy present is intensified by their past difficulties. Implications for practice are discussed.

Are Personal Resources and Perceived Stress Associated with Psychological Outcomes among Israeli Teachers during the Third COVID-19 Lockdown?

Teachers' psychological responses during a pandemic, such as COVID-19, play an important role in their adaptation to the new routine. This research aimed to explore the association between personal resources (sense of control, social support), perceived stress, and three psychological outcomes (resilience, depression, loneliness) among teachers during the third COVID-19 lockdown in Israel. A cross-sectional study was conducted among 208 teachers. Significant associations were found between perceived stress, resilience, depression, and loneliness. Sense of control was significantly associated with perceived social support. The research model was tested using Structural Equation Modeling. The model yielded appropriate indices of fit (χ2(10) = 10.31, χ2/df = 1.03, p = 0.413, NFI = 0.970, NNFI = 0.997, CFI = 0.999, RMSEA = 0.012, 95%CI RMSEA = 0.077), demonstrating that the model fits the data well. Findings suggest that in order to improve teachers' psychological health during a virus outbreak, it is recommended to pay attention to their personal resources and perceived stress.

Perceived support and preparedness for the next pandemic among Israeli social workers in hospital settings during the COVID-19 pandemic.

This study describes the conditions under which Israeli social workers in hospital settings operated s during the COVID-19 pandemic, and assesses their perceived support (informal and organizational support) and preparedness for the next pandemic. It further assesses correlates for perceived support and associations between perceived support and preparedness. The participants were 163 social workers from four hospitals who completed an on-line survey. The findings revealed that the level of exposure to COVID-19 and fear of contracting COVID-19 were unrelated to perceived informal and organizational support. Age and having children who are minors living at home moderated the relationship between fear of contracting COVID-19 and both types of perceived support. Each type of perceived support was significantly associated with preparedness beyond age, having minors at home, exposure to COVID-19, and fear of contracting COVID-19. Implications for research and practice are discussed.

"A kaleidoscope of relationships" - cervical cancer survivors' perspectives on their intimate relationships: A qualitative study.

OBJECTIVE: Cervical cancer is known to affect survivors' intimate relationships, as well as their communication and coping. Yet little is known about the perspectives of these survivors on their intimate relationships in the context of their needs during and after medical treatment. Additionally, only a few studies have focused on survivors' perceived needs or on existing psychosexual support. Understanding these perceptions can help provide a tailored response and improve dyadic interventions. The aim of this study was to examine cervical cancer survivors' perspectives on their intimate relationships during and after their treatment. METHOD: The present study adopted a qualitative-phenomenological approach. In-depth, semi-structured interviews were conducted with 15 survivors of cervical cancer between the ages of 38 and 44 who were diagnosed at stages I-II and were treated with radiotherapy or chemo-radiotherapy and surgery. Data collection continued until saturation of concepts was reached. The results underwent thematic analysis. RESULTS: Analysis of the findings revealed two key themes: (1) Together and apart in the shadow of cervical cancer. This theme focuses on the recovery period as a potential opportunity for changing and improving the couple relationship, such that men no longer withdraw but rather provide their partners with needed support and encouragement. (2) Changes in sexual life and couple intimacy. This theme focuses on changes in sexual relations, which have become a burden, painful, and something to avoid. SIGNIFICANCE OF RESULTS: The study provides a comprehensive picture of intimate relationships during and after cervical cancer treatment and highlights the women's needs and desires for support from their intimate partners. The discussion notes that oncology providers can better facilitate supportiveness on the part of cervical cancer partners by offering better couple-oriented education and interventions to promote couple communication.

Cognitive illness representations among Israeli Arabs diagnosed with depression and their relationship with health-related quality of life.

BACKGROUND: The number of studies that have assessed cognitive illness representations among people diagnosed with depression, and their relationship to health outcomes, has clearly grown. Nevertheless, the relationship between cognitive illness representations and health-related quality of life (HRQoL) has received very little research attention. AIMS: This study examined cognitive illness representations, based on the self-regulation model (SRM), and the contribution of each dimension of these cognitive illness representations to health-related quality of life (HRQoL) among Israeli Arabs diagnosed with depression. METHODS: A convenience sample of 160 Israeli Arabs with depression completed measures of cognitive illness representations (identity, timeline, consequences, personal control, treatment control, and coherence), HRQoL, and sociodemographic and health characteristics. RESULTS: Participants reported high levels of negative perceptions in the identity, timeline, and consequences dimensions, and moderate levels in the dimensions of personal control, treatment control, and coherence. Also, participants reported low levels of HRQoL. Identity, consequences, and coherence were found to be the main determinants of HRQoL. CONCLUSION: This study underlines the crucial role of the identity, consequences, and coherence dimensions in the HRQoL of individuals diagnosed with depression. The findings indicate that clinical interventions targeting cognitive illness representations of individuals with depression, and in particular identity, consequences, and coherence, might be helpful in improving the HRQoL of this population.

Emotional reactions towards COVID-19 among persons with diabetes.

The emotional impact of the coronavirus disease 2019 (COVID-19) pandemic on populations at large is emerging in the literature. However, the emotional response of persons with diabetes to the pandemic is only now beginning to emerge. Therefore this study aimed to identify factors contributing to emotional reactions towards this pandemic among persons with diabetes. A total of 205 persons with diabetes participated in this cross-sectional online survey between 14 May and 22 June 2020. Participants completed measures of emotional reactions towards COVID-19, perceived diabetes status, perceived susceptibility, knowledge about COVID-19, sense of mastery and sociodemographic questionnaires. Statistical analyses included Pearson correlations and regression analysis. According to the results, the mean score of negative emotional reactions towards COVID-19 was 3.45 (standard deviation 1.11, range 1-5), meaning that the score was relatively high. Higher levels of negative emotional reactions towards COVID-19 were associated with higher perceived susceptibility, greater knowledge about COVID-19 and a lower sense of mastery. The study's findings emphasize the need to communicate ongoing knowledge regarding COVID-19 and diabetes as well as to provide persons with diabetes with the necessary emotional support related to coping with diabetes and COVID-19.

The intrapersonal and interpersonal processes of fear of recurrence among cervical cancer survivors: a qualitative study.

OBJECTIVE: Cervical cancer's emotional and mental toll often extends beyond the disease's duration. Fear of cancer recurrence has been identified as prominent in patients and survivors, yet there is a paucity of studies regarding this population. The present study sought to explore and expand the understanding of the meaning of fear of cancer recurrence among cervical cancer survivors. METHODS: In this qualitative study, semi-structured interviews were conducted with 15 cervical cancer survivors. The interviewees' mean age was 41.33 years (range 34-47 years), and the mean time since diagnosis was 3.1 years (ranged from 0.5 to 7 years). RESULTS: Three central themes emerged that represent intrapersonal and interpersonal processes: The first, "No longer resilient" refers to feelings of uncertainty in the face of the illness experienced on the intrapersonal level, where the interviewee mostly engaged with efforts to return to the "normal" state that existed before the cancer diagnosis. The second, "To be afraid in a dyad," relates to the interpersonal level that included mutual fears shared by the interviewee and her partner. The third "And what if the disease comes back and I die?" represents a combination of intrapersonal and interpersonal processes manifested by the greatest fear - death - expressed by both the interviewee and her partner. CONCLUSIONS: The present findings revealed that the fear of cancer recurrence represents intrapersonal and interpersonal processes encompassing three factors - uncertainty, social-cognitive processing, and death anxiety. Accordingly, potential psycho-social treatment options could be tailored to specifically address the prominence of these factors for cervical cancer survivors.

Short report: engagement with health services during the COVID-19 outbreak: the case of Israeli people with diabetes.

Although continuing to utilize health services remains a key determinant of health, the association between the COVID-19 pandemic and engagement with health services among people with diabetes (PWD) remains unknown. This cross-sectional online survey examined factors associated with PWD's engagement with health services among 205 Israeli PWD during the subsiding of the first COVID-19 wave in Israel. Participants completed measures of perceived diabetes status, perceived risk, emotional reactions toward COVID-19, sense of mastery, engagement with health services (fear of contracting the virus in health services, canceling a medical appointment), and socio-demographic questionnaires. Most participants were women, their mean age was 40.18 years, and mean years since diagnosis was 15.70. Participants were recruited mainly via diabetes internet forums. Logistic and multiple hierarchical regressions were calculated. The odds of canceling appointment were higher for younger participants and for participants experiencing greater negative emotional reactions. Higher fear of contracting the virus in health services was related to higher perceived risk and experiencing greater negative emotional reactions. Findings suggest that in order to encourage PWD to utilize health services during a virus outbreak, clinical interventions should address PWD's perceived risk of contracting the virus and their emotional reactions toward COVID-19.

Israeli Health Care Social Workers' Personal and Professional Concerns during the COVID-19 Pandemic Crisis: The Work-Family Role Conflict.

This exploratory study focuses on the personal and professional concerns of Israeli social workers in hospitals and community health settings during the coronavirus (COVID-19) pandemic. Other studies omitted health care social workers' needs and concerns. Participants included 126 social workers (120 females, 5 males and 1 other gender identity) in hospitals and community health settings who completed an online survey during the height of the first wave of COVID-19 in Israel. Measures included questions on exposure to COVID-19, sense of safety at work, perceived support, and personal and professional concerns. Two open-ended questions about the social workers' concerns and the perceived concerns of their patients were included. The results showed that 17 per cent reported one of their inter-disciplinary team testing positive for COVID-19. Only one-third of the social workers felt safe from COVID-19 infection in their workplace. Mothers of dependent children were more concerned about income loss and about balancing work and family requirements than mothers of older children. 'Home-work conflict' was also a main theme in the qualitative data. In conclusion, the work-home role conflict took an especially heavy toll during the COVID-19 pandemic on social workers who were mothers to dependent children.

Perceptions among diabetic patients in the ultra-orthodox Jewish community regarding medication adherence: a qualitative study.

BACKGROUND: Promoting a healthy lifestyle and achieving strict adherence to medical treatment among patients with diabetes are key objectives in public health. Yet health behaviors are often culturally driven, especially in closed religious communities. This study seeks to reveal key cultural-religious factors, attitudes and behaviors characterizing the lifestyle in one such closed community-the ultra-Orthodox Jewish community-by understanding the attitudes of ultra-Orthodox patients with diabetes toward coping with their illness and the factors impacting their adherence to medicinal treatment. METHOD: Qualitative interviews were conducted with 16 ultra-Orthodox patients with diabetes using a semi-structured, in-depth questionnaire. RESULTS: Three main themes emerged: 1) "The disease as a secret": Hiding the disease among patients with diabetes in ultra-Orthodox society; 2) "Distinguishing between sacred and secular occasions": ultra-Orthodox diabetes patients distinguish between treatment adherence on weekdays and treatment adherence on holidays or special occasions; 3) "Ask the rabbi": In cases of dilemmas that involved conflicts between halakhic rulings and doctors' instructions, the rabbi's decision was usually the final one. CONCLUSIONS: The findings of this study may help provide an in-depth understanding of the obstacles and motives of ultra-Orthodox patients in adhering to medicinal treatment of diabetes in particular and to medicinal treatment in general, thus helping family physicians who treat this population provide optimal and appropriate treatment.

Palliative Care in Advanced Dementia: Comparison of Strategies in Three Countries.

Palliative care including hospice care is appropriate for advanced dementia, but policy initiatives and implementation have lagged, while treatment may vary. We compare care for people with advanced dementia in the United States (US), The Netherlands, and Israel. We conducted a narrative literature review and expert physician consultation around a case scenario focusing on three domains in the care of people with advanced dementia: (1) place of residence, (2) access to palliative care, and (3) treatment. We found that most people with advanced dementia live in nursing homes in the US and The Netherlands, and in the community in Israel. Access to specialist palliative and hospice care is improving in the US but is limited in The Netherlands and Israel. The two data sources consistently showed that treatment varies considerably between countries with, for example, artificial nutrition and hydration differing by state in the US, strongly discouraged in The Netherlands, and widely used in Israel. We conclude that care in each country has positive elements: hospice availability in the US, the general palliative approach in The Netherlands, and home care in Israel. National Dementia Plans should include policy regarding palliative care, and public and professional awareness must be increased.