Facilitating end-of-life decision-making: strategies for communicating and assessing.
End-of-life decision-making is often a difficult process and one that many elderly patients and their families will undergo. The grounded theory study of nurses, physicians, and family members (n = 20) reported in this article examined provider behaviors that facilitated the process of decision-making near the end of patients' lives. According to participants, providers who are experienced and comfortable are more likely to engage in communication and assessment strategies that facilitate end-of-life decision-making. Communication strategies included: being clear, avoiding euphemisms, spelling out the goals and expectations of treatment, using words such as "death" and "dying," and being specific when using such words as "hope" and "better." Assessment strategies included: assessing patients' physical conditions and end-of-life wishes, patients' and family members' understandings of the disease and prognosis, and their expectations and goals. An important first step for improved care is making explicit the provider's communicating and assessing strategies that facilitate end-of-life decision-making.
Norton
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School of Nursing, Oregon Health Sciences University, Portland 97201-3098, USA.
Talerico
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D000368:Aged; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D001294:Attitude to Health; D003142:Communication; D003657:Decision Making; D005190:Family / Q000523:psychology*; D015577:Geriatric Assessment; D005851:Geriatric Nursing / Q000379:methods*; D005853:Geriatrics / Q000379:methods*; D006801:Humans; D008503:Medical Staff / Q000523:psychology; D015146:Midwestern United States; D009730:Nursing Assessment / Q000379:methods*; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000523:psychology; D010353:Patient Education as Topic / Q000379:methods; D011368:Professional-Family Relations; D011369:Professional-Patient Relations; D011379:Prognosis; D012660:Semantics; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods* / Q000523:psychology*