title: The 2000 Helene Hudson Memorial Lecture. Decisional role in seriously ill hospitalized patients near the end of life: the patient's and provider's perspective.
abstract: Decisions about whether or not to implement life-sustaining therapies are complex and are becoming more so as the ability to prolong life with advanced technologies and care increases. The objectives of this study were: (1) to determine seriously ill hospitalized patients' preferences for decisional role with respect to decisions about life-sustaining treatments, and (2) to determine if providers were aware of patients' preferences. This prospective, descriptive pilot study was conducted at an Ontario teaching hospital. One hundred and seventeen seriously ill adult patients admitted with cancer and non-cancerous conditions participated in a structured interview. Fifty-three nurses and 63 physicians responsible for the care of the participating patients also participated. Patients and providers were asked similar questions about end-of-life discussions and preference for decisional responsibility for life-sustaining treatments. Most patients (n = 89, 77%) had thought about end-of-life issues and were willing to discuss these with their physicians and nurses, but few (n = 37, 37%) reported such discussions. Preferences for decisional role varied; most indicated a preference for a shared role (n = 80, 80%) and there were no differences in patients with or without cancer. Generally, both physicians and nurses were not aware of or did not determine accurately patient preferences for decisional role. The findings from this study show that seriously ill hospitalized patients have thought about and are willing to share in discussions about end-of-life care with their providers, yet many have not.
authors.affiliation: Kingston General Hospital.
authors.forename: J E
authors.initials: JE
authors.lastname: Tranmer
authors.forename: D
authors.initials: D
authors.lastname: Heyland
mesh_terms: D003430:Cross-Sectional Studies; D003657:Decision Making; D006760:Hospitalization; D007407:Interviews as Topic; D024802:Nurse's Role; D013727:Terminal Care / Q000458:organization & administration*