title: Challenges to end of life care in the acute hospital setting.
abstract: BACKGROUND
  Research exploring patients' care and treatment preferences at the end of life (EOL) suggests they prefer comfort more than life-extension, wish to participate in decision-making, and wish to die at home. Despite these preferences, the place of death for many patients is the acute hospital, where EOL interventions are reported to be inappropriately invasive and aggressive.
  
  
  OBJECTIVE
  This paper discusses the challenges to appropriate EOL care in acute hospitals in the UK, highlighting how this setting contributes to the patients' and families' care and treatment requirements being excluded from decision-making.
  
  
  METHODS
  Twenty-nine cancer nurse specialists from five hospitals participated in a grounded theory study, using observation and semi-structured interviews. Data were collected and analysed concurrently using the constant comparative method.
  
  
  RESULTS
  EOL interventions in the acute setting were driven by a preoccupation with treatment, routine practice and negative perceptions of palliative care. All these factors shaped clinical decision-making and prevented patients and their families from fully participating in clinical decision-making at the EOL.
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK. carole.willard@manchester.ac.uk
authors.forename: Carole
authors.initials: C
authors.lastname: Willard
authors.forename: Karen
authors.initials: K
authors.lastname: Luker
mesh_terms: D003657:Decision Making; D003695:Delivery of Health Care / Q000941:ethics / Q000458:organization & administration; D005190:Family / Q000523:psychology*; D006292:Health Priorities / Q000941:ethics; D006760:Hospitalization; D006801:Humans; D010358:Patient Participation / Q000523:psychology*; D017060:Patient Satisfaction; D013727:Terminal Care / Q000941:ethics / Q000379:methods* / Q000523:psychology; D019452:Terminally Ill