Initiating end-of-life care pathways: a discussion paper.
OBJECTIVE
To discuss the intricacies of the decision-making process about initiating end-of-life care pathways.


BACKGROUND
Internationally, enhancing the quality of end-of-life care has become a central concern in governments' health policies. Despite limited empirical evaluation, end-of- life care pathways have been championed and widely adopted as complex interventions to enhance end-of-life care worldwide.


METHODS
A literature search of established electronic databases was conducted for published articles in English addressing decision-making and end-of-life care pathways between 1997-2010. Manual searches of relevant journals and internet sites were also undertaken.


CONCLUSIONS
The initiation of an end-of-life care pathway marks the transition to the terminal phase of care. Although guidance for commencing these pathways exists, this may not overcome the complexities of the decision-making process, which must be viewed in context, namely: marking the transition to terminal care, dealing with ambiguity, reaching professional consensus and engaging patients and families. Implications for nursing. Nurses in all care settings have an important role in easing the transition to end-of- life care. Accordingly, nurses need not only an appreciation of end-of-life care pathways, but the complexities surrounding the decision to commence a pathway and their role within.


CONCLUSIONS
The initiation of an end-of-life care pathway is contingent on the outcome of a complex decision-making process which is rarely explored and poorly understood.
Department of Nursing, College of Human and Health Sciences, Swansea University, Swansea, UK. t.watts@swansea.ac.uk
Tessa
T
Watts
D019091:Critical Pathways; D003657:Decision Making; D006801:Humans; D024802:Nurse's Role; D010166:Palliative Care; D010358:Patient Participation; D019555:Physician-Nurse Relations; D013727:Terminal Care; D035501:Uncertainty