title: End-of-life expectations and experiences among nursing home patients and their relatives--a synthesis of qualitative studies.
abstract: OBJECTIVE
  Synthesize research about patients' and relatives' expectations and experiences on how doctors can improve end-of-life care in nursing homes.
  
  
  METHODS
  We systematically searched qualitative studies in English in seven databases (Medline, Embase, PsycINFO, CINAHL, Ageline, Cochrane Systematic Reviews and Cochrane Trials). We included 14 publications in the analysis with meta-ethnography.
  
  
  RESULTS
  Patients and families emphasized the importance of health personnel anticipating illness trajectories and recognizing the information and palliation needed. Family members who became proxy decision-makers reported uncertainty and distress when guidance from health personnel was lacking. They worried about staff shortage and emphasized doctor availability. Relatives and health personnel seldom recognized patients' ability to consent, and patients' preferences were not always recognized.
  
  
  CONCLUSIONS
  Nursing home patients and their relatives wanted doctors more involved in end-of-life care. They expected doctors to acknowledge their preferences and provide guidance and symptom relief.
  
  
  CONCLUSIONS
  High-quality end-of-life care in nursing homes relies on organization, funding and skilled staff, including available doctors who are able to recognize illness trajectories and perform individualized Advance Care Planning.
authors: Research Unit for General Practice, Uni Health Research, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. Electronic address: anettfos@online.no.
authors: Anette
authors: A
authors: Fosse
authors: Department of Pulmonary Disease, Haukeland University Hospital, Bergen, Norway.
authors: Margrethe Aase
authors: MA
authors: Schaufel
authors: Research Unit for General Practice, Uni Health Research, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors: Sabine
authors: S
authors: Ruths
authors: Research Unit for General Practice, Uni Health Research, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Research Unit for General Practice, Copenhagen, Denmark.
authors: Kirsti
authors: K
authors: Malterud
mesh_terms: D001293:Attitude to Death; D003657:Decision Making; D005190:Family / Q000523:psychology*; D006282:Health Personnel / Q000523:psychology*; D006707:Homes for the Aged; D006801:Humans; D009735:Nursing Homes; D057240:Patient Preference / Q000523:psychology*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D036301:Qualitative Research; D013727:Terminal Care
keywords: Attitude to death; Doctor–patient relations; Family; Meta-analysis; Nursing homes; Patient preference; Qualitative research; Terminal care