title: Dying in the hospital setting: A meta-synthesis identifying the elements of end-of-life care that patients and their families describe as being important.
abstract: BACKGROUND
  Despite most expected deaths occurring in hospital, optimal end-of-life care is not available for all in this setting.
  
  
  OBJECTIVE
  To gain a richer and deeper understanding of elements of end-of-life care that consumers consider most important within the hospital setting.
  
  
  METHODS
  A meta-synthesis.
  
  
  METHODS
  A systematic search of Academic Search Complete, AMED, CINAHL, MEDLINE, EMBASE, PsycINFO, PubMed, Google, Google Scholar and CareSearch for qualitative studies published between 1990 and April 2015 reporting statements by consumers regarding important elements of end-of-life hospital care. Study quality was appraised by two independent researchers using an established checklist. A three-stage synthesis approach focusing on consumer quotes, rather than primary author themes, was adopted for this review.
  
  
  RESULTS
  Of 1922 articles, 16 met the inclusion criteria providing patient and family data for analysis. Synthesis yielded 7 patient and 10 family themes including 6 common themes: (1) expert care, (2) effective communication and shared decision-making, (3) respectful and compassionate care, (4) adequate environment for care, (5) family involvement and (6) financial affairs. Maintenance of sense of self was the additional patient theme, while the four additional family themes were as follows: (1) maintenance of patient safety, (2) preparation for death, (3) care extending to the family after patient death and (4) enabling patient choice at the end of life.
  
  
  CONCLUSIONS
  Consumer narratives help to provide a clearer direction as to what is important for hospital end-of-life care. Systems are needed to enable optimal end-of-life care, in accordance with consumer priorities, and embedded into routine hospital care.
authors.affiliation: 1 Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia.
authors.forename: Claudia
authors.initials: C
authors.lastname: Virdun
authors.affiliation: 1 Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia.
authors.forename: Tim
authors.initials: T
authors.lastname: Luckett
authors.affiliation: 2 Center for Innovation to Implementation, VA Palo Alto Health Care System, USA.|3 The RAND Corporation, USA.|8 Stanford School of Medicine, USA.
authors.forename: Karl
authors.initials: K
authors.lastname: Lorenz
authors.affiliation: 1 Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia.|4 School of Nursing, Johns Hopkins University (JHU), Baltimore, MD, USA.|5 St. Vincent's Hospital, Sydney, NSW, Australia.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
authors.affiliation: 1 Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia.|2 Center for Innovation to Implementation, VA Palo Alto Health Care System, USA.|6 School of Nursing, Sydney, The University of Notre Dame Australia, Sydney, NSW, Australia.|7 Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Phillips
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D003657:Decision Making; D004645:Empathy; D005190:Family / Q000523:psychology*; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology*; D011368:Professional-Family Relations; D011369:Professional-Patient Relations; D036301:Qualitative Research; D013727:Terminal Care / Q000523:psychology*
keywords: Palliative care; consumer participation; hospital; qualitative; terminal care