Abstract
Background: involving patient in end of life decision is important to understand their wishes and preference, which will help health care providers in improving the quality of dying and minimizing suffering. Aim: the aim of this review was to provide a detailed examination of the available literature related to patients’ involvement in decision making at end of life. Design: a systematic review following the PRISMA protocol was used, the review protocol was registered on PROSPERO: CRD42019128556. Data sources: we conducted a literature search in two electronic databases “CINAHL and Medline” during March-April 2019. The retrieved articles were included if they were: research reports or literature review; examined patient involvement in end of life discussions; full text publications, written in English and published from 2000-2019. Results: a total of (22) articles were included in the review; there was diversity in the purposes and design approach of the retrieved studies. The available literature explored patient’s involvement at end of life decision making through; describing current practices; understanding perspectives of end of life discussions; investigating the impact and identifying the barriers and facilitators of patients’ involvement in end of life discussions. Conclusion: involvement in end of life discussions improved the recognition of patients’ wishes, improved death experience, and decreased posttraumatic stress, depression, and anxiety among family members. Despite the documented benefits, some barriers against patient’s involvement in EOL decisions were recognized; lack of awareness; lack of education, training and experience; concerns about ethical and legal issues; and personal preferences of doctors or nurses were among the most commonly identified barriers.
Highlights
Even though the health care providers (HCPs) recognize the importance of ongoing communication and providing adequate information about the patient’s condition; reports indicate that the majority of family members of in-hospital deceased patients were dissatisfied with HCPs’ communication regarding end of life (EOL) decisions, and they clearly verbalized their preferences to have more communication regarding their patient’s condition [7]
The studies showed a lack of involving patients in EOL decision making
A qualitative descriptive study reported that most patients did not have the opportunity to discuss their values and preferences for EOL treatment, relatives stated that staff did not initiate discussions with them [22]
Summary
Being hospitalized or having a hospitalized family member is overwhelming and a stressful experience, especially if the illness is terminal and death is imminent. Patients, their family caregivers and health care providers (HCPs) are obligated to make crucial decisions challenged by the sensitive circumstances surrounded by end of life (EOL) which increase the difficulty of making them [1]. Their family caregivers and health care providers (HCPs) are obligated to make crucial decisions challenged by the sensitive circumstances surrounded by end of life (EOL) which increase the difficulty of making them [1] Patients differ in their preference for participation in treatment decisions at EOL [2]. It is necessary to evaluate the available evidence in order to enhance patients’ involvement in EOL decision making
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