Theories of Health Care Decision Making at the End of Life: A Meta-Ethnography.
Kyounghae Kim, Katherine Heinze, Jiayun Xu and 4 others
PMID 28816094WHAT IT FOUND
End-of-life decision-making theories mostly described the process, not outcomes.
A synthesis of 43 articles grouped them into context, communication, decision-maker traits, goals, options, and outcomes. Nurses can use it as a checklist for advance care planning conversations.
Key findings
01The review synthesized 43 articles that explicitly addressed theory in end-of-life decision making for advanced cancer, heart failure, or ALS, and produced a conceptual framework.
02The included theories mainly addressed process: Thirty-three were mainly process-related, four outcome-related, and six related to both.
03The framework grouped end-of-life decision making into themes: context, communication and negotiation, characteristics of decision makers, goals, options and alternatives, and outcomes of decisions.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review synthesizes theories from published studies; it does not test whether any decision-making framework improves patient or family outcomes. It included only advanced cancer, heart failure, and ALS, so it may not apply to other life-limiting illnesses. The search may have missed relevant articles. It did not report theories separately by race, gender, or educational level, so subgroup cultural differences cannot be judged. Only articles that explicitly addressed a theory were included, so the synthesis does not represent all end-of-life decision-making studies.
Declared interests
The article is tagged as supported by NIH extramural and U.S. government P.H.S. research support. No author conflict-of-interest statement is provided.
The easy way to misread this
Do not read this framework as proof that shared decision-making improves end-of-life care. It synthesizes 43 theory-focused articles and reports no tested patient outcomes.