“…However, the review demonstrated how contextual factors such as level of education, rural or urban settings and nationality all influence individuals' responses to decision making about place of care and interventions at the end of life (Caron et al, 2005a(Caron et al, , 2005bChen et al, 2006;Gessert et al, 2006). Very few studies have engaged with how carers interact with professionals in the decision-making process, nor have they described what is required for effective communication (Caron et al, 2005b) even though it is clear that how physicians resolve and negotiate patient and family preferences regarding care appears to directly influence patient outcomes (Helton et al, 2006). In the absence of agreed guidelines, and advance care plans, decision making for people with dementia at the end of life is shaped by differences in religious beliefs, professional training, understanding of the disease, what is meant by palliative care, perspectives of other patients, culture and beliefs (Luchins and Hanrahan, 1993;Cavalieri et al, 2002;Hinkka et al, 2002;The Anne Mei, 2002;Lacey, 2005;Haydar et al, 2004;Rurup et al, 2006).…”