Patients’ Involvement in Decision Making at End of Life—A Systematic Review of Literature

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.