The role of hospital nurses in shared decision‐making about life‐prolonging treatment: A qualitative interview study

Abstract

Aims To examine hospital nurses’ perception of their actual and potential contribution to shared decision‐making about life‐prolonging treatment and their perception of the pre‐conditions for such a contribution. Design A qualitative interview study. Methods Semi‐structured face‐to‐face interviews were conducted with 18 hospital nurses who were involved in care for patients with life‐threatening illnesses. Data were collected from October 2018‐January 2019. The interviews were recorded, transcribed verbatim and analysed using thematic analysis by two researchers. Results Nurses experienced varying degrees of influence on decision‐making about life‐prolonging treatment. Besides, we identified different points of contact in the treatment trajectory at which nurses could be involved in treatment decision‐making. Nurses’ descriptions of behaviours that potentially contribute to shared decision‐making were classified into three roles as follows: checking the quality of a decision, complementing shared decision‐making and facilitating shared decision‐making. Pre‐conditions for fulfilling the roles identified in this study were: (a) the transfer of information among nurses and between nurses and other healthcare professionals; (b) a culture where there is a positive attitude to nurses' involvement in decision‐making; (c) a good relationship with physicians; (d) knowledge and skills; (e) sufficient time; and (f) a good relationship with patients. Conclusion Nurses described behaviour that reflected a supporting role in shared decision‐making about patients’ life‐prolonging treatment, although not all nurses experienced this involvement as such. Nurses can enhance the shared decision‐making process by checking the decision quality and by complementing and facilitating shared decision‐making. Impact Nurses are increasingly considered instrumental in the shared decision‐making process. To facilitate their contribution, future research should focus on the possible impact of nurses’ involvement in treatment decision‐making and on evidence‐based training to raise awareness and offer guidance for nurses on how to adopt this role.

Role of GPs in shared decision making with patients about palliative cancer treatment: a qualitative study in the Netherlands

“… 22 The importance of healthcare professionals cooperating to reach high-quality decisions is stressed by Légaré and others, 22 , 44 who proposed an interprofessional model of SDM in which several healthcare professionals, including a decision coach, are involved in the SDM process. Both the findings of the authors’ previous study involving hospital nurses, 40 and the findings of the current study involving GPs show that healthcare professionals who are already involved in a patient’s care may take on the role of decision coach without the need to involve additional healthcare professionals.…”

“…Previously, the authors of the current study interviewed hospital nurses about their role in SDM about life-prolonging treatment and extracted similar categorisations of SDM support. 40 Although their roles are not identical, nurses and GPs might both be regarded as ‘decision coaches’ : 42 ‘a health professional who is trained to support the patient’s involvement in healthcare decision making but who does not make the decision’ . 22 The importance of healthcare professionals cooperating to reach high-quality decisions is stressed by Légaré and others, 22 , 44 who proposed an interprofessional model of SDM in which several healthcare professionals, including a decision coach, are involved in the SDM process.…”

“…The final categorisation of some themes and subthemes was informed, and likely influenced, by the simultaneous analysis of interviews with hospital nurses about their role in SDM about palliative treatment. 40 Three researchers were involved in the coding process. Four interviews were double-coded independently by two researchers and discussed until they reached consensus.…”

Shared decision making in a semi-secluded chronic psychiatric ward: The reflective lifeworld experiences of patients with schizophrenia or schizoaffective disorders and nursing staff

“…Existing models of SDM, are to a large extent, focused on medical decision-making processes involving pharmaceutical consultation and treatment options and the doctor-patient alliance (Beitinger, Kissling, & Hamann, 2014;Charles, Gafni, & Whelan, 1997;Elwyn et al, 2012), But, studies on SDM in nursing practice are increasing. It is known that nurses play an important complementary role in medical decision-making processes in lifeprolonging treatment by facilitating and checking the information is well understood by patients and significant others (Bos-van den Hoek et al, 2020;Matthias et al, 2014;Jo et al, 2015). The stepwise approach of facilitating SDM by nurses follows approximately the following sequence: 1) informing patients that a decision have to be made, 2) explaining options and associated benefits or disadvantages, 3) exploring the patients" preferences, and finally 4) the making or deferring the decision (Siggelbout et al, 2015).…”

The effectiveness of simulation education program on shared decision-making attitudes among nurses in Taiwan

“…However, as far as our knowledge, it is unclear which components of SDM are necessary to achieve these outcomes [ 4 ]. There is an important role to be played by nurses in ELO to advance the field of SDM [ 5 ]. Attitude influences actions and behaviors; therefore, a nurse’s attitude may affect their communication with palliative-care and terminally ill patients [ 6 , 7 ].…”