Awareness of Doctors’ Shared Decision-Making in Life-Sustaining Care Decisions

Abstract

Purpose: At the end of life, communication is a key factor for good care. However, in clinical practice, it is difficult to adequately discuss end-of-life care. In order to understand and analyze how decision-making related to life-sustaining treatment (LST) is performed, the shared decision-making (SDM) behaviors of physicians were investigated. Methods: A questionnaire was designed after reviewing the literature on attitudes toward SDM or decision-making related to LST. A final item was added after consulting experts. The survey was completed by internal medicine residents and hematologists/medical oncologists who treat terminal cancer patients. Results: In total, 202 respondents completed the questionnaire, and 88.6% said that the decision to continue or end LST is usually a result of SDM since they believed that sufficient explanation is provided to patients and caregivers, patients and caregivers make their own decisions according to their values, and there is sufficient time for patients and caregivers to make a decision. Expected satisfaction with the decisionmaking process was the highest for caregivers (57.4%), followed by physicians (49.5%) and patients (41.1%). In total, 38.1% of respondents said that SDM was adequately practiced when making decisions related to LST. The most common reason for inadequate SDM was time pressure (89.6%). Conclusion: Although most physicians answered that they practiced SDM when making decisions regarding LST, satisfactory SDM is rarely practiced in the clinical field. A model for the proper implementation of SDM is needed, and additional studies must be conducted to develop an SDM model in collaboration with other academic organizations.

Hospice-Palliative Medicine as a Model of Value-Based Healthcare

“… 14 The communication method has also changed, and the choice between hospice-palliative care and life-sustaining treatment requires a shared decision that reflects the patient’s opinion and is no longer a paternalistic decision made by medical staff. 15 …”

Perspectives of healthcare professionals and older patients on shared decision-making for treatment escalation planning in the acute hospital setting: a systematic review and qualitative thematic synthesis

“…20 It is increasingly expected in ‘western’ societies 20 , 21 , 22 and less established worldwide. 23 , 24 SDM reflects a cultural move away from paternalism towards greater patient empowerment. 25 Models can encompass a spectrum of patient involvement, 26 , 27 but usually involve presenting more than one management option and prioritising individualised communication.…”