Factors associated with the decision-making process in palliative sedation therapy. The experience of an Italian hospice struggling with balancing various individual autonomies

Endrizzi, Cristina; Senore, Carlo; D’Amico, Gabriella; Palella, Mirella

doi:10.1080/2331205x.2017.1290307

Cited by 5 publications

(8 citation statements)

References 31 publications

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“…We found 54 influencing factors that referred to health team professionals. Initially, we verified factors associated with the patient’s profile, which includes age , [ 16 , 17 , 23 , 25 , 28 , 31 , 63 ] gender, [ 15 , 28 ] comorbidities, [ 23 , 28 , 31 , 63 ] physiological status, [ 23 , 28 , 61 , 63 ] the patient’s degree of dependence, [ 31 , 63 ] the patient’s ability to interact [ 50 ] and the current physical symptoms [ 28 ] that the patient is experiencing. The reason for hospitalisation, [ 43 ] the type of information that the health professional collected, [ 60 , 63 ] the opinion from assistant physicians who already know the patient [ 63 ] and the degree of urgency of this decision-making [ 28 , 44 ] are the elements that build an initial picture of which patient is being approached.…”

Section: Discussionmentioning

confidence: 99%

The Mapping of Influencing Factors in the Decision-Making of End-of-Life Care Patients: A Systematic Scoping Review

Silva

Corradi-Perini

2023

IJPC

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Decisions in end-of-life care are influenced by several factors, many of which are not identified by the decision maker. These influencing factors modify important decisions in this scenario, such as in decisions to adapt to therapeutic support. This presented scoping review aims to map the factors that influence end-of-life care decisions for adult and older adult patients, by a scoping review. The review was carried out in 19 databases, with the keyword ‘clinical decision-making’ AND ‘terminal care’ OR ‘end-of-life care’ and its analogues, including publications from 2017 to 2022. The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. The search resulted in 3474 publications, where the presence of influencing factors in end-of-life decision-making for adults and the elderly was applied as a selection criterion. Fifty-four (54) of them were selected, which means 1.5% of all the results. Among the selected publications, 89 influencing factors were found, distributed in 54 (60.6%) factors related to the health team, 18 (20.2%) to patients, 10 (11.2%) related to family or surrogates and 7 (7.8%) factors related to the decision environment. In conclusion, we note that the decision-making in end-of-life care is complex, mainly because there is an interaction of different characters (health team, patient, family, or surrogates) with a plurality of influencing factors, associated with an environment of uncertainty and that result in a critical outcome, with a great repercussion for the end of life, making it imperative the recognition of these factors for more competent and safe decision-making.

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Section: Discussionmentioning

confidence: 99%

The Mapping of Influencing Factors in the Decision-Making of End-of-Life Care Patients: A Systematic Scoping Review

Silva

Corradi-Perini

2023

IJPC

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“…Integrating the patient´s personal and cultural perspectives into their therapeutic plans and decision-making process is key for personalized care [ 39 ]. This is a challenge as difficulties in talking about palliative sedation at admission are reported, because the health care team were unfamiliar with the values of the patient and family [ 40 ]. Decision making is not only about doing but also about how it is undertaken.…”

Section: Discussionmentioning

confidence: 99%

The Decision-Making Process for Palliative Sedation for Patients with Advanced Cancer–Analysis from a Systematic Review of Prospective Studies

Belar

Arantzamendi

Menten

et al. 2022

Cancers

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Background. The involvement of patients in decision making about their healthcare plans is being emphasized. In the context of palliative sedation, it is unclear how these decisions are made and who are involved in. The aim of the study is to understand how this decision-making is taken. Method. Information from a systematic review on clinical aspects of palliative sedation prospective studies were included. PubMed, CINAHL, Cochrane, MEDLINE, and EMBASE were searched (January 2014–December 2019). Data extraction and analysis regarded: (a) When and by whom the decision-making process is initiated; (b) patient involvement; (c) family involvement and (d) healthcare involvement. Results. Data about decision making were reported in 8/10 included articles. Palliative sedation was reported in 1137 patients (only 16 of them were non-cancer). Palliative sedation was introduced by the palliative care team during the disease process, at admission, or when patients experienced refractory symptoms. Only two studies explicitly mentioned the involvement of patients in decision making. Co-decision between families and the regular health care professionals was usual, and the health care professionals involved had been working in palliative care services. Conclusion. Patient participation in decision making appeared to be compromised by limited physical or cognitive capacity and family participation is described. The possibility of palliative sedation should be discussed earlier in the disease process.

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“…Building this type of situational awareness has been described in other decision making theories (Turpin & Marais, 2004;Schwartz, 2016). In this way, prognostication functioned as a significant catalyst in acknowledging the terminal illness state (Enzinger, Zhang, Schrag, & Prigerson, 2015;Ahn et al, 2013), a critical tool for ensuring more informed end-of-life decisions (Alonso, Hupcey, & Kitko, 2017;Campos-Calderón et al, 2016;Cristina et al, 2017;Drought & Koenig, 2002;Lamont, 2005;Waldrop et al, 2015). Despite this need, difficulty with prognostication was recognized as it required periodic reformulation across the chronic illness phase, and sometimes resulted in prognostic discordance (Alonso et al, 2017;Back, Arnold, & Quill, 2003;Caswell, Pollock, Harwood, & Porock, 2015;Geerse et al, 2019;Gramling et al, 2016a;Watts, 2012).…”

Section: Concept Antecedentsmentioning

confidence: 98%

“…Collaboration.-End-of-life decisions were consistently described as a collaborative enterprise between patients and caregivers (Cristina et al, 2017;Fritsch, Petronio, Helft, & Torke, 2013;Nunez et al, 2015;Vig, Taylor, Starks, Hopley, & Fryer-Edwards, 2006;Winzelberg, Hanson, & Tulsky, 2005). The literature highlighted a shift in decision making control, from healthcare providers during the chronic illness phase (Ejem et al, 2018) to patients and caregivers during the terminal illness phase (Hirschman et al, 2010;Rosenfeld, Wenger, & Kagawa-Singer, 2000).…”

Section: Concept Attributesmentioning

confidence: 99%

“…This may be due to the more personal nature of end-oflife decisions, in that, these decisions are primarily informed by and considered in terms of the patient's needs, values, and preferences, rather than by healthcare provider expertise (American Psychological Association [APA], 2017;IOM, 2015;Rosenfeld et al, 2000;Scheunemann, Cunningham, Arnold, Buddadhumaruk, & White, 2015;Ventres et al, 1999). Consequently, healthcare providers were not described with active decision making roles at the end-of-life, but as "guidance counselors" in negotiating family conflict, "information brokers" in providing technical guidance, "implementers" in executing decisions, and "supporters" in affirming choices (Adams et al, 2011;Braun et al, 2010;COE, 2014;Cristina et al, 2017;El-Jawahri et al, 2017;Gallagher et al, 2015;Hirschman et al, 2010;Melhado & Byers, 2011;Nunez et al, 2015;Osborn et al, 2012;Quill & Brody, 1996;Rosenfeld et al, 2000).…”

Section: Concept Attributesmentioning

confidence: 99%

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End-of-life decision making in the context of chronic life-limiting disease: a concept analysis and conceptual model

2020

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Factors associated with the decision-making process in palliative sedation therapy. The experience of an Italian hospice struggling with balancing various individual autonomies

Cited by 5 publications

References 31 publications

The Mapping of Influencing Factors in the Decision-Making of End-of-Life Care Patients: A Systematic Scoping Review

The Mapping of Influencing Factors in the Decision-Making of End-of-Life Care Patients: A Systematic Scoping Review

The Decision-Making Process for Palliative Sedation for Patients with Advanced Cancer–Analysis from a Systematic Review of Prospective Studies

End-of-life decision making in the context of chronic life-limiting disease: a concept analysis and conceptual model

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