Shared decision making and its role in end of life care.

Currently, 'shared decision making', which involves the multi-disciplinary team, i.e. the patient, nurse and doctor making joint decisions is advocated in many governing policies to improve the care of the dying patient. The UK population is ageing at an ever-increasing rate, which means that more people are experiencing a progressive death typical of that associated with chronic disease. These patients are suitable for participation in end of life decision making due to the pre-existing knowledge of impending death. Health-care professionals can assist the patient to achieve a 'good death' based on the patient's preferences, wishes and needs. The aim of the literature review discussed in this article was to identify the extent to which shared decision making currently exists during end of life care in the acute/hospice setting. Particular attention is paid to patient participation, the nurse's role, and the doctor/nurse relationship - factors that may facilitate or prevent shared decision making. Eighteen qualitative research papers published between 1997-2007 were reviewed and analysed, and demonstrated a strong link between shared decision making and a 'good death'. However, the research reviewed identified that although shared decision making can exist within end of life care, there are a number of reasons why this is not being achieved throughout the secondary care setting.