Examining the barriers and facilitators that impact adult end-of-life conversations and decision-making in hospital: An integrative literature review
Date
2015-12-01
Authors
Forster, Jennifer
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Abstract
In acute care, end-of-life (EOL) communication is limited between healthcare providers (HCP)s and recipients suffering progressive, life-limiting-illnesses, who appear to be at the end of their lives. Few researchers have demonstrated how increasingly sicker and aging patients affect the quality of EOL care, or have evaluated the effectiveness of the current EOL care in hospitals. Ineffective communication is a major source of poor, overall EOL experiences. In this integrative literature review (ILR) project, I explore the barriers and/or facilitators in relation to EOL communication, particularly conversations about EOL decision-making, and identify what factors prevent HCPs from engaging in EOL decision-making with patients and families. Communication barriers and facilitators identified in this review include: (a) HCP factors such as intrapersonal and professional issues, ethical and learner factors; (b) interdisciplinary factors such as teamwork, hierarchies, and divergent EOL paradigms; (c) hospital system factors such as policy, education, and resource allocation; and (d) recipient factors such as knowledge, attitudes, age, and illness type. Nurses care for, spend significant amounts of time with patients and their families in acute care, and are well positioned to improve EOL communication practices.
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Keywords
end-of-life, conversation, hospital, life-limiting-illness