COMMUNICATION AND PROBLEMATIC INTEGRATION IN END-OF-LIFE DECISIONS - DIALYSIS DECISIONS AMONG THE ELDERLY

End-of-life (EOL) decisions made by and for elderly patients often per petuate unwanted suffering at great expense. Recent efforts to improve the decision-making process have been ineffective. In this article, w e argue that Babrow's (1992, 1995) problematic integration (PI) theory can enhance understandings of flaws in EOL decisions. Face-to-face in terviews of 142 elderly hemodialysis patients were conducted to test p redictions derived from the theory. Results supported the prediction t hat doctors would often fail to disclose the need for dialysis until a decision had to be made. And, as expected, patients were satisfied wi th the decision-making process despite relatively little discussion of their options. When EOL discussions occurred, they focused on topics that were least likely to evoke PI. Moreover, as expected, patients an d doctors relied on stereotypical roles to minimize ambiguity in EOL d ecisions. Results suggest that PI theory can contribute to improved EO L decisions by demonstrating that poor decision making is the collabor ative consequence of efforts by both doctors and patients to cope with PI.