End-of-life decision making in the seriously ill hospitalized patient: an organizing framework and results of a preliminary study

Recent studies of patient/family satisfaction with end-of-life care suggest that improvements in communication and decision making are likely to have the greatest impact on improving the quality of end-of-life care. The appar ent failure of recent studies specifically designed to improve decision mak ing strongly suggest that there are powerful determinants of the decision m aking process that are not completely understood. In this paper, we present an organizing framework that describes the decision making process and bre aks it into three analytic steps: information exchange, deliberation, and m aking the decision. in addition, we report the results of a preliminary stu dy of end-of-life decision making that incorporates aspects of this organiz ing framework. Thirty-seven seriously ill hospitalized patients were interv iewed. The majority wanted to share decisional responsibility with physicia ns. We demonstrated the feasibility of measuring certain aspects of the dec ision making process in such patients. By providing and using a framework r elated to end-of-life decision making, we hope to better understand the com plex interaction and processes between dying patients, caregivers, and phys icians.