Role of patients' family members in end-of-life communication: an integrative review.

BMJ Open

Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, People's Republic of China.

Published: February 2023

AI Article Synopsis

  • The study aims to synthesize findings on the family's role in end-of-life (EOL) communication and identify key practices for decision-making in family-centric cultures.
  • A systematic review of 53 studies was conducted to analyze EOL communication issues, focusing on family dynamics, conflicts, and cultural influences.
  • Results highlighted four main themes: conflicts in decision-making, timing of communication, challenges in identifying decision-makers, and cultural variations, ultimately emphasizing the need for a framework tailored to enhance family involvement in EOL care, especially in Chinese and Eastern contexts.

Article Abstract

Objectives: To synthesise empirical findings on the role of family in end-of-life (EOL) communication and to identify the communicative practices that are essential for EOL decision-making in family-oriented cultures.

Setting: The EOL communication settings.

Participants: This integrative review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Relevant studies published between 1 January 1991 and 31 December 2021 were retrieved from four databases, including the PsycINFO, Embase, MEDLINE and Ovid nursing databases, using keywords with meanings of 'end-of-life', 'communication' and 'family'. Data were then extracted and coded into themes for analysis. The search strategy yielded 53 eligible studies; all 53 included studies underwent quality assessment. Quantitative studies were evaluated using the Quality Assessment Tool, and Joanna Briggs Institute Critical Appraisal Checklist was used for qualitative research.

Primary And Secondary Outcome Measures: Research evidence on EOL communication with a focus on family.

Results: Four themes emerged from these studies: (1) conflicts in family decision-making in EOL communication, (2) the significance of timing of EOL communication, (3) difficulty in identification of a 'key person' who is responsible for decisions regarding EOL care and (4) different cultural perspectives on EOL communication.

Conclusions: The current review pointed towards the importance of family in EOL communication and illustrated that family participation likely leads to improved quality of life and death in patients. Future research should develop a family-oriented communication framework which is designed for the Chinese and Eastern contexts that targets on managing family expectations during prognosis disclosure and facilitating patients' fulfilment of familial roles while making EOL decision-making. Clinicians should also be aware of the significance of the role of family in EOL care and manage family members' expectations according to cultural contexts.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9945016PMC
http://dx.doi.org/10.1136/bmjopen-2022-067304DOI Listing

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