Shared decision-making at the end of life: A focus group study exploring the perceptions and experiences of multi-disciplinary healthcare professionals working in the home setting

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Abstract

Background:

Globally recommended in healthcare policy, Shared Decision-Making is also central to international policy promoting community palliative care. Yet realities of implementation by multi-disciplinary healthcare professionals who provide end-of-life care in the home are unclear.

Aim:

To explore multi-disciplinary healthcare professionals’ perceptions and experiences of Shared Decision-Making at end of life in the home.

Design:

Qualitative design using focus groups, transcribed verbatim and analysed thematically.

Setting/participants:

A total of 43 participants, from multi-disciplinary community-based services in one region of the United Kingdom, were recruited.

Results:

While the rhetoric of Shared Decision-Making was recognised, its implementation was impacted by several interconnecting factors, including (1) conceptual confusion regarding Shared Decision-Making, (2) uncertainty in the process and (3) organisational factors which impeded Shared Decision-Making.

Conclusion:

Multiple interacting factors influence implementation of Shared Decision-Making by professionals working in complex community settings at the end of life. Moving from rhetoric to reality requires future work exploring the realities of Shared Decision-Making practice at individual, process and systems levels.

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