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Decision aids may increase patient knowledge about end-of-life care but information is often incomplete

Cardona-Morrell M, Benfatti-Olivato G, Jansen J, et al. A systematic review of effectiveness of decision aids to assist older patients at the end of life Patient Education and Counseling. 2016 Jul.

Review question

  • Does providing information in different formats such as video and print (decision aids) help older patients nearing end-of-life in making decisions about their end-of-life care?

Background

  • Making decisions about end-of-life care can be stressful and difficult for older patients, especially if they are not given enough information to prepare them for such tasks.
  • As a result of this knowledge gap, healthcare professionals are tempted to pass off recommendations as facts rather than providing patients with information to make decisions on their own.
  • Decision aids are different tools through which information can be provided and may better prepare older patients in making decisions about their end-of-life care.

How the review was done

  • A detailed search of four electronic databases for studies published up to and including May 2015 was conducted. Studies that focused on older patients with terminal illness such as cancer or dementia were included.
  • A total of 1,419 studies were identified in searches, and 17 were included in the review after assessments for eligibility.
  • This review was funded by a grant from the National Health and Medical Research Council of Australia.

What the researchers found

  • This review found that there are many different formats, such as print and video, through which information can be given to support older patients when making decisions about end-of-life care. This information, however, often does not include facts on harms, benefits, treatment options or the likely course of the disease.
  • Many studies focused on self-administered decision aids that did not require the presence of a healthcare provider. These tools may not be ideal for end-of-life care because of how quickly disease can change.
  • The review also found that patients who were given decision aids appeared to have more knowledge about their care and were usually more satisfied with the decision-making process than patients who were not given decision aids.

Conclusion

  • This review identified many different tools that can be used to help patients make decisions about end-of-life care. The information helps improve patient knowledge and satisfaction, but is often incomplete. This prevents patients from making fully informed decisions. 



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