Communication about advance directives: are patients sharing information with physicians?

Family surrogate decision making at the end of life: seeing them through with care and respect

Family surrogate decision makers are pivotal in end-of-life decision-making processes. The author investigated decision-making experiences of 20 surrogates who assisted terminally ill family members for this grounded theory study. Findings describe a basic social process of Seeing Them Through With Care and Respect, during which surrogates continuously synthesized the core values of caring for their family member and respecting their family member's autonomy. Surrogate narratives began with Learning the Diagnosis. The major categories of surrogate decision makers' activities during the process were Standing With and Acting For the ill family member. Events reported in two gating categories, Brokering Information and Working With Family, facilitated or impeded decision making. A final category, Outcomes, reports consequences for the surrogate of having been a decision maker.

Knowledge and attitudes of health care social workers regarding advance directives

This cross sectional investigation describes the knowledge and attitudes of health care social workers regarding advance directives and explores factors that influence them. As major contributors to quality patient care, the level of knowledge and attitudes held by health care social workers regarding health care policy mandates are important. Mail survey methods were used to collect data from a systematic random sample (n = 324) of social workers throughout one mid-western state. Results indicate that the majority of health care social workers have high to moderate levels of knowledge about advance directives and hold positive attitudes regarding the policy. Social workers with more experience working with the elderly had higher levels of knowledge. Those employed in nursing homes and hospice settings had more positive attitudes than did those working in other health care facilities.

A systemic perspective of life-prolonging treatment decision making

This ethnographic, ethnomethodological study prospectively examined eight life-prolonging treatment decisions in two long-term care centers in Quebec. This study distinguishes itself from prior empirical studies in this domain by the qualitative methods and the systemic perspective used. The results, contrasting with prior studies, illustrate that the participation of long-term care residents in their life-prolonging treatment decisions is not dependent simply on the communication between the physician and his patient. In fact, the opportunity of long-term care residents to participate in their life-prolonging treatment decisions can be facilitated by effective communication between members of a system of persons found in this setting. These results shift the focus of future inquiry, for both research and clinical practice, from the communication between physician and resident to the patterns of communication between all persons in the clinical setting who know the resident's treatment wishes.