Nurses want to be involved in medical end-of-life decisions

The majority of nursing staff members want to be involved in medical decisions that are made when their patients are receiving end-of-life care. This has become clear from a publication by researchers at the Netherlands Institute for Health Services Research (NIVEL) and VUB University Brussels in the journal Patient Education and Counseling.

Whilst doctors are formally responsible for medical decisions such as withholding or withdrawing artificial nutrition and hydration, intensifying pain medication, and palliative sedation, approximately three-quarters of the nursing staff members want to be involved when these decisions are made. They often have an intensive and personal relationship with a patient which makes them an important source of information for doctors.
The majority (64%) of nursing staff members think that patients are more likely to express their feelings to them rather than a doctor. When compared with home care staff, hospital nurses want to be involved more often in end-of-life medical decisions. In addition, Registered Nurses are more likely to want to be involved than Certified Nursing Assistants.
Three-quarters of the nursing staff believe that doctors are prepared to listen to what they have to say about the terminally ill patient. However, one quarter thinks that their hierarchically subordinate position makes it difficult for them to discuss proposed end-of-life decisions with doctors. Nursing staff members who work in teams or departments that are specialized in palliative care find more often that doctors listen to their opinion.
Close collaboration
The NIVEL project leader Professor Anneke Francke explains: “Palliative care is pre-eminently suitable for a multidisciplinary approach. This means that doctors and nurses work very closely in teams or departments that are specialized in palliative care. In such an environment shared decision making is more likely to occur.”
Panel of nurses and carers
The study is based on questionnaires that were returned by 587 members of the panel of nurses and carers at the NIVEL. The questions were about relevant situations and the participants’ attitude towards decisions and treatment during end-of-life care.
Collaborating partners
VUB University, Brussels
VU Medical Centre