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Life-and-death decision-making in the acute phase after a severe stroke: interviews with relatives.

Boer, M.E. de, Depla, M., Woijtkwiak, J., Visser, M.C., Widdershoven, G., Francke, A., Hertogh, C.M.P.M. Life-and-death decision-making in the acute phase after a severe stroke: interviews with relatives. Palliative Medicine: 2015, 29(5), 451-457
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Background
Decision-making in the acute phase after a severe stroke is complex and may involve life-and-death decisions. Apart from the medical condition and prognosis, quality of life and the deliberation of palliative care should be part of the decision-making process. Relatives play an important role by informing physicians about the patient’s values and preferences. However, little is known about how the patients’ relatives experience the decision-making process.

Aim
To elicit the perspective of relatives of severe stroke patients with regard to the decision-making process in the acute phase in order to understand how they participate in treatment decisions.

Design
An exploratory qualitative interview approach guided by the principles of grounded theory.

Settings/participants
Relatives of severe stroke patients (n = 15) were interviewed about their experiences in the decision-making process in the acute phase.

Results
Four categories reflecting relatives’ experiences were identified:
(1) making decisions under time pressure,
(2) the feeling of ‘who am I’ to decide,
(3) reluctance in saying ‘let her die’,
(4) coping with unexpected changes.

Following the treatment proposal of the physician was found to be the prevailing tendency of relatives in the decision-making process.

Conclusion
A better understanding of the latent world of experiences of relatives that influence the decision-making process may help physicians and other health-care providers to better involve relatives in decision-making and enhance the care, including palliative care, for patients with severe stroke in line with their values and preferences. Communication between physician and relatives seems vital in this process.