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Nurses' perspective on their involvement in decision-making about life-prolonging treatments: a quantitative survey study.

Arends, S.A.M., Thodé, M., Veer, A.J.E. de, Pasman, H.R.W., Francke, A.L., Jongerden, I.P. Nurses' perspective on their involvement in decision-making about life-prolonging treatments: a quantitative survey study. Journal of Advanced Nursing: 2022, 78(9), p. 2884-2893
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Aims
In hospital settings, decisions about potentially life-prolonging treatments are often made in a dialogue between a patient and their physician, with a focus on active treatment. Nurses can have a valuable contribution in this process, but it seems they are not always involved. Our aim was to explore how hospital nurses perceive their current role and preferred role in shared decision-making about potentially life-prolonging treatment in patients in the last phase of life.

Design
Cross-sectional quantitative study conducted in the Netherlands in April and May 2019.

Methods
An online survey, using a questionnaire consisting of 12 statements on nurses' opinion about supporting patients in decisions about potentially life-prolonging treatments, and 13 statements on nurses' actual involvement in these decisions.

Results
In total 179 hospital nurses from multiple institutions who care for adult patients in the last phase of life responded. Nurses agreed that they should have a role in shared decision-making about potentially life-prolonging treatments, indicating greatest agreement with 'It is my task to speak up for my patient' and 'It is important that my role in supporting patients is clear'. However, nurses also said that in practice they were often not involved in shared decision-making, with least involvement in 'active participation in communication about treatment decisions' and 'supporting a patient with the decision'.

Conclusion
There is a discrepancy between nurses' preferred role in decision-making about potentially life-prolonging treatment and their actual role. More effort is needed to increase nurses' involvement.

Impact
Nurses' contribution to decision-making is increasingly considered to be valuable by the nurses themselves, physicians and patients, though involvement is still not common. Future research should focus on strategies, such as training programs, that empower nurses to take an active role in decision-making.