The creation of quality decisions when providing end-of-life (EOL) care is of paramount importance to both clinicians and terminally ill patients because it aids in the delivery of high-quality healthcare services. Moreover, such quality decisions can only be attained if there is a proper communication infrastructure in a healthcare setting, particularly, between terminally ill patients, relatives, and healthcare providers. Furthermore, the analogous goal of EOL and decision-making process is to attain a shared understanding pertaining a patient's values as well as treatment preferences. Subsequently, this aids in the development of a plan of care that is consistent to the EOL individualized wishes of patients, which also promotes their quality of life. This is a critical review of research publication that defines the importance of proper communication between patients and clinicians during the EOL decision making process on the nature of healthcare services to offer patients.
Background to the Study
The research was focused on evaluating the effectiveness of using structured communication tools amongst patients in ambulatory care settings to facilitate end-of-life decision-making process and the completion of advanced care planning. Also, there existed a gap in knowledge as to whether the use of proper communication infrastructure between patients, relatives and healthcare practitioners can improve the quality of healthcare services offered to terminally ill persons. Moreover, Oczkowski et al. (2016) established the significance of the study by citing that today, with the advancement in medical care services, end-of-life (EOL) communication, as well as decision making, has become critically essential. Furthermore, this is in ensuring that patients at their end-of-life stages do not attain unwanted or invasive treatments (Oczkowski et al., 2016). Furthermore, Oczkowski et al. (2016) asserted that unwanted treatments at EOL are linked to poorer quality of life among the patients as well as psychological harm to them as well as to their families. Moreover, according to Oczkowski et al. (2016), critical patients who lack EOL treatment preferences and with unclear decision on their substitute decision makers (SDMs) and clinicians face a high mortality risk.
As such, in an effort to address such issues, Oczkowski et al. (2016), in their research, proposed for the development of communications tools like decision aids, educational interventions as well as structured meeting plans. Additionally, this is in an effort to assist clinicians and patients in the EOL decision making process, in order to facilitate the provisioning of high-quality healthcare services. Additionally, although Oczkowski et al.'s (2016) research did not have a defined research question, the objective of the research was clearly defined. In this case, the objective of the research was to investigate the effect of structured communication tools in facilitating good EOL decision making process between clinicians and patients. Also, the primary research question that was employed in the execution of the research was as follows.
Does the use of structured communication tools in EOL decision-making process between patients and clinicians aid in the delivery of high-quality healthcare services to patients?
Ultimately, the purpose and research questions that were employed to provide the parameters of conducting the research were sufficiently answered by the findings of the research. Additionally, the findings were supported by a total of 47 studies as well as 46 RCTs that confirmed that effective communication using structured communication tools could be employed in EOL decision making process.
Methods Used In the Study
The Modified Delphi Method was employed as the primary data analysis methodology in the study. Additionally, the Modified Delphi Method is a communication methodology that is considered to be a systematic, forecasting as well as interactive methodology that is reliant on a panel of experts (Underwood, 2015). Furthermore, in this method, the experts provide their feedback to questions asked through questionnaires in rounds of two or more (Rich & Brown, 2014; Eubank et al., 2016). Additionally, after each round, a facilitator or a change agent provides a detailed summary of the experts' forecasts from the preceding rounds until an anonymous consensus is attained. In the research, Oczkowski et al. (2016) used a multidisciplinary group of experts that developed definitions, EOL communication conceptual framework, quality indicators as well as decision-making models using the Modified Delphi Method.
The findings of the study asserted that the use of structured communication tools could be employed to enhance the frequency of discussions between healthcare providers and patients on matters pertaining end-of-life decisions. Furthermore, the use of structured communication tools was supported by the research instead of using ad-hoc approaches in generating critical end-of-life decisions on the quality of care that should be accorded to chronic patients. Moreover, the findings of Oczkowski et al.'s (2016) research have a major implication in the field of nursing. Additionally, the implication is that effective communication between health providers, patients, and relatives is imperative in developing logical and acceptable decisions about the end-of-life care that should be accorded to patients. Moreover, Oczkowski et al.'s (2016) research contributed to the nursing knowledge by providing a validated conclusion that proper communication is fundamental in the decision making process pertaining end-of-life care offered to terminally ill patients. Furthermore, this finding should implicate all areas of nursing in that it will enlighten all healthcare practitioners on the importance of involving patients as well as their relatives in making essential clinical-related decisions.
Despite the comprehensive analysis of data collected from randomized controlled trials (RCTs) as well as non-randomized intervention studies to justify the findings, Oczkowski et al.'s (2016) research was not approved by an institutional review board. However, the findings and arguments presented by Oczkowski et al.'s (2016) research were supported by a variety of other relevant research publications published by other scientific researchers in the past. Furthermore, since Oczkowski et al.'s (2016) research was a systematic review of RCTs and non-randomized intervention studies, the anonymity aspect of participants' ethicality was not applicable. Nevertheless, the reporting of the findings of the research was done transparently and correctly.
In conclusion, proper communication between patients and clinicians during the EOL decision-making process can promote the quality of healthcare services offered to patients. Additionally, this is because patients can clarify their preferences in the form of EOL treatment they may desire from the clinicians. Subsequently, the healthcare practitioners are also let off from the burden of making critical EOL healthcare decisions that may not be well appreciated by the patients. Ultimately, it is essential for all healthcare practitioners to seek effective structural communication tools that can be employed to promote the level of communication between patients and clinicians. Consequently, this will ensure that there will be an improvement of care offered to patients in EOL situations. Also, the findings of this research can be applied in all medical institutions in promoting the quality of life offered to chronically ill patients.
Eubank, B. H., Mohtadi, N. G., Lafave, M. R., Wiley, P. J., Bois, A. J., Boorman, R. S., et al. (2016). Using the modified Delphi method to establish clinical consensus for the diagnosis and treatment of patients with rotator cuff pathology. BMC Medical Research Methodology, 16(56). doi: 10.1186/s12874-016-0165-8
Rich, M., & Brown, A. (2014). ECRM2014-Proceedings of the 13th European Conference on Research Methodology for Business and Management Studies: ECRM 2014. Wood Lane Sonning Common: Academic Conferences Limited.
Oczkowski S. J., Chung H-O., Hanvey L., Mbuagbaw L., & You J. J. (2016). Communication Tools for End-of-Life Decision-Making in Ambulatory Care Settings: A Systematic Review and Meta-Analysis. PLoS ONE 11(4): e0150671. doi: 10.1371/journal.pone.0150671
Underwood, C. (2015). Fulfilling Restorative Justice Efforts: A Model Supporting Capacity Building. Bloomington: Xlibris Corporation
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