Nursing Practices Supporting Decision-Making in Taiwanese Patients with Terminal Illness in Intensive Care Units: A Literature Review

Abstract

Uncertainty about the decision-making capacity of patients with terminal illness in intensive care units (ICUs) is common, and family members often make decisions on their behalf. Health care professionals rarely engage patients in advance care planning; moreover, the decision-making support needs of patients with terminal illness in ICUs have not been adequately explored.
Purpose
Through a literature review, this study aimed to understand the status of decision-making for patients with terminal illnesses in ICUs in Taiwan, where patients’ self-determined decision making has been legislated, and to clarify the characteristics of nursing practice supporting decision-making.
Methods
The Chinese electronic periodical service and Taiwan periodical literature databases were searched from inception to May 2021. ‘ICU’, ‘decision-making’, and ‘end-of-life’ were used as search terms. Inclusion and exclusion criteria were employed to screen for eligibility. The findings were analysed and synthesised into major categories regarding nursing practices facilitating decision-making.
Results
Thirteen articles were selected for the final review. Seven major categories emerged: 1) consideration of patients’ best interests; 2) advocacy of self-determination for terminally ill patients with decision-making capacity; 3) emotional sharing and stability through coordinated family visits; 4) attitudes towards family surrogate decision-makers; 5) establishing a system for providing information according to family situation; 6) multi-interdisciplinary collaboration in family meetings; and 7) sharing the concept of hospice palliative care among healthcare professionals.
Discussion
It is crucial to develop a system to share hospice palliative care concepts by proposing treatment options focusing on patients’ best interests during decision-making.