End-of-Life Care Decision Making

This assignment focuses on the complex topic of end-of-life care decision making. It requires students to analyze a collection of research articles that delve into various aspects of this subject. These articles examine factors influencing end-of-life decisions, including patient autonomy, family perspectives, and the role of healthcare professionals in facilitating communication. Students are expected to synthesize information from these sources to gain a comprehensive understanding of the challenges and considerations involved in end-of-life care decision making.

Dissertation on-
To what extent does the family
involve in making decision to
initiate end of life care

TABLE OF CONTENTS
2. INTRODUCTION.......................................................................................................................1
2.1 Background............................................................................................................................1
2.2 Rationale................................................................................................................................1
2.4 Aim and objectives................................................................................................................2
3. METHODOLOGY......................................................................................................................2
3.1 Introduction............................................................................................................................2
3.2 PICO Framework...................................................................................................................2
3.3 Search strategy.......................................................................................................................3
3.4 Electronic databases...............................................................................................................3
3.5 Key search terms....................................................................................................................4
3.6 Boolean operators..................................................................................................................4
3.7 Inclusion and exclusion criteria.............................................................................................5
3.8 Overview of literatures..........................................................................................................5
4. LITERATURE REVIEW............................................................................................................9
4.1 Ethical issue...........................................................................................................................9
4.2 Critiquing the studies thematically........................................................................................9
REFERENCES..............................................................................................................................16

2. INTRODUCTION
2.1 Background
End - of - life care concern with caring for all those who are suffering with a terminal
illness that is at an advanced and incurable stage. While enabling the patient to die with dignity,
end - of - life care provides support to people when they are going through the last months and
years of their life (Detering and et.al., 2010). This care depicts a serious commitment involving
both patient as well as his carers. It also includes the treatment provided to the patient during this
time as well as the legal matter involved. Quality end - of - life care is important because it
makes a significant contribution to making the life of people dignified and comfortable during
the period before passing. Planning for end – of – life care requires making a range of decisions.
These include decisions regarding palliative care, medical experimentation, ethics, patient’s right
to self- determination etc. (Curtis and Vincent, 2010).
The decisions are taken by the patient, family members and their physicians. Mostly, the
patients who are seriously ill become incapable of making some or all medical decisions
concerning end - of - life care. In the situation when patient’s lack capacity to decide, decision
making is initiated through discussion between the patient’s physician and family members
(Funk and et.al., 2010). The family members of the patient act as surrogate decision makers.
Family involvement plays an important role in helping the clinical team of the patient in
interpreting advance directives and goals of patient care. It further assists in aligning the medical
decisions with the preferences of the patient. Moreover, even when the ability for decision
making is retained with the patient, the support that family members provide by advocating goes
a long way in relieving stress and providing comfortable environment at the end- of- life
(Edwards and et.al., 2010).
2.2 Rationale
Involving family in the decision making during end- of- life care is important. An
appropriate plan of care can be established with the involvement of family as they are able to
identify behaviours and attitudes for constructing a reasonable value history (Barry and Edgman-
Levitan, 2012). However, the family is required to understand the difference between substituted
judgment and judgment made in the best interest of the patient. While a substituted judgment
refers to determining how the decision would be made by the patient if he fully understands his
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condition; best interest decisions refer to family making the decisions on behalf of the patient on
the basis of their own values. Furthermore, it is even more important to determine the knowledge
of the family and the degree to which they accept the condition of the patient. This is because
achieving an appropriate plan of care becomes difficult if the family’s views about patient’s
medical condition are different from those of the physician (Sudore and Fried, 2010). Thus, the
present research is being conducted as it becomes important to determine the extent to which
family is involved in making decisions for initiating end- of- life care.
2.4 Aim and objectives
Aim
To analyse the extent to which family involves in making decision to initiate end- of- life care
Objectives
 To study the importance of family involvement in end- of- life care
 To evaluate various considerations regarding family involvement in making decision to
initiate end- of- life care
 To analyse the extent to which family is involved in making decisions to initiate end- of-
life care
3. METHODOLOGY
3.1 Introduction
For carrying out the present study, appropriate methodology was adopted which
comprised of search strategy, electronic search, key search terms, Boolean operators and
inclusion and exclusion criteria. A systematic electronic search was conducted to find relevant
articles on the involvement of family in decision making to initiate end- of- life care.
3.2 PICO Framework
PICO framework is an effective tool that helps in framing a clinical question which is
patient specific. It comprises of four parts that help in articulating a clinical question. These parts
are namely, problem/population, Intervention, Comparison and Outcome (McGowan and et.al.,
2016). For the present dissertation, PICO framework has been applied as follows:
 P- Problem/ Population- People about to receive end- of- life care
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 Intervention- Family involvement
 C- Comparison- Nil
 O- Outcome- Decision making to initiate end- of- life care
3.3 Search strategy
The search strategy for the present research comprised of conducting an online search by
using various electronic databases. By using appropriate key search terms, the databases were
searched to find the most suitable articles on family involvement in decision making to initiate
end- of- life care. While conducting the search, Boolean operators were used for narrowing and
expanding the search. Lastly, with the help of inclusion and exclusion criteria, the articles that
were most relevant were selected for the research.
3.4 Electronic databases
An electronic database is referred to as an organized electronic collection of data on
various subjects that can be searched and retrieved in a number of ways (Kable, Pich and Maslin-
Prothero, 2012). For conducting search in the present study, electronic databases were used. This
is because these provided various advantages to the researcher. With the help of these databases,
a number of results could be retrieved in minimum time. The databases provide efficient
searching speed which acts as an advantage over manual search which may consume time
(Behzadian and et.al., 2010). Moreover, electronic databases provided flexibility as researcher
could access them from any place. Also, a large number of results could retrieved which helped
in selecting the relevant articles.
For the present research on end- of- life care, the following databases were used:
Electronic database Description
PsychINFO This database contains abstracts of literature
from the field of behavioural and social
sciences. There are citations and summaries
of journal articles, book chapters,
dissertations etc. (PsycINFO. 2017).
CINAHL This comprises of an index of journal articles
about biomedicine, nursing healthcare and
allied health in English and other languages
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(CINAHL Complete, 2017).
Medline Medline is a bibliographic database which
contains abstracts and journal citations for
biomedical literature. It comprises of
bibliographic information for articles
belonging to pharmacy, healthcare, nursing,
medicine etc. (MEDLINE, 2017).
3.5 Key search terms
These are the words that are used for conducting a search. These help in obtaining the search
results for a particular topic (Ridley, 2012). For the present study, the following key search terms
were used:
SEARCH TERM 1 Family
SEARCH TERM 2 Involvement, inclusion
SEARCH TERM 3 End- of- life care
SEARCH TERM 4 Decision, judgment
3.6 Boolean operators
Boolean operators find their use in connecting the key words and defining relationship
between them. While conducting a search on electronic databases, Boolean operators are used
for narrowing the search or expanding it. There are three Boolean operators, namely, AND, OR
and NOT (McGowan and et.al., 2016). For the present study on end- of- life care, Boolean
operator OR and AND were used. Boolean operator OR is used for expanding the search. This is
because it helps in retrieving all the articles that contain either one or all the search terms. In
contrast to this, Boolean operator AND helps in retrieving only those articles that contain all the
search terms. Hence, this helps in narrowing the search.
3.7 Inclusion and exclusion criteria
Inclusion criteria refer to the characteristics that must be present in the articles to be
included in the study. In contrast to this, exclusion criteria are those characteristics on the basis
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of which studies are disqualified from being included in the study (Kable, Pich and Maslin-
Prothero, 2012). For the present study, the following inclusion and exclusion criteria were used:
Inclusion criteria Exclusion criteria
Researches done in English language Researches done in other languages
Studies published from 2008- 2017 Studies published prior to the year 2008
Research done on involvement of family Research done on involvement of others such
as agencies, support groups, healthcare
professionals
Research done on end- of- life care Researches done on any other type of care
3.8 Overview of literatures
Paper Journal Type of study Purpose Findings
Lorenz, A. K.
and et.al., 2008.
Evidence for
improving
palliative care at
the end of life”
A systematic
review.
Annals of
internal medicine
Systematic review To assess
evidence about
interventions for
improving end
of life and
palliative care
There is strong
evidence that
support
treatment of
cancer pain with
opioids and
cancer
associated
depression with
psychotherapy.
Interventions
should be
employed for
improving
important
aspects of end of
life care.
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Mo, H. N. and
et.al., 2011. Is
patient
autonomy a
critical
determinant of
quality of life in
Korea? End of
life decision
making from the
perspective of
the patient.
Palliative
medicine
Cross sectional
survey
To investigate
current practice
regarding
involvement in
decision making
from the
perspective of
terminally ill
cancer patients.
The study also
intended to
explore its
associations with
quality of life in
Korea
The patents were
aware of their
terminal
illnesses and
hence shared the
decision making
responsibility
with the family
as well as the
staff.
Nolan, M. T.
and et.al., 2008.
Family health
care decision
making and self-
efficacy with
patents with
ALS at the end
of life.
Palliative and
Supportive care
Descriptive
correlational
design
To compare the
preferences of
patients with
ALS for
involving family
in decisions
regarding
healthcare.
Majority of the
respondents
opted to make
health care
decisions
independently.
Pattison, N. and
et.al., 2013.
‘Viewing in
slow motion’:
patients’,
families’,
nurses’ and
Journal of
clinical nursing.
Qualitative
phenomenologica
l in-depth
interviews
To explore
meaning of end
of life care for
critically ill
cancer patients
as well as
family, palliative
For all the
patients, end of
life care was
considered as an
emotive
experience.
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doctors’
perspectives on
end of life care
in critical care.
care specialists,
nurses.
Quinn, J. R. and
et.al., 2012.
Family
members’
informal roles in
end of life
decision making
in adult
intensive care
units
American
journal of critical
care
Ethnographic
study
To provide
description of
informal roles
that family
members
involved in end
of life decision
making enact.
The various
informal roles
observed for
family members
were family
spokes person,
primary care
giver, primary
decision maker,
patient’s wishes
expert etc.
Raijmakers, N.
J. H. and et.al.,
2011. Issues and
needs in end of
life decision
making: An
international
modified Delphi
study
Palliative
medicine
Delphi study To identify
issues and
consideration
associated with
end of life
decision making
219 issues
identified were
related to
medical domain,
122 were related
to patient’s
wishes while 92
were associated
with wishes of
the relatives
Curtis, J. R. and
Vincent, J. L.,
2010. Ethics and
end-of-life care
for adults in the
intensive care
The Lancet Randomized trial To explore if
family distress
and intensity if
end of life care
is reduced by
communication
Decreased
depressive
symptoms were
found if
communication
facilitator was
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unit. facilitator in
Intensive care
unit.
present.
Stajduhar, I. K.
and Davies, B.
2005. Variations
in and factors
influencing
family
members’
decisions for
palliative home
care.
Palliative
medicine
Qualitative study To describe the
factors
influencing
decisions of
family members
to provide home
based palliative
care
Findings
indicated three
type of
decisions,
namely,
uninformed,
indifferent and
negotiated
decisions.
Ho, A.,
Jameson, K. and
Pavlish, C.,
2016. An
exploratory
study of inter-
professional
collaboration in
end of life
decision making
beyond
palliative care
settings.
Journal of
interprofessional
care.
Qualitative study To investigate
how personal
experiences of
healthcare
professionals
and roles
enhance or
hinder ability to
support patients
and families
The study found
that an
interprofessinal
team approach
should be used
for facilitating
decision making
regarding End of
Life care
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4. LITERATURE REVIEW
4.1 Ethical issue
Literature review provides the substantive findings and methodological contributions
made to a topic. It comprises of evaluation of available literature on a given subject. Literature
reviews are significant as they help the researchers in gaining an up- to – date understanding of
the subject and establishing a theoretical and methodological focus (Fink, 2013). Further,
literature reviews help in justifying the reasons for carrying out a particular research. There are
various ethical issues that need to be taken into consideration while carrying out a literature
review. In this regard, avoiding plagiarism is an ethical consideration for the researcher.
Plagiarism is concerned with using somebody else’s work and claiming it as your own work
without acknowledgement or prior permission (Boell and Cecez-Kecmanovic, 2015). This is
regarded as unethical and hence can lead to issues. In the present literature review, care will be
taken to ensure that the research conducted by other authors will be described in own words o
researchers. Another ethical consideration is to treat the work of other authors accurately and
fairly (Boell and Cecez-Kecmanovic, 2010).
4.2 Critiquing the studies thematically
Family involvement in decision making for end- of- life care
There are various serious chronic illnesses which become a burden on the patient as well
as family in late life. In this regard, the best way for supporting quality of life is important to be
considered. Lorenz and et.al. (2008), systematically reviewed the evidence for improving
palliative care at the end- of- life. The authors found strong evidence regarding treatment of
cancer pain with radionuclides, non-steroids, opioids, radiotherapy etc. Further, it was found that
continuity in heart failure could be improved by multicomponent interventions. Moreover, the
authors found moderate evidence supporting involvement of key decision makers for alleviating
the burden of the caregiver. This indicates that in order to reduce the burden of the care giver of
patient receiving end- of- life care, key decision makers could be involved. However, the study
focused more on reducing the burden of caregivers. But, as it involved the role of key decision
makers, it provides answer to the present research question.
The present research question is about involvement of family in initiating end- of- life
care. It can be analysed that family members are also considered as key decision makers as they
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are better aware about the needs and preferences of the patient. Hence, it is a critical element to
be addressed while initiating end- of- life care. However, when the patent possesses the capacity
to decide for himself, the need and preferences can be communicated by him effectively. This
limits the role of family as the patient himself takes important decisions concerning initiation of
end of life care. It can be critically evaluated that Lorenz and et.al. (2008) selected only
systematic reviews to be included for the study. It can be analysed that use of only systematic
reviews would have affected the results.
Nolan and et.al. (2007) compared patient preferences for involvement of family in
decisions of end- of- life care. The study adopted a descriptive correlational design which
included 16 amyotrophic lateral sclerosis patients. Along with the quantitative findings, in-depth
interviews were also conducted. The study found that when shared decision making was
undertaken, the families reported that the decisions were made in an independent style. This
indicates that family was involved in decision making during end- of- life care, though the
decisions were made by patient independently. With regards to the present research question, the
study informs that family should be involved in decision making but the extent to which it is to
be involved should be determined according to the patient’s need. However, it can be critically
evaluated that people with ALS retain their capacity to decide during end- of- life. This makes
them different from those with other terminal illnesses. Hence, in this situation, the involvement
of family would either be minimum or not be involved at all. But, the findings of the study are
relevant as these guide the clinicians about the decision making with the patients and their
families during end of life care.
Quinn and et.al. (2012) described the informal roles that family members enacted during
the process of end- of – life decision making. The author, undertook ethnographic study in
which, the data was collected through participant observation and semi- structured interviews.
Ethnographic study is effective for examination of complex cultural phenomena. Moreover, it
allows for direct observation of the participants. Furthermore, the data collected can be compared
by the researcher with the theories. It can be analysed that Quinn and et.al (2012) adopted
suitable design for the study. As the authors required to observe participants, ethnographic
design supported this aim of the study. However, it can be argued that huge time investment is
required for ethnographic study. Further, the presentation of results often seems to be a problem
as the results are diverse. This creates difficult during collation and analysis of data.
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From the study by Quinn and et.al. (2012), it was found that family members played a
number of informal roles such as primary decision maker, patient’s wishes expert, primary
caregiver, family spokesperson, vulnerable member and healthcare expert. These roles formed an
integral part of decision making process of the family. Each role depicted potentially
complicated family dynamic for end- of- life decision making. With respect to the present
research question, this study informs that every family member plays a distinct role in the
decision making processes of the family. This information is capable of providing guidance to
the clinicians to develop strategies with the help of which effectiveness of family decisions can
be increased. This would further inform the extent to which individual members of the family
should be involved in making decisions for commencing end- of- life care of the patient.
Curtis and et.al. (2015) explored the role of intensive care unit communication facilitator
in reducing family distress during end of life care. The study was carried out with the rationale of
issue of poor communication with family of patients who are critically ill which is often
associated with distress. A randomized control trail was undertaken at two hospitals.
Randomized control trails are effective at minimizing the bias of allocation and selection. Also,
this design helps in minimizing the confounding factors. However, it can be critically evaluated
that results may not be capable of mimicking the real life situations. Moreover, due to long trail
run time, the study may lose its relevance as by the time the trial is published, the practice may
have been evolved. But, RCTs are considered to be statistically reliable.
In the study, Curtis and et.al. (2015) employed facilitators who performed the work of
supporting communication between clinicians and families. Depression, anxiety and post-
traumatic stress disorder was found among the family members. The study concluded that
decreased family depressive symptoms can be seen when a communication facilitator is
involved. The study found a reduction in the end – of – life care intensity when the family
distress was similar or improved. The study answers the present research question related to
family involvement by highlighting the importance of communication and its impact on the
family distress and intensity of end- of – life care. The study by Curtis and et.al. (2015) indicates
that family distress has an impact on the intensity of end- of- life. It can be analysed that family
should be involved in the decision making to initiate end – of – life care. Moreover, in order to
11

reduce family distress, communication facilitators ply an important role and thus can be
employed.
In contrast to this, Stajduhar and Davies (2005) explored the various in family members’
decision for palliative home care and factors influencing the decision. An ethnographic study
was undertaken by the authors where they examined the social context of home based care
giving. Participant observations and interviews were used for collecting the data. Observations
are a useful method in accurately depicting the participants. Further, in- depth interviews help in
obtaining detailed information abut the subjects of the study. Hence, suitable methods were
adopted by Stajduhar and Davies (2005). The study found that there were three types of
decisions made by the caregivers. These fell in the categories of uninformed, indifferent and
negotiated decisions. Further, it was also found that there are three factors that influence the
decisions. These include previous negative encounters with care in an institution, desire to lead a
normal family life and fulfilling the promise to care for the patient at home. From the findings, it
can be analysed that there is a need for interventions that could prepare the caregivers for their
roles in a better manner. Interventions are also required so that caregiver’s choice in decision
making can be enhanced.
End- of- life decision making from patient’s perspective
Mo and et.al., (2011) explored patient autonomy as a critical determinant of quality of
life. The authors investigated the current practice of involvement in the decision making by
considering the perspective of terminal cancer patients. The research concluded that majority of
patients were aware of their terminal illness and the responsibility for decision making was
shared by them with the family members as well as medical staff. With regards to the current
research question of family involvement, this study highlights the extent to which family
involvement should be accompanied with the involvement of the patient. It provides information
on the important aspect of patient autonomy which needs to be considered while initiating end -
of - life care. Hence, it informs the current dissertation and answers the research question as
family is to be involved to an extent such that patient autonomy is respected. However, it can be
critically evaluated that patient autonomy can improve quality of life of patents receiving end -
of - life care only when the information provided is tailored as per the needs and culture of the
12

patient. Also, the level of information as well as the pace at which it is delivered should be
decided taken into consideration the above aspects.
As compared to Mo and et.al. (2011), Raijmakers and et.al. (2011) also conducted a study
on end of life decision making and the issues and needs associated with it. During end of life
care, end – of – life decision making is regarded as an important aspect which has the potential
of significantly impacting the dying process and comfort of the patient. Authors undertook a
modified Delphi study on 90 palliative care experts. Delphi study helps in maintaining the
anonymity of the participants. However, it may suffer from time delays between rounds in data
collection process as there is multiple data collection. But, as it avoids direct confrontation of the
experts with one another, hence, there are fewer chances of bias and extrinsic pressure which
could otherwise alter the results. Hence, it provides reliability of the results.
Raijmakers and et.al. (2011) found that majority of the issues in end- of – life decision
making were related to medical domain. Around 122 issues were found to be associated with the
patient’s wishes while 92 were related to the wishes of the relatives. Further, it was found that
patient’s wishes, comfort and futility of treatment were important considerations during decision
making in end- of- life care. The study answers the present research question by focusing on the
patient’s wishes and comforts as important aspects during end of life care. It can be analysed that
family is involved to an extent in initiating the decisions making during end of life care. From
the study, it was found that some of the issues were related to the patient’s wishes. Hence, it can
be inferred that family can be involved to the extent as per the wishes of the patient.
Different perspectives on end – of – life care
Pattison and et.al. (2013) conducted a study to explore the patient’s, families’ and health
care professional’s perspectives on end - of - life care with respect to critically ill cancer
patients. A qualitative design was adopted for study whereby experiences of 27 participants were
explored with the help of in- depth interviews. All the participants reported end - of - life care as
an emotive experience. Good end - of - life care was regarded as one which is characterized by
less visible technology, comforts, dignity and privacy. It can be analysed that in a critical illness
one is not aware about the speed of dying and this has impact on the potential for end - of - life
care. Considering the present research question of family involvement, this study informs the
researcher that comfort is an important aspects of good end - of - life care. It can be analysed that
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a patient is more comfortable with his family during the end of his life. Hence, family
involvement is required while making decision to initiate end – of – life care. However, the study
conducted by Pattison and et.al. (2013) also informed that patient’s privacy is also crucial for end
– of – life care. Hence, this suggests that family involvement while making decision to initiate
end – of – life care should be limited to the extent that it does not invade patient’s privacy.
In contrast to this, Ho, Jameson and Pavlish (2016) carried out an exploratory study that
focussed on inter-professional collaboration in end – of – life decision making. It can be analysed
that health care delivery has become increasingly inter – professional. This calls for the
identification of opportunities regarding effective coordination and collaboration of care. In this
regard, Ho, Jameson and Pavlish (2016) reported how the ability of families and patients
planning for end of life care is hindered or enhanced by the intersection of the personal
experiences and professional roles. Criterion based sampling strategy was adopted by the authors
which assisted in selecting health care professionals (HCPs) who were directly engaged with
families and patients in decision making regarding treatment, care planning and discharge
planning.
The study concluded that an end of life approach facilitates end of life decision making.
HCPs can better understand each other’s roles as well as perspectives with the help of increased
educational initiatives. It can also be fostered by development of tools that lay emphasis on inter-
professional collaboration. This will further assist in providing a coordinated and coherent
approach toward end of life decision making. The study answers the research question that inter-
professional team approach is more effective than family involvement in decision making for
initiating end of life (EOL) care. It informs the researcher about the perspective of and roles of
health care professionals which are also important to be considered while making decision to
initiative EOL care.
Steinhauser and et.al. (2000) determined the factors that are considered important by
patients, family, physicians and care providers at end of life. The study was based on the context
of improving care of dying patients. The authors conducted a cross sectional National survey that
employed stratified random sampling. Cross sectional design contains multiple variables and
does not require much time. However, it can be critically evaluated that with this design, the
findings can be flawed. Also, putting together he sampling pool on the basis of variables can be
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challenging. The study found that pain and symptom management, achievement of sense of
completion, preparation for death, treatment decisions were considered to be the most important
factors at the end of life care. Being mentally aware, helping others and not being a burden were
also considered to be important factors. Further, it was found that factors important for end of
life care were dependent on the role as well as on the individual.
Considering the research question of the present research, the study by Steinhauser and
et.al. (2000) indicates that family involvement is required to some extent while making decision
to initiate EOL care. This is because some of the factors that are regarded as important for end of
life care are associated with family. These include planning for funeral arrangement, dying at
home, achieving a sense of completion etc. Though the definition good death may vary for
individuals, but family involvement is required due to the factors that are considered important
during end of life care.
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REFERENCES
Journals and Books
Barry, M. J. and Edgman-Levitan, S., 2012. Shared decision making—the pinnacle of patient-
centered care. New England Journal of Medicine. 366(9). pp.780-781.
Behzadian, M. and et.al., 2010. PROMETHEE: A comprehensive literature review on
methodologies and applications. European journal of Operational research. 200(1).
pp.198-215.
Boell, S. K. and Cecez-Kecmanovic, D., 2010. Literature reviews and the hermeneutic
circle. Australian Academic & Research Libraries. 41(2). pp.129-144.
Boell, S. K. and Cecez-Kecmanovic, D., 2015. On being ‘systematic’in literature reviews in
IS. Journal of Information Technology. 30(2). pp.161-173.
Curtis, J. R. and Vincent, J. L., 2010. Ethics and end-of-life care for adults in the intensive care
unit. The Lancet. 376(9749). pp.1347-1353.
Detering, K. M. and et.al., 2010. The impact of advance care planning on end of life care in
elderly patients: randomised controlled trial. Bmj. 340. p.1345.
Edwards, A. and et.al., 2010. The understanding of spirituality and the potential role of spiritual
care in end-of-life and palliative care: a meta-study of qualitative research. Palliative
Medicine. 24(8). pp.753-770.
Fink, A., 2013. Conducting research literature reviews: From the Internet to paper. Sage
Publications.
Funk, L. and et.al., 2010. Part 2: Home-based family caregiving at the end of life: a
comprehensive review of published qualitative research (1998-2008). Palliative
medicine. 24(6). pp.594-607.
Kable, A. K., Pich, J. and Maslin-Prothero, S. E., 2012. A structured approach to documenting a
search strategy for publication: a 12 step guideline for authors. Nurse education
today. 32(8). pp.878-886.
Lorenz, A. K. and et.al., 2008. Evidence for improving palliative care at the end of life” A
systematic review. Annals of internal medicine. 148. pp.147-159.
McGowan, J. and et.al., 2016. PRESS peer review of electronic search strategies: 2015 guideline
statement. Journal of clinical epidemiology. 75. pp.40-46.
Mo, H. N. and et.al., 2011. Is patient autonomy a critical determinant of quality of life in Korea?
End of life decision making from the perspective of the patient. Palliative medicine.
26(3). pp.222-231.
Nolan, M. T. and et.al., 2008. Family health care decision making and self- efficacy with patents
with ALS at the end of life. Palliative and Supportive care. 6. pp.273- 280.
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