Informed shared decision-making in planning for the end of life

In recent years, a number of shortcomings in the NHS have been identified in end-of-life care delivered in hospital for people with long-term conditions other than terminal cancer. This article gives an overview of the findings of a Dignity in Care travel scholarship, which was undertaken to establish whether an American shared informed decision aid, specifically designed to initiate therapeutic conversations for this patient group, might reasonably be adopted in an NHS setting. One tool specifically for this purpose was in use in the USA at the time, and its efficacy formed part of a broader research study being carried out at Dartmouth Hitchcock Medical Center (DHMC) in New England. Concurrently in the UK, The Health Foundation supported a 3-year study that focused exclusively on the development of a range of 'option grids' for clinical interventions and did not include an end-of-life model.