Prognostic decision-making about imminent death within multidisciplinary teams: a scoping review

Area of Science:

• Palliative Care
• Healthcare Decision-Making
• End-of-Life Care

Background:

• Identifying imminently dying patients is crucial for timely end-of-life care.
• Multidisciplinary teams (MDTs) play a key role in these identification processes.
• Evidence on how MDTs make these critical decisions is fragmented.

Purpose of the Study:

• To summarize existing evidence on the decision-making processes within multidisciplinary teams (MDTs) for identifying imminently dying patients.
• To identify gaps in the research regarding MDT decision-making in end-of-life care.
• To inform future research and clinical practice in palliative care settings.

Main Methods:

• A comprehensive scoping review was conducted.
• Searched multiple databases (AMED, CINAHL, Embase, MEDLINE, PsychINFO, Web of Science) from inception to May 2021.
• Included 40 qualitative studies focusing on MDT discussions about identifying imminently dying adults, excluding acute care settings.

Main Results:

• MDT decision-making often involved doctors and nurses.
• Decision-making focused on recognizing dying, initiating care pathways, or clarifying goals.
• A partial collaborative approach was common, with information sharing more prevalent than joint decision-making.
• Challenges included staff disagreement and doctors often being perceived as the primary decision-makers.

Conclusions:

• Prognostic decision-making was not consistently the focus of reviewed studies.
• Further research is needed on MDT prognostication, particularly within specialist palliative care.
• The role of allied health professionals in prognostication requires further investigation.