Providing End-of-Life Care to Older Adults: A Qualitative Interpretative Meta-Synthesis of Clinicians' Experiences

Clinicians are integral to end-of-life (EOL) care decision-making and play a critical role in shaping the experiences of older adults and their families during the final days of life. This qualitative interpretative meta-synthesis (QIMS) examined the existing published qualitative literature to synthesize the experiences and perspectives among clinicians in the provision of EOL care to older adults. The search yielded 2822 potentially relevant articles, and 137 duplicates were eliminated resulting in a final sample of six articles. Four new themes were developed: Theme 1: Ambiguity and negotiation in end-of-life communication and decision making; Theme 2: Provider Emotional and Ethical Burden; Theme 3: Tensions with age-based treatment and perceived worth; and Theme 4: Systemic Constraints and Institutional Barriers in End-of-life care. The findings highlight that to mitigate and improve the EOL care experience for older adults, it is imperative to implement system-level reforms that support proactive communication, reduce implicit age-related assumptions, and provide ethical solutions for clinicians.