Learning Objective #1: discuss pros and cons of family as the center of end-of-life decision-making.

Learning Objective #2: identify the challenges of patient-centeredness as the norm at the end-of-life care.

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Background. Despite of overwhelming support for patient-centered care in nursing, little is known about the applicability of treating patients as the center of decision-making at the end of life. Objective. The study used an exploratory-descriptive design to describe the decision-maker of end-of-life communication in intensive care units via semi-structure interview. The analysis of interview data utilized a qualitative content analysis. Methods. One-on-one interview was conducted with families of patients who died under the care of intensive care unit (ICU) and nurses who were working in ICU in Taiwan. An inductive approach to content analysis was used to analyze interview data after verbatim transcription by three content experts. Techniques were used to establish trustworthiness of the analysis. Results. A total of 17 nurse and 12 family participants were interviewed in this study. The length of interview ranged from 50 minutes to two hours. One of the major challenges nurse participants identified in providing patient-centered care to patients at the end of life in the intensive care settings was to know what the dying patient really wanted. It was common that the dying patients had not expressed their wish and preferences concerning end-of-life care or treatments. They were not informed their terminal illness at the first place. Typically, the information of terminal illness was related to family members only. The family members then decided whether the information would be shared with the patients. The end-of-life decision-maker of the patients was not the patients themselves, but their adult children, usually the oldest sons. That is, the end-of-life decisions were deferred to family members without any input from the patients themselves. Conclusions. Patient-centeredness might not be practical at the end-of-life decision-making in Taiwan. Perhaps a better approach is a fusion of patient and family-centered care.