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High-quality patient-centred care for hospitalised patients at the end of life requires health care teams to engage patients and families in communication and decision-making about goals of care. In the absence of such engagement, patient preferences may not be reflected in their care, and patients may be subjected to unwanted life-sustaining technologies such as mechanical ventilation and cardiopulmonary resuscitation. The DECIDE (DECIsion-making about goals of care for seriously ill, hospitalised medical patients) study was conducted with the aims of identifying barriers and ideas for improving end-of-life communication and decision-making with seriously ill patients in Canadian hospitals. Its qualitative component involved interviews with 30 physicians and nurses asking them to recall and describe hospital-based goals of care communication and decision-making incidents that had gone ‘well’ or ‘unwell’. This article explores a dominant pattern in participants’ accounts, which is a norm of waiting to initiate end-of-life discussions until seriously ill patients are within days or even hours of death. Attending to clinicians’ explanations of when and why goals of care discussions are routinely delayed provides opportunity to clarify and critically consider important and normally unarticulated rationales underlying end-of-life discussion practices between health care teams and patients/families in Canadian hospitals. [ABSTRACT FROM AUTHOR]

Healthcare professionals and organizations, policy makers, and the public are calling for safe and effective care that is centered on patients' needs, values, and preferences. The goals of interprofessional shared decision making and decision support are to help patients and professionals agree on choices that are effective, health promoting, realistic, and consonant with patients' and professionals' values and preferences. This requires collaboration among professionals and with patients and their family caregivers. Continuing professional development is urgently needed to help healthcare professionals acquire the knowledge, skills, and attitudes necessary to create and sustain a culture of collaboration. We describe a model that can be used to design, implement, and evaluate continuing education curricula in interprofessional shared decision making and decision support. This model aligns curricular goals, objectives, educational strategies, and evaluation instruments and strategies with desired learning and organizational outcomes. Educational leaders and researchers can institutionalize such curricula by linking them with quality improvement and patient safety initiatives. [ABSTRACT FROM AUTHOR]

Most shared decision-making (SDM) models within healthcare have been limited to the patient-physician dyad. As a first step towards promoting an interprofessional approach to SDM in primary care, this article reports how an interprofessional and interdisciplinary group developed and achieved consensus on a new interprofessional SDM model. The key concepts within published reviews of SDM models and interprofessionalism were identified, analysed, and discussed by the group in order to reach consensus on the new interprofessional SDM (IP-SDM) model. The IP-SDM model comprises three levels: the individual (micro) level and two healthcare system (meso and macro) levels. At the individual level, the patient presents with a health condition that requires decision-making and follows a structured process to make an informed, value-based decision in concert with a team of healthcare professionals. The model acknowledges (at the meso level) the influence of individual team members' professional roles including the decision coach and organizational routines. At the macro level it acknowledges the influence of system level factors (i.e. health policies, professional organisations, and social context) on the meso and individual levels. Subsequently, the IP-SDM model will be validated with other stakeholders. [ABSTRACT FROM AUTHOR]