End-of-Life Decision Making in Multidisciplinary Teams: Ethical Challenges and Solutions–A Systematic Review
DOI:
https://doi.org/10.63278/jicrcr.vi.814Keywords:
Ethics training, patient autonomy, end of life care, ethical decision making, Patient autonomy, Ethical decision making, End of life care, Cultural competence, Multidisciplinary teams, Healthcare policy, PRISMA.Abstract
Background: To provide high quality end of life (EOL) care, multidisciplinary teams (MDTs) need to be able to proficiently navigate the intricacies of ethical dilemmas faced by EOL care; to maintain an equilibrium between patient autonomy, family involvement and cultural competence. Yet, the lack of cohesive EOL decision making currently continues to occur because of communication barriers, role ambiguity and a lack of sufficient ethics training within MDTs. As a consequence, these issues demonstrate the necessity of having structured protocols to help MDTs make ethically sound decisions in the EOL care.
Aim: The purpose of this paper is to identify and review major ethical factors that affect ethical decision-making in EOL MDTs, and explore the themes of patient autonomy, communication, cultural sensitivity, ethics training, and institutional barriers.
Method: Ten studies were reviewed systematically according to PRISMA criteria using data sources including PubMed, Scopus, Web of Science, and CINAHL databases. The analysis included studies published between the years 2020 and 2024 and the ethical decision–making challenges and solutions that MDTs face in EOL care contributing to those decisions.
Results: Four key themes were identified: Issues concerning balancing patient autonomy with family input, communication challenges in MDTs, cultural sensitivity in EOL care and the necessity of ethics training. Results indicate that MDTs are often faced with ethical dilemmas when patient’s wishes diverge from those of their family and experience communication difficulties that resulted in degradation of care quality. Simulation is an entertaining and effective way to develop cultural awareness and ethics training in EOL care practice.
Conclusion: Ethical challenges in EOL decision making must be addressed with an intervention encompassing improved ethics training, MDT role clarity, culturally aware practice, and institutional support. These strategies, if implemented will support MDTs in providing patient centered and ethically sound EOL care. Further study of ethics training, communication frameworks and cultural competence on EOL decision-making in MDTs is warranted for future research.
