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Patient Educ Couns. 2019 Jun 27. pii: S0738-3991(19)30251-4. doi: 10.1016/j.pec.2019.06.018. [Epub ahead of print]

Mechanisms by which end-of-life communication influences palliative-oriented care in nursing homes: A scoping review.

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Department of Biomedicine and Prevention, University of Roma Tor Vergata, Via Montpellier 1, 00133, Roma, Italy; Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Corso Bramante 88-90, 10126, Torino, Italy. Electronic address:
Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126, Torino, Italy.
Nursing Research Unit, University Campus Bio Medico of Roma, Via Alvaro del Portillo 200, 00128, Roma, Italy.



End-of-life communication has been largely recognized to promote quality end-of-life care in nursing home (NHs) by increasing residents' likelihood of receiving comfort-oriented care. This scoping review summarizes what is known about the potential mechanisms by which end-of-life communication may contribute to palliative-oriented care in NHs.


Using the framework proposed by Arksey and O'Malley and refined by the Joanna Briggs Institute methodology, five literature databases were searched. We extracted 2159 articles, 11 of which met the inclusion criteria: seven quantitative, three qualitative, and one mixed-methods study.


Three mechanisms were identified: a) promotion of family carers' understanding about their family member's health condition, prognosis, and treatments available; b) fostering of shared decision-making between health care professionals (HCPs) and residents/family carers; and c) using and improving knowledge about residents' preferences.


Family carers' understanding, shared decision-making, and knowledge of residents' preferences contribute to palliative-oriented care in NHs.


Discussions about end-of-life should take place early in a resident's disease trajectory to allow time for family carers to understand the condition and participate in subsequent, mindful, shared decision-making. HCPs should conduct systematic and thorough discussions about end-of-life treatment options with all cognitively competent residents to promote informed advance directives.


Communication; Conversation; End of life care; Family carers; Nursing home; Palliative care


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