Interactional decision-making processes and communication on aid in dying: an international scoping review
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Background and objectives
Aid in dying (AID) means assisting a person in their voluntary death. Despite a trend toward AID legalization, knowledge on how AID decisions (should) unfold is limited. We synthesized the current scientific understanding of interactional AID decision-making processes in the healthcare context.
Methods
For this scoping review, we searched Web of Science, PubMed, and CINAHL. Records were that reported own results on interactional AID decision-making processes in healthcare were eligible. Study designs or populations were not restricted. Data was extracted and synthesized with a structured excel sheet by three researchers.
Results
We identified 109 eligible records with diverse study designs and populations. They mentioned various participants in interactional AID decision-making processes, some specifically trained. Organizational and system characteristics also influenced such processes. Records described a longitudinal and iterative process, including several phases (beginning, assessment, preparation, realization, aftercare) and overarching themes (coordination, patient-centered care, inter-/multidisciplinary teamwork). A range of decisions were identified that need to be made by different stakeholders throughout the process. This complex process requires appropriate communication skills. Examples of facilitators were a trusting pre-existing patient-clinician-relationship, guidelines, and an open, non-judgmental attitude. Examples of challenges were power imbalances, clinicians’ subjective interpretations, and insufficient self-reflection. Future research to better understand and improve AID processes was called for.
Conclusion
Several publications explored interactional AID decision-making processes. Our comprehensive synthesis is a start to painting a comprehensive picture, e.g. in a scientific model. The knowledge gained can structure future AID research and inform implementation efforts.
HIGHLIGHTS
– We synthesized the scientific understanding of interactional decision-making processes on aid in dying in the healthcare context from 109 publications.
– We synthesized across countries, patient and health care professional populations, settings, and study designs.
– Interactional decision-making processes on aid in dying are highly complex and can involve various participants.
– Interactional decision-making processes on aid in dying are a longitudinal and iterative process with several phases.
– A range of decisions were identified to be made by different stakeholders throughout the process.
