Prognostic decision-making about imminent death within multidisciplinary teams: a scoping review

OBJECTIVE: To summarise evidence on how multidisciplinary team (MDTs) make decisions about identification of imminently dying patients. DESIGN: Scoping review. SETTING: Any clinical setting providing care for imminently dying patients, excluding studies conducted solely in acute care settings. DATA SOURCES: The databases AMED, CINAHL, Embase, MEDLINE, PsychINFO and Web of Science were searched from inception to May 2021. Included studies presented original study data written in English and reported on the process or content of MDT discussions about identifying imminently dying adult patients. RESULTS: 40 studies were included in the review. Studies were primarily conducted using interviews and qualitative analysis of themes. MDT members involved in decision-making were usually doctors and nurses. Some decisions focused on professionals recognising that patients were dying, other decisions focused on initiating specific end-of-life care pathways or clarifying care goals. Most decisions provided evidence for a partial collaborative approach, with information-sharing being more common than joint decision-making. Issues with decision-making included disagreement between staff members and the fact that doctors were often regarded as final or sole decision-makers. CONCLUSIONS: Prognostic decision-making was often not the main focus of included studies. Based on review findings, research explicitly focusing on MDT prognostication by analysing team discussions is needed. The role of allied and other types of healthcare professionals in prognostication needs further investigation as well. A focus on specialist palliative care settings is also necessary.