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American Journal of Hospice and Palliative Medicine®
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The contextual nature of decision making near the end of life: Hospice patients’ perspectives

Donna M. Gauthier, RN, PhD

University of Louisiana at Lafayette, College of Nursing and Allied Health Professions, Lafayette, Louisiana

Valerie A. Swigart, RN, PhD

University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania

Mr. C. was diagnosed with lung cancer seven months ago. The cancer then spread to his brain. He was fully aware that the physicians were treating his symptoms, not the disease; however, discussions regarding the goals of treatment did not occur. He continued the treatment regimen of chemotherapy and radiation therapy. While at home one evening, he fell and fractured his femur. His mobility and independence were at once greatly compromised. While recovering in the hospital, he made the decision to opt out of curative treatment. He stated, "I want to go home, play with my cat, smoke cigarettes, and be with my friends when they can visit."

What are the processes by which adults with life-threatening conditions make decisions about their care? What is the context of these decisions? The purpose of this study was to describe the process of decision making for adults with a terminal illness.

Key Words: decision making • hospice patients • terminal illness

American Journal of Hospice and Palliative Medicine®, Vol. 20, No. 2, 121-128 (2003)
DOI: 10.1177/104990910302000210
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