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From Cure to Palliation: Agreement, Timing, and Decision Making Within the Staff

Malmö University, School oF Health and Society, Malmö, Ingrid.Agren-Bolmsjo{at}hs.mah.se

Tore Nilstun, PhD

Department oF MediPhDcal Ethics, Lund University, Lund

Rurik LöFmark, MD, PhD

Centre For Bioethics at Karolinska Institutet and Uppsala University, Uppsala Sweden

Important issues in the transition From curative treatment to palliative care are agreement, timing, and decision making. A survey oF 309 nurses and 415 physicians in Sweden showed that 61% oF the nurses and 83% oF the physicians thought agreement was current practice. None said that the decisions were made too early, but 19% oF the nurses and 14% oF the physicians thought that they oFten were made too late. Very Few respondents stated that such decisions are changed, 0% and 1%, respectively. More than halF oF the inFormants made detailed comments on such transitions indicating that awareness and Flexibility are desirable to make well-inFormed decisions. Three themes that emerged From the analysis concerning the decision to stop curative treatment and Focus on palliative care were that the staFF members should (iF possible) make such decisions in agreement and should sometimes make the decisions earlier and that well-based reasons are required to make changes.

Key Words: agreement • decision making • palliative care • timing • transition

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