No votes yet

The Use of Palliative Care to Promote Autonomy in Decision Making

Ruth Zalonis
Margaret Slota
CJON 2014, 18(6), 707-711 DOI: 10.1188/14.CJON.707-711

This article explores barriers to informed decision making in health care, and it proposes palliative care as one means of responding to the challenge of a widespread lack of autonomy in decision making. Through an exploration of research in the fields of autonomy and palliative care, the advantages of informed decision making and advance care planning by patients with advanced illness are discussed, and the implications for clinical practice and patient outcomes are described. Continuity, collaboration, and communication have a synergistic effect on autonomy. The expectation that the palliative care team will be in constant communication with the attending physician, nurses, and other specialists also promotes autonomous decision making. Patients who receive palliative care may have multiple advantages, including increased survival, improved quality of life, and opportunities for the exercise of autonomy.


Agency for Healthcare Research and Quality. (2003). Advance care planning: Preferences for care at the end of life. Retrieved from <a target="_blank" href='http://www.ahrq.gov/research/findings/factsheets/aging/endliferia/index....

American Academy of Hospice and Palliative Medicine. (2008). Statement on access to palliative care and hospice. Retrieved from <a target="_blank" href='http://www.aahpm.org/positions/access'>http://www.aahpm.org/positions/ac...

American Academy of Nursing. (2013). Advance care planning as an urgent public health concern. Retrieved from <a target="_blank" href='http://www.aannet.org/policy-brief-advance-care-planning-as-an-urgent-pu...

Beauchamp, T. L., & Childress, J. F. (2001). <i>Principles of biomedical ethics</i> (5th ed.). Oxford, UK: Oxford University Press.

Cassell, E. J. (1982). The nature of suffering and the goals of medicine. <i>New England Journal of Medicine, 306</i>, 639-645.

Center to Advance Palliative Care. (2009). CAPC statement on palliative care [Press release]. Retrieved from <a target="_blank" href='http://www.capc.org/news-and-events/releases/09-08-09'>http://www.capc.o...

Center to Advance Palliative Care. (2012). Palliative care in hospitals continues rapid growth trend for 11th straight year, according to latest analysis [Press release]. Retrieved from <a target="_blank" href='http://www.capc.org/news-and-events/releases/08-27-12'>http://www.capc.o...

Dawson, K. A. (2008). Palliative care for critically ill older adults: Dimensions of nursing advocacy. <i>Critical Care Nursing Quarterly, 31</i>, 19-23. doi:10.1097.01.CNQ.0000306392.02154.07

Ferrell, B., Connor, S. R., Cordes, A., Dahlin, C. M., Fine, P. G., Hutton, N., … National Consensus Project for Quality Palliative Care Task Force Members. (2007). The national agenda for quality palliative care: The National Consensus Project and the National Quality Forum. <i>Journal of Pain and Symptom Management, 33</i>, 737-744.

Hospice and Palliative Nurses Association. (2003). Position paper: Palliative sedation at the end of life. <i>Journal of Hospice and Palliative Nursing, 5</i>, 235-236.

Hospice and Palliative Nurses Association. (2013a). HPNA position statement: Assuring high quality in palliative nursing. Retrieved from <a target="_blank" href='http://www.hpna.org/displaypage.aspx?title=position%20statements'>http:/...

Hospice and Palliative Nurses Association. (2013b). HPNA position statement: The nurse's role in advance care planning. Retrieved from <a target="_blank" href='http://www.hpna.org/displaypage.aspx?title=position%20statements'>http:/...

Kiernan, S. P. (2007). <i>Last rights: Rescuing the end of life from the medical system.</i> New York, NY: St. Martin's Griffin.

Lavoie, M., Blondeau, D., & Picard-Morin, J. (2011). The autonomy experience of patients in palliative care. <i>Journal of Hospice and Palliative Nursing, 13</i>, 47-53.

Malloy, P., Virani, R., Kelly, K., Harrington-Jacobs, H., & Ferrell, B. (2008). Seven years and 50 courses later: End-of-Life Nursing Education Consortium continues commitment to provide excellent palliative care education. <i>Journal of Hospice and Palliative Nursing, 10</i>, 233-239.

Maltoni, M., Caraceni, A., Brunelli, C., Broeckaert, B., Christakis, N., Eychmueller, S., … Steering Committee of the European Association for Palliative Care. (2005). Prognostic factors in advanced cancer patients: Evidence-based clinical recommendations—A study by the steering committee of the European Association for Palliative Care. <i>Journal of Clinical Oncology, 23</i>, 6240-6248.

Meier, D. E., Spragens, L. H., & Sutton, S. (2004). <i>A guide to building a hospital-based palliative care program.</i> New York, NY: Center to Advance Palliative Care.

Melhado, L. W., & Byers, J. F. (2011). Patients' and surrogates' decision-making characteristics: Withdrawing, withholding, and continuing life-sustaining treatments. <i>Journal of Hospice and Palliative Nursing, 13</i>, 16-28. doi:10.1097/NJH.0b013e3182018f09

Morrison, E. E. (2009). <i>Health care ethics: Critical issues for the 21st century</i> (2nd ed.). Sudbury, MA: Jones and Bartlett.

Murray, M. A., Fiset, V., Young, S., & Kryworuchko, J. (2009). Where the dying live: A systematic review of determinants of place of end-of-life cancer care. <i>Oncology Nursing Forum, 36</i>, 69-77. doi:10.1188/09.ONF.69-77

National Consensus Project for Quality Palliative Care. (2004). What is palliative care? Retrieved from <a target="_blank" href='http://www.nationalconsensusproject.org/displaypage.aspx?title=what%20is...

National Hospice and Palliative Care Organization. (n.d.). Taking care of yourself—Hospice benefits for family and friends. Retrieved from <a target="_blank" href='http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3300'>http://www.ca...

National Hospice and Palliative Care Organization. (2008). <i>Position statement on access to palliative care in critical care settings: A call to action.</i> Retrieved from <a target="_blank" href='http://www.nhpco.org/sites/default/files/public/NHPCO_PC-in-ICU_statemen...

National Hospice and Palliative Care Organization. (2009). NHPCO standards of practice for hospice programs. Retrieved from <a target="_blank" href='http://www.nhpco.org/i4a/pages/index.cfm?pageid=4646'>http://www.nhpco.o...

National Quality Forum. (n.d.). Effective communication and care coordination. Retrieved from <a target="_blank" href='http://www.qualityforum.org/topics/effective_communication_and_care_coor...

Porter-O'Grady, T., & Malloch, K. (2007). <i>Quantum leadership: A resource for healthcare innovation</i> (2nd ed.). Sudbury, MA: Jones and Bartlett.

Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admane, S., Jackson, V. A., … Lynch, T. J. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. <i>New England Journal of Medicine, 363</i>, 733-742.

Tong, R. (2007). <i>New perspectives in healthcare ethics: An interdisciplinary and crosscultural approach.</i> Upper Saddle River, NJ: Pearson/Prentice Hall.

Uhlmann, R. F., Pearlman, R. A., & Cain, K. C. (1988). Physicians' and spouses' predictions of elderly patients' resuscitation preferences. <i>Journal of Gerontology, 43</i>, M115-M121.

Winter, L., & Parks, S. M. (2008). Family discord and proxy decision makers' end-of-life treatment decisions. <i>Journal of Palliative Medicine, 11</i>, 1109-1114.

Zomorodi, M., & Bowen, G. L. (2010). Value-behavior congruency when providing end-of-life care in the intensive care unit. <i>Journal of Hospice and Palliative Nursing, 12</i>, 295-302. doi:10.1097/NJH.0b013e3181eb385e