• Debra Parker Oliver, Karla Washington, George Demiris, Audrey Wallace, Marc R Propst, Aisha M Uraizee, Kevin Craig, Margaret F Clayton, Maija Reblin, and Lee Ellington.
• Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA. Electronic address: oliverdr@missouri.edu.
• J Pain Symptom Manage. 2018 Mar 1; 55 (3): 922-929.

ContextShared decisions between health care providers and patients and families are replacing the traditional physician-driven plans of care. Hospice philosophy recognizes the patient and family as a unit of care and embraces their role in decision making.ObjectiveThe goal of this study was to evaluate the shared decisions between hospice nurses and patients and family members.MethodsA secondary analysis of audio recordings of 65 home hospice nurse visits from 65 home hospice nurse visits in 11 different U.S. hospice programs.ResultsTo varying degrees, hospice nurses used all the recommended elements of shared decision making during home visits with patients and families; however, not all elements were used in every visit. The most commonly used element was defining a problem, and the least used element was the assessment of patient and family understanding.ConclusionsHospice staff can benefit from a more purposeful shared decision-making process and a greater focus on assessment of patient and family understanding and ability to implement plans of care.Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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