Patients’ selection of their preferred decision-making style is only the first step in EOL decision-making. Implementing decisions is the crucial next step. Implementation strategies should be distinguished by whether participants (1) made and clearly communicated their decisions to those who needed to know them, (2) made but did not clearly communicate their decisions to others, or (3) did not make decisions or even minimally prepare others to make decisions for them and were thus at risk http://www.selleckchem.com/products/cobimetinib-gdc-0973-rg7420.html for receiving any treatment by default [31]. Autonomists followed through either by completing a living will that included directions about
life-sustaining treatments or by naming someone as their medical power of attorney and discussing their wishes with that person, or both. There was a somewhat fluid transition to the Authorizers, as some would not specifically name someone as their power of selleck products attorney. If they felt that the potential for conflict
was low due to only one or two potential legal decision makers, they were inclined to only verbally discuss their wishes and not formally appoint a power of attorney. Absolute Trusters commonly expressed complete trust in the person who would be their legal surrogate. They either felt the person would make “right” decisions because they knew the person well and trusted her/him; or because the person knew the patient well and thus would know to do the “right” thing. Their follow-through consisted only of identifying a power of attorney in cases where the legal surrogate might not be their preferred one. Despite consisting of only two patients, the Avoiders were a heterogenous group. One (Hispanic) Avoider let others decide quasi-by-default, because he had not thought Mirabegron about things and was not sure about what he wanted. It was not because he put complete trust in someone to make the “right” decisions. He had not been challenged
to think about EOL care or he had avoided discussing it, thus his wife had to decide for him without any guidance. The other (African American) Avoider similarly let others decide by default, but he did not appreciate this as letting others decide. Because he put complete faith in God to make all decisions, any decision-making on his part – or any other persons’ part – was superfluous. This patient considered deciding anything as unnecessary as all decisions lie in God’s hands. Limitations of this qualitative study relate to the number and composition of the focus groups, an academic setting, and the mostly male population of a VA Medical Center. Strengths of our study are that we directly obtained information from patients who were living with serious life-threatening illnesses, who were well familiar with EOL decision-making, and that we purposively included patients with diverse racial/ethnic background.