Interactional decision-making processes and communication on aid in dying: an international scoping review

ABSTRACT Background and objectives Aid in dying (AID) means assisting a person in their voluntary death. Despite a trend toward AID legalization, knowledge on how AID decisions (should) unfold is limited. We synthesized the current scientific understanding of interactional AID decision-making processes in the healthcare context. Methods For this scoping review, we searched Web of Science, PubMed, and CINAHL. Records were that reported own results on interactional AID decision-making processes in healthcare were eligible. Study designs or populations were not restricted. Data was extracted and synthesized with a structured excel sheet by three researchers. Results We identified 109 eligible records with diverse study designs and populations. They mentioned various participants in interactional AID decision-making processes, some specifically trained. Organizational and system characteristics also influenced such processes. Records described a longitudinal and iterative process, including several phases (beginning, assessment, preparation, realization, aftercare) and overarching themes (coordination, patient-centered care, inter-/multidisciplinary teamwork). A range of decisions were identified that need to be made by different stakeholders throughout the process. This complex process requires appropriate communication skills. Examples of facilitators were a trusting pre-existing patient-clinician-relationship, guidelines, and an open, non-judgmental attitude. Examples of challenges were power imbalances, clinicians’ subjective interpretations, and insufficient self-reflection. Future research to better understand and improve AID processes was called for. Conclusion Several publications explored interactional AID decision-making processes. Our comprehensive synthesis is a start to painting a comprehensive picture, e.g. in a scientific model. The knowledge gained can structure future AID research and inform implementation efforts. HIGHLIGHTS – We synthesized the scientific understanding of interactional decision-making processes on aid in dying in the healthcare context from 109 publications. – We synthesized across countries, patient and health care professional populations, settings, and study designs. – Interactional decision-making processes on aid in dying are highly complex and can involve various participants. – Interactional decision-making processes on aid in dying are a longitudinal and iterative process with several phases. – A range of decisions were identified to be made by different stakeholders throughout the process.