Communication and Problematic Integration in End-of-Life Decisions: Dialysis Decisions among the Elderly

End-of-life (EOL) decisions made by and for elderly patients often perpetuate unwanted suffering at great expense. Recent efforts to improve the decision-making process have been ineffective. In this article, we argue that Babrow's (1992, 1995) problematic integration (PI) theory can enhance understandings of flaws in EOL decisions. Face-to-face interviews of 142 elderly hemodialysis patients were conducted to test predictions derived from the theory. Results supported the prediction that doctors would often fail to disclose the need for dialysis until a decision had to be made. And, as expected, patients were satisfied with the decision-making process despite relatively little discussion of their options. When EOL discussions occurred, they focused on topics that were least likely to evoke PI. Moreover, as expected, patients and doctors relied on stereotypical roles to minimize ambiguity in EOL decisions. Results suggest that PI theory can contribute to improved EOL decisions by demonstrating that poor decision making is the collaborative consequence of efforts by both doctors and patients to cope with PI.