Most patients and families want to discuss end-of life care with their nurse; but they need to hear the physician. Thus, the same message from the patient's nurse must be in communication with the physician about the elder patient's prognosis and the patient and family's preferences about end-of-life care. Hanson et al. 1997) note that one reason for delays in the withdrawal of patient treatments is that, although patient preferences are documented, they are not communicated to physicians so that the physicians actually appreci ate the patient's wishes. When there are differences in expectations of patient outcome or confusion over the appropriateness of various therapies, interdisciplinary patient care conferences are very appropriate. Discussion about CPR with families or patients in crisis cannot come as a barrage of questions all at once from multiple healthcare providers. It is best if the patient or family has some time to consider end life care. Thus, often, withholding CPR is discussed first, and gradually questions concerning withholding or withdrawal of other life sustaining interventions introduced.
As the ANA has stated in its position statement, it is the responsibility of nurses to facilitate informed decision making for patients at the end of life. This responsi bility begins when the nurse has a patient consider what would be important to him or her at the end of life, continues with the nurse educating the person about end of life care options, and is completed when the nurse advocates for and delivers the type of care the patient desires at the end of her/his life. However, this process of communication about end-of-life care is not solely the responsibility of the patient and the nurse: it is an interdisciplinary process that includes at least the physician and family in addition to the patient and nurse.