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Mixed methods analysis of hospice staff perceptions and shared decision making practices in hospice



Shared decision making has been a long-standing practice in oncology and, despite a lack of research on the subject, is a central part of the philosophical foundation of hospice. This mixed methods study examined the perceptions of staff regarding shared decision making and their use of shared decision elements in hospice interdisciplinary team meetings.


The revised Leeds Attitude to Concordance scale (LatConII) was used to measure the attitudes of hospice staff toward shared decision making. Field notes and transcripts of hospice interdisciplinary team meetings that included family caregivers as participants were coded to identify 9 theory-driven shared decision making elements. The results were mixed in a matrix analysis comparing attitudes with practice. Three transcripts demonstrate the variance in the shared decision making process between hospice teams.


Hospice staff reported overall positive views on shared decision making; however, these views differed depending on participants’ age and position. The extent to which staff views were aligned with the observed use of shared decision making elements in hospice interdisciplinary team meetings varied.


Policy and practice conditions can make shared decision making challenging during hospice interdisciplinary team meetings despite support for the process by staff.

Trial registration

This study is a sub-study of a parent study registered with (NCT02929108).

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Data availability

Data is available with a Data Use Agreement.

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Code is available with a Data Use Agreement.


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Research reported in this publication was supported by the National Cancer Institute under award number R01CA203999 (Parker Oliver). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations



All the authors contributed to the study conception and design. Material preparation, and data collection and analysis were performed by Dr Parker Oliver, Dr. Wallace, Kyle Pitzer, and Amy Grimsley. The first draft of the manuscript was written by Dr. Parker Oliver and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

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Correspondence to Debra Parker Oliver.

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The authors declare no competing interests.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This sub-study was approved by Washington University, St. Louis, through a reliance agreement with the University of Missouri.

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Informed consent to participate was obtained from all individual participants included in the study.

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Oliver, D.P., Washington, K.T., Pitzer, K. et al. Mixed methods analysis of hospice staff perceptions and shared decision making practices in hospice. Support Care Cancer 30, 2679–2691 (2022).

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  • Hospice
  • Caregiving
  • Psychosocial
  • Intervention
  • Clinical Trial
  • Decision making