Objectives: To review factors in the health care culture that deny seriously ill patients' last wishes regarding care.
Data sources: Review articles and research studies that pertain to decision making.
Conclusions: Decision making in palliative care has been identified as an understudied area. Although there are significant benefits to being involved in treatment decision making, long-term follow-up of the consequences of active participation in the final stages of life is lacking.
Implications for nursing practice: Nurses have a role to play in assisting patients and their families in treatment decision making in both the curative and palliative phase of care. A nursing intervention to promote patient involvement in decision making is described.