gms | German Medical Science

Background and Purpose: Living with terminally illness is a complex affair that involves ongoing changes, challenges and decision in everyday life. Although it is clear that the process of contending with advanced illness is commonly recursive rather than linear, previous research does not consider this. This study aims to gain a deep understanding of the complex and demanding decisions that have to be made by patients at different stages within end of life care. This study is part of a cooperative research project funded by the Hamburg Research Foundation.

Methods: This study employs a qualitative approach, informed by Philosophical Hermeneutic (Gadamer, 1990). Indepth semi-structured repeated dialogues were conducted with dying people (n=15) about the meaning of the decision making process and the experiences of it.

The analysis of dialogues occur with the hermeneutic rule of movement from the whole to the part and back to the whole (Gadamer, 1990). A cycle of five steps by Fleming et al. (2003) and Gaidys/Fleming (2005) is used.

Results: Health care requires an ongoing sequence of complex decisions. This hermeneutic study enabled units of meaning to be categorised, grouped into topics regarding and its meaning for understanding of the health care situation of dying patients and its decisions. Understanding for this decision making process should lead to support patients, their families and health care professionals more profoundly.

Conclusions: The study describes the meaning of the decision making of dying patients while supporting the development of nursing knowledge for end of life care.