ABSTRACT
Improving the effectiveness of advance care planning for the seriously ill through shared decision-making has been an elusive goal for medical care near the end of life (Field & Cassel, 1997). Even well-conceived, intensive projects like the SUPPORT study (1995) have not been able to change the troubling deficits in medical care for the patient with life-limiting illness. Weiner and Cole (2004a) have hypothesized that professional training efforts in shared decision-making at the end of life have not yet led to large changes in patient care, because they have not effectively helped the clinician to overcome his or her individual and highly specific emotional, cognitive, and skill barriers to engaging in these discussions.
