Table 2.

Main ideas of the themes emerged from the reviewed studies

Theme	Main ideas	Studies
1. Conflicts in family decision-making in EOL communication	There existed a certain degree of discrepancies in decision-making between the patient and family caregivers; to optimise EOL communication among the relevant stakeholders, physicians should be able to gauge and respond to the patient’s psychosocial needs and to also take the family’s perspective into account when having EOL conversations.	9 20 23 29 44–54
2. The significance of timing of EOL communication	There is typically a delay in initiating EOL communication; it is often due to the avoidance of having open physician-patient discussion about the illness. Patients were generally worried about making EOL decisions once informed about the diagnosis, while physicians were concerned that the negative prognostic information would impact the patients and hence, leading to a late timing of EOL communication.	22 26 49 50 55–61
3. Difficulty in identification of a ‘key person’ responsible for decisions regarding EOL care	Some patients were found to not wish to be involved in making their own palliative care decision out of the fear and uncertainty of their EOL stage, family members or even the physicians themselves might in turn have to be responsible for decision-making; this likely leads to an unclear division of responsibility regarding EOL decision-making.	14 62–67
4. Different cultural perspectives on EOL communication	Individualism is of value in the West where most patients preferred having the autonomy to make EOL decision for themselves, while collectivism and filial piety are the main values typically found in Eastern society; patients tended to rely on their children or discussing within the family when making palliative care decisions.	14 25 68–76

EOL, end-of-life.