We found, except for Avoiders, patients across all racial/ethnic groups representing the different preferred decision-making variants. Physicians should not stereotype a Ku-0059436 datasheet patient into a specific decision-making variant based on their race/ethnicity. Moorman et al. examined older adults’ preferences for autonomy

in EOL decision-making and found that the majority preferred deciding independently, which was associated with being less avoidant of thoughts of death, not wishing to burden a caregiver, and being more likely to make a living will and appoint a medical power of attorney [25]. A fundamental ethical requirement of the principle of respect for patient autonomy is to identify and empower patients’ self-selected decision-making styles [3]. Patients who want to decide for themselves are likely to implement their wishes differently from patients who let others decide. This is reflected in the typology portrayed in Fig. 2. Because we observed some fluidity and overlap among the different variants we emphasize that they should not be seen as “silos.” Identifying how patients want to make EOL decisions is necessary, but insufficient. One also needs to address which implementation strategies may best serve the patient’s decision-making style, especially with Selleck BIBF1120 respect to effective decision-making. For example, our findings

suggest that efforts toward increasing completing advance directives [26], [27] and [28] are likely to best serve patients who already made or are ready to make decisions and are comfortable with formally expressing

them, i.e., Autonomists, Altruists, and some Authorizers. However, asking patients to complete advance directives will not be effective for some Authorizers nor for Absolute Trusters, Avoiders, or even some Altruists if they prefer verbal communication only. In clinical Masitinib (AB1010) practice, completing advance directives is an important accomplishment – for patients for whom this is a suitable way to express their preferred decision-making-style. However, future focus on improving EOL decision-making for Authorizers, Absolute Trusters, and Avoiders should shift from trying to increase completion rates for advance directives toward, as other have suggested [29] and [30], preparing patients for EOL decision-making, encouraging clear guidance through effective verbal communication with surrogates, identifying legal surrogates, and appointing a preferred agent as appropriate. Even though only two patients represented the Avoiders, we decided to include “Avoiders” as a distinct variant in our model as we believe that such patients were underrepresented in our focus groups; by definition Avoiders would be highly unlikely to participate in a study discussing EOL decision-making (not avoiding it), and many practicing physicians are familiar with such patients.