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Decision making near life's end: a prescription for change.

Abstract The publication of SUPPORT (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments) in 1995 identified major problems with decision making near the end of life. Since that time, palliative care has developed as a specialty and end-of-life communication has evolved. However, five problems in decision-making remain today: the need to discuss underlying health status with patients; the overburdening of patients and families with too many choices; lack of appreciation of the importance of symbolism in end-of-life care; confusion between cultural beliefs and scientific facts; and difficulties with making decisions because of rapid shifts by the medical team from advocating cure to comfort. Each of these issues is described.