The Role of Family in End-of-Life Decisions of Older Adults with End Stage Kidney Disease: Scoping Review Protocol

The objective of this scoping review is to survey and examine available empirical evidence on the role of the family in end-of-life (EoL) decision-making of competent older adults with end-stage kidney disease (ESKD). Introduction: Given the complexities in managing kidney failure, especially in older adults, the Renal Physicians Association (RPA) have developed clinical guidelines to promote shared decision-making between patients, families, and healthcare professionals in making decisions on the appropriate initiation, withholding, and/or withdrawal of dialysis treatment. Although numerous professional bodies recognise the role of the family in shared decision-making (SDM), they are only briefly discussed or mentioned in existing literature. Inclusion criteria: This review will include studies where member(s) of the family system are involved in EoL decision-making of older adults (60 years and above) diagnosed with ESKD. It will also consider studies where the perspectives of older adult patients, the medical care team and the public on involving families in EoL decision-making. Quantitative and qualitative analyses will be included, with the exclusion of theoretical and opinion-based articles. Methods: This review is informed by JBI methodology and reported according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses extension for Scoping Review (PRISMA-ScR) guidelines. MEDLINE (Ovid), Scopus, CINAHL Ultimate, PsycINFO and PubMed will be searched for full-text studies in English. Data will be extracted and charted by two independent reviewers using a framework aligned with the Three-Talk Model of SDM. Data will be presented in tabular form, and a narrative summary will describe how the results relate to the review's objective and questions.