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Objectives: People receiving end-of-life care often require assistance with decision-making. We aimed to ascertain from the perspective of palliative care healthcare professionals in Ireland, the impact of the Assisted Decision-Making (Capacity) Act 2015 (as amended) in Ireland on their practice for end-of-life care decision-making with patients and family caregivers., Methods: A qualitative study comprising focus groups was conducted with 22 healthcare professionals from different healthcare professions. Participants were recruited from a large regional specialist palliative care service in Ireland comprising two hospice sites. Data were analysed using thematic analysis., Results: Participants reported uncertainty about the Assisted Decision-Making (Capacity) Act 2015 (as amended) and emphasised a need for more public education to avoid misinterpretation of the Act. Participants felt that patients who need assistance with decision-making should be autonomous in decision-making but expressed concerns when patients made decisions about care that participants considered unwise. Participants considered that the Act would be beneficial in situations to support early communication between patients and their family caregivers about patient preferences for care., Conclusions: Larger scale multicentre examination of the Assisted Decision-Making (Capacity) Act among specialist palliative care providers in Ireland is needed to better understand its utility for practice., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Decision-making in palliative care usually involves both patients and family caregivers. However, how concordance and discordance in decision-making manifest and function between patients and family caregivers in palliative care is not well understood., Objectives: To identify key factors and/or processes which underpin concordance and/or discordance between patients and family caregivers with respect to their preferences for and decisions about palliative care; and ascertain how patients and family caregivers manage discordance in decision-making in palliative care., Methods: A systematic review and narrative synthesis of original studies published in full between January 2000 and June 2021 was conducted using the following databases: Embase; Medline; CINAHL; AMED; Web of Science; PsycINFO; PsycARTICLES; and Social Sciences Full Text., Results: After full-text review, 39 studies were included in the synthesis. Studies focused primarily on end-of-life care and on patient and family caregiver preferences for patient care. We found that discordance between patients and family caregivers in palliative care can manifest in relational conflict and can result from a lack of awareness of and communication about each other's preferences for care. Patients' advancing illness and impending death together with open dialogue about future care including advance care planning can foster consensus between patients and family caregivers., Conclusions: Patients and family caregivers in palliative care can accommodate each other's preferences for care. Further research is needed to fully understand how patients and family caregivers move towards consensus in the context of advancing illness., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)