PP-28 Reductionism and misrepresenting patient autonomy

<h3>Introduction</h3> Traditional models of autonomy are constructed within an individualistic framework.¹ These are challenged as relational autonomy gathers traction to account for the complexities of social and cultural factors in patients’ lived experiences.² However, does switching from one model to another continue a reductionistic approach and ignore the complexity of interrelationships, thereby maintaining inequities for patients in end-of-life care? <h3>Aim</h3> To understand what is known about the interrelationship between patient autonomy and ending inequity in end-of-life for all. <h3>Methods</h3> A Rapid Scoping Review was chosen, and articles were selected from the PubMed database. PubMed is known for its comprehensive coverage of biomedical and life sciences literature that aims to improve health for individuals and the global community. The search string ‘end-of-life care AND patient autonomy’ was used. Limiters were applied, including only peer-reviewed, English full texts from 1 January 2000 to 11 August 2024. <h3>Results</h3> A total of 1959 results were retrieved, of which 183 were deemed eligible based on their title and abstracts. An exclusion of a further 155 followed, leaving 28 results eligible based on their full text. These results produced four key themes: 1. Cultural &amp; Spiritual, 2. Safeguarding, 3. Paternalism, 4. Relational. Within these themes emerged eleven common sub-themes, of which five were over-arching and could be divided into two categories. The first category contained medical professionals, the family and communication. The second category contained Advance Care Plans and decision-making. <h3>Conclusion</h3> The literature offers an unexplored route to understanding patient autonomy in end-of-life care. Interpreting the themes through their interrelations will provide a deeper insight into patient inequities and how to address them through the lens of the whole rather than the separate. <h3>Impact</h3> Understanding autonomy at end-of-life within the context of the whole enables a targeted approach to research in reducing inequities. <h3>References</h3> Wilson F, Ingleton C, Gott M, Gardiner C. Autonomy and choice in palliative care: time for a new model? <i>J Adv Nurs</i>. 2014 May;<b>70</b>(5):1020–9. doi: 10.1111/jan.12267. Epub 2013 Oct 10. PMID: 24118083. Gómez-Vírseda C, de Maeseneer Y, Gastmans C. ‘Relational autonomy in end-of-life care ethics: a contextualized approach to real-life complexities.’ <i>BMC medical ethics.</i> 2020;<b>21</b>(1). doi: 10.1186/s12910-020-00495-1.