Understanding the dynamics of decision-making in palliative care within collectivist contexts: integrative review

End-of-life decision-making in palliative care requires timely and compassionate communication to align care with patients’ goals and values. While shared decision-making is regarded as optimal for patient-centered care, its application in collectivist societies, where familial, religious, and social norms predominate over individual likes, remains understudied. This integrative review aims to synthesize the evidence on the dynamics of decision-making in palliative care within collectivist contexts from the perspectives of patients, family caregivers, and healthcare providers. Following Whittemore and Knafl’s (2005) integrative review methodology, a systematic search of four databases (PubMed, CINAHL, PsycINFO, EMBASE) was conducted using the PICo search framework. To enhance the search strategy, reference lists of the review and included papers were scanned, and forward citations were sought. The initial search was conducted in September 2024 and updated in June 2025. The eligible studies were empirical, peer-reviewed, English studies, conducted between 2010 and 2025 in collectivist contexts, as defined by the Inglehart–Welzel World Cultural Map. From the 1084 studies identified, 78 full texts were retrieved for assessment. Twenty studies met the inclusion criteria. Three interrelated themes were synthesized: (1) Patient Preferences in Decision-Making , highlighting varied roles: passive, shared, or active, shaped by age, gender, religiosity, education, and illness stage; (2) Patient-Clinician Communication : often characterized by limited information sharing, asymmetrical power relations, limited institutional support, and marginal nurse involvement; and (3) The Role of Family , depicted by heavy involvement in decision-making, tendency towards withholding prognostic information and the influence of financial constraints and emotional burdens on care choices. In collectivist contexts, end-of-life decisions unfold through complex interactions among patients, families, and clinicians, shaped by the interplay of established interpersonal and sociocultural values within broader institutional and economic systems. A relational decision-making conceptual framework is proposed, emphasizing culturally embedded, ongoing interactions among patients, families, and healthcare providers that accommodate a continuum of decision-making preferences, ranging from full family dependence or clinician-led to greater patient involvement, within the context of shared cultural values and healthcare structures.