The South African Constitution (South Africa, 1996) states that access to healthcare services is a basic human right. The Patients’ Rights Charter (HPCSA, 2008: 6) stipulates that the provision for “special needs in the case of persons living with HIV or AIDS” and palliative care be “affordable and effective”. The need for palliative care in South Africa today continues to increase. Khan and Sayed 2011[2]) found that five years after commencement of anti-retrovirals, twenty five percent of their patients had passed away. This study was performed in the Eastern Cape which is one of the poorest provinces with the second highest HIV prevalence rate. Since 2008, Sophumelela Centre Incorporated has offered palliative care for HIV and AIDS patients in Buffalo City. Some of these patients and their families were interviewed about their experiences in this care centre. The South African Constitution (South Africa, 1996) states that access to healthcare services is a basic human right. The Patients’ Rights Charter (HPCSA, 2008: 6) stipulates that the provision for “special needs in the case of persons living with HIV or AIDS” and palliative care be “affordable and effective”. The need for palliative care in South Africa today continues to increase. Khan and Sayed (2011[2]) found that five years after commencement of anti-retrovirals, twenty five percent of their patients had passed away. This study was performed in the Eastern Cape which is one of the poorest provinces with the second highest HIV prevalence rate. Since 2008, Sophumelela Centre Incorporated has offered palliative care for HIV and AIDS patients in Buffalo City. Some of these patients and their families were interviewed about their experiences in this care centre.

Background: Decisions about potentially life-sustaining treatment are often not raised with patients and families until end of life (if at all), and are influenced by their many relationships. Objective: Understand how patients and families' relationships impacted their experiences of making these decisions, and how healthcare philosophies impacted authors' portrayal of these experiences. Methods: Qualitative metasynthesis design. Purposeful sampling was used to select the 19 qualitative studies included. Relational ethics and meta-study (an approach to metasynthesis) guided data collection and analysis. Findings: 1) Closeness in relationships was valued. Healthcare professionals' (dis)honesty and (lack of) empathy affected closeness with patients/families; 2) Patients' identity and quality of life was considered in decisions, and was maintained through close relationships; 3) Reliance on relationships occurred for information, care and support; 4) Decision makers felt a sense of responsibility to consider their relationships when deliberating treatments; 5) Normative discourses were reflected in authors' writing.