ObjectiveTo explore the emotional experience of physicians in acute settings when encountering end-of-life conversations and decision making.MethodThematic synthesis of qualitative studies. Medline, PsychInfo, PubMed, BNI and CIAHL were searched from 1985 to 2021 for studies published in English. Data extraction was informed by a framework created for assessing methodological quality by Polanin, Pigott, Espelage and Grotpeter (2019) and adapted by Draper et al. (2019).ResultsOf 8429 papers identified, 17 were selected for review. Two themes containing 10 subthemes described the emotional and psychological factors impacting the experience of end-of-life care, namely: a tension between desire and ability to communicate end-of-life news, and a conflict of hiding versus revealing self across several practical and emotional contexts.ConclusionMedical training is only a small factor in how well a person copes with end-of-life care and may sometimes feed negative appraisals . Lack of support from senior colleagues, fear of criticism and a sense of perceived failure were linked to lower self-efficacy in end-of-life care. Beyond learning practical skills, physicians benefit from understanding the psychological factors impacting their experience and in building self-efficacy, and observing senior colleagues effectively process strong and difficult emotions.Practical implicationsPromoting personal reflection and sharing of the experiences encountered in end-of-life care, especially modelled from senior colleagues, may contribute to improvements in competence and reduce the impact of heroism, feelings of failure and avoidance in practice.

Objective: To investigate whether fear of failure (FOF) influences a clinician’s perception of how confident and comfortable they are in their delivery of end-of-life (EOL) care. Methods: Cross-sectional questionnaire study with recruitment of physicians and nurses across two large NHS hospital trusts in the UK and national UK professional networks. A total of 104 physicians and 101 specialist nurses across 20 hospital specialities provided data that were analysed using a two-step hierarchical regression. Results: The study validated the PFAI measure for use in medical contexts. Number of EOL conversations, gender, and role were shown to impact confidence and comfortableness with EOL care. Four FOF subscales did show a significant relationship with perceived delivery of EOL care. Conclusion: Aspects of FOF can be shown to negatively impact the clinician experience of delivering EOL care. Clinical Implications: Further study should explore how FOF develops, populations that are more susceptible, sustaining factors, and its impact on clinical care. Techniques developed to manage FOF in other populations can now be investigated in a medical population.

ObjectiveTo investigate whether fear of failure (FOF) influences a clinician’s perception of their confidence and comfortableness with the delivery of end of life (EOL) care, controlling for gender, role, years of experience, and number of EOL conversations. DesignCross-sectional questionnaire study.Setting Two large NHS hospital trusts in the UK, and national UK professional networks.Participants105 doctors and 104 specialist nurses across 20 hospital specialities. Main outcome measuresThe Performance Failure Appraisal Inventory, the Self-Efficacy in Palliative Care scale, the Thanatophobia Scale. Analysis A two-step multiple regression.ResultsThe study validated the use of the PFAI and its subscales within a novel population group of medical professionals. No. of EOL conversations, gender, and role impacted confidence and comfortableness with EOL care. Fearing loss of interest negatively impacted a clinician’s confidence in communicating with patients. Fear of devaluing one’s self-estimate negatively impacted confidence in decision making, working with others, and total self-efficacy.ConclusionThree aspects of FOF negatively impacted both doctors and nurses delivery of EOL care. Practical ImplicationsFurther study should look at how FOF develops, sustaining factors, and other areas of clinical practice that FOF impacts, drawing also from FOF research outside the field of medicine. Techniques developed to manage FOF in other populations can now be investigated with a medical population.