A Qualitative Study of Oncologists' Approaches to End-of-Life Care

Abstract

Purpose: To understand how oncologists provide care at the end of life, the emotions they experience in the provision of this care, and how caring for dying patients may impact job satisfaction and burnout.Participants and methods: A face-to-face survey and in-depth semistructured interview of 18 academic oncologists who were asked to describe the most recent inpatient death on the medical oncology service. Physicians were asked to describe the details of the patient death, their involvement with the care of the patient, the types and sequence of their emotional reactions, and their methods of coping. Grounded theory qualitative methods were utilized in the analysis of the transcripts.Results: Physicians, who viewed their physician role as encompassing both biomedical and psychosocial aspects of care, reported a clear method of communication about end-of-life (EOL) care, and an ability to positively influence patient and family coping with and acceptance of the dying process. These physicians described communication as a process, made recommendations to the patient using an individualized approach, and viewed the provision of effective EOL care as very satisfying. In contrast, participants who described primarily a biomedical role reported a more distant relationship with the patient, a sense of failure at not being able to alter the course of the disease, and an absence of collegial support. In their descriptions of communication encounters with patients and families, these physicians did not seem to feel they could impact patients' coping with and acceptance of death and made few recommendations about EOL treatment options.Conclusion: Physicians' who viewed EOL care as an important role described communicating with dying patients as a process and reported increased job satisfaction. Further research is necessary to determine if educational interventions to improve physician EOL communication skills could improve physician job satisfaction and decrease burnout. 893

Early Palliative Care and Its Role in Oncology: A Qualitative Study

“…Other potential models include the "solo practice model," in which oncologists assume all care from diagnosis to death, and the "congress practice model," referring to multiple consultants who specialize in various symptom and psychosocial concerns [15,34]. The solo practice model is limited by time constraints, variable interest in and comfort with discussing palliative and end-of-life care [35][36][37], and the lack of specialized training in palliative medicine [16]. This model also risks higher rates of burnout among oncologists, especially those who identify their role as rooted mainly in the biomedical realm [35].The congress model has the disadvantage of necessitating the coordination of a myriad of appointments I think she's finding that she's able to talk and express herself and that people are interested in how she's thinking and feeling.…”

“…The solo practice model is limited by time constraints, variable interest in and comfort with discussing palliative and end-of-life care [35][36][37], and the lack of specialized training in palliative medicine [16]. This model also risks higher rates of burnout among oncologists, especially those who identify their role as rooted mainly in the biomedical realm [35].The congress model has the disadvantage of necessitating the coordination of a myriad of appointments I think she's finding that she's able to talk and express herself and that people are interested in how she's thinking and feeling. C-580i Medical relationship I think it's important that they understand from a medical point of view what's going on in my life.…”

Social support in the workplace for physicians in specialization training

“…Some studies indicate that social support significantly explains job satisfaction [21,22] and positively correlates with physicians’ organizational commitment and engagement [23]. There is also some evidence showing connections between social support and learning or professional development; there are correlations between social support and physicians’ work orientation [24], as well as general practitioners’ work practices [25]. There is some evidence that social support can develop working skills in patient–caregiver relationships [13], and social support can impact managerial learning [26].…”

Impact of Oncologists’ Attitudes Toward End-of-Life Care on Patients’ Access to Palliative Care

“…A few studies have examined the attitudes among oncologists toward EOL care [8,9]. Jackson et al conducted a qualitative study of 18 academic oncologists and reported that oncologists varied in their approaches to EOL care [8].…”

“…Jackson et al conducted a qualitative study of 18 academic oncologists and reported that oncologists varied in their approaches to EOL care [8]. In an accompanying editorial, von Gunten expanded on this concept and labeled the oncologists as either type I or type II.…”