Palliative and end-of-life care and junior doctors: a systematic review and narrative synthesis

Abstract

BackgroundPalliative and end-of-life care is a core competency for doctors and is increasingly recognised as a key clinical skill for junior doctors. There is a growing international movement to embed palliative care education in medical student and junior doctor education. To date there has been no review of the literature concerning the views and experiences of junior doctors delivering this care.AimTo review the published literature between 2000 and 2019 concerning junior doctors’ experience of palliative and end-of-life care.MethodsSystematic literature review and narrative synthesis.ResultsA search of six databases identified 7191 titles; 34 papers met the inclusion criteria, with a further 5 identified from reference searching. Data were extracted into a review-specific extraction sheet and a narrative synthesis undertaken. Three key themes were identified: (1) ‘Significance of death and dying’: all papers found that junior doctors care for many patients approaching the end of life, and this often causes emotional distress and can leave persisting memories for many years afterwards; (2) ‘Thrown in at the deep end’: junior doctors feel unprepared and unsupported in providing palliative and end-of-life care; and (3) ‘Addressing the gaps’: junior doctors often experience a medical culture of disengagement towards dying patients and varying attitudes of senior doctors. Subsequently they have to learn the skills needed through seeking their own opportunities.ConclusionMedical education needs to change in order to better prepare and support junior doctors for their role in caring for dying patients. This education needs to focus on their knowledge, skills and attitudes.

General Practitioner Residents and Patients End-of Life: Involvement and Consequences

“…Our study blends in the current work about young physicians' preoccupations regarding end-of-life care (9), even though the population is younger and working in a different place than the one they are training to work in the future. Despite those differences, results are similar (9), which underlines that di culties in apprehending end-of-life care depends very little on the professional orientation of young physicians.…”

“…Patients with fatal disease often ask for the possibility to discuss end of life care with their physician (28). However young physicians (9,29,30) as well as residents (29) are faced with di culties in communicating in this situation. In the same fashion, residents nd it di cult to determine the right time for implementing palliative care as well as the practical management of patients' complaints.…”

“…Most death, in particular those of patients who have chronic illnesses or require end-of-life care, take place in hospital settings (6)(7)(8). In most case, end of life care is provided in department that are not specialized in palliative care (9).…”

Improving medical students’ confidence in end‐of‐life consultations

“…Patients are more likely to receive care consistent with their End‐of‐life wishes if they have had a chance to discuss these with a physician 5 . However, a recent systematic review revealed that medical students and practising doctors feel ill equipped to conduct these difficult conversations with patients and their families 6 …”

“…5 However, a recent systematic review revealed that medical students and practising doctors feel ill equipped to conduct these difficult conversations with patients and their families. 6 Although teaching on the principles and practice of breaking bad news is well established in medical schools, specific educational interventions to support undergraduate medical students to conduct end-of-life discussions are still emerging. There is some evidence that the use of online resources can support medical students with skills to conduct these discussions, and that using tools to enable students to start such conversations and reflect on their own wishes may help medical students feel more confident to initiate end-of-life discussions.…”