Physician emotional experience of communication and decision making with end-of-life patients: qualitative studies systematic review

Abstract

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.

Lifestyle Medicine Practitioners Implementing a Greater Proportion of Lifestyle Medicine Experience Less Burnout

“…39,40 This inability to heal 3,38 can lead to a feeling of powerlessness within a system that repeats moral distress 41 and further adds to burnout (depression, fatigue, depersonalization, and relationship stress). 37,38 Among those practitioners who previously experienced burnout but no longer do in the current study (28%), the majority attributed their reduction to a change in work, with 43% of these having changed their practice to incorporate LM.…”

“…Practitioners may be ill-equipped to overcome a sense of failure or lack of accomplishment if their patients' conditions progress unresolved, 37,38 and, in our analysis, survey respondents shared in their own words that poor patient outcomes and treatment focused on symptoms rather than causes contribute to their experience of burnout, leading to a sense of “moral injury.” 39,40 This inability to heal 3,38 can lead to a feeling of powerlessness within a system that repeats moral distress 41 and further adds to burnout (depression, fatigue, depersonalization, and relationship stress). 37,38 Among those practitioners who previously experienced burnout but no longer do in the current study (28%), the majority attributed their reduction to a change in work, with 43% of these having changed their practice to incorporate LM.…”

Investigating the Relationship between Fear of Failure and the Delivery of End-of-Life Care: A Questionnaire Study

“…These factors include healthcare staff heroism [ 19 ], a desire for paternal control [ 20 , 21 ], apathy as a form of abstention [ 22 ], fear of uncertainty [ 23 ], decision regret [ 24 ], a sense of expectation of oneself and others and the resulting fear of failure [ 25 ], death anxiety and the reminders of the mortality of self, friends, or family [ 18 ], and protecting oneself from the experience of grief [ 21 ]. All the above have all been linked with the avoidance of or difficulty with effective EOL communication in qualitative interviews with physicians in acute healthcare settings [ 26 ].…”

Facilitators and Barriers for Initiating Conversations About End of Life

“…The perception of self-efficacy was linked to the physicians' sense of feeling able and prepared to handle EOL conversations, and was improved after the observation of senior colleagues. 12 …”