Doctors caring for patients with life-limiting illness are often exposed to emotional distress.
We aimed to explore the experiences and perceptions of junior doctors working full time in a palliative care rotation. We examined the lessons junior doctors learnt in managing their emotions as they face patients' death on a daily basis.
We conducted a qualitative study with seven focus group discussions involving 21 junior doctors (medical officers and residents). Data were analyzed using qualitative thematic analysis to identify the themes related to the perceived challenges of these junior doctors and how they managed the struggles. Interviews were conducted with junior doctors who spent at least two months in a palliative care unit in a tertiary hospital or an inpatient hospice.
Junior doctors caring for dying patients in a palliative care rotation faced internal conflicts. Conflicting feelings arose because of differing expectations from their preconceived notions of their roles as doctors. Two main themes of internal struggles were professional distancing and emotional detachment as well as prognostic uncertainty and when to withhold and withdraw medical treatments. Coping strategies that helped included mentoring and role modeling provided by palliative care physicians, reframing their care experiences and reflection to find meaning in their work.
A palliative care rotation exposes junior doctors to emotionally overwhelming experiences. With proper guidance, this exposure is useful in teaching junior doctors important coping strategies, allowing learning to occur at a deeper level.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Pain and Symptom Management
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Palliative care professionals' inner life: exploring the relationships among awareness, self-care, and compassion satisfaction and fatigue, burnout, and coping with death.J Pain Symptom Manage. 2015; 50: 200-207
- The inner life of physicians and care of the seriously ill.JAMA. 2001; 286: 3007-3014
- Is work stress in palliative care nurses a cause for concern? A literature review.Int J Palliat Nurs. 2012; 18: 561-567
- Whole person self-care: self-care from the inside out.in: Hutchinson T.A. Whole person care. Springer, New York2011: 109-125
- Transforming experience into wisdom: healing amidst suffering.J Palliat Care. 2000; 16: 25-29
- Doctors' emotional reactions to recent death of a patient: cross sectional study of hospital doctors.BMJ. 2003; 327: 185-188
- Perceived skills in palliative medicine of newly qualified doctors in the U.K..J Palliat Care. 2000; 16: 27-32
- Why are newly qualified doctors unprepared to care for patients at the end of life?.Med Educ. 2011; 45: 389-399
- Are newly qualified doctors prepared to provide supportive and end-of-life care? A survey of Foundation Year 1 doctors and consultants.J R Coll Physicians Edinb. 2013; 43: 24-28
- Disturbing and distressing: a mixed methods study on the psychological impact of end of life care on junior doctors.Ir J Med Sci. 2019; 188: 633-639
- Effectiveness of a teaching programme in pain and symptom management for junior house officers.Support Care Cancer. 2001; 9: 606-610
- Special not different: general practitioners' accounts of their care of dying people.Soc Sci Med. 1998; 46: 1111-1120
- Association between physician burnout and patient safety, professionalism, and patient satisfaction: a systematic review and meta-analysis.JAMA Intern Med. 2018; 178: 1317-1330
- Linking physician burnout and patient outcomes: exploring the dyadic relationship between physicians and patients.Health Care Manage Rev. 2008; 33: 29-39
- “It is like heart failure. It is chronic . and it will kill you”: a qualitative analysis of burnout among hospice and palliative care clinicians.J Pain Symptom Manage. 2017; 53: 901-910
- Strategies to promote coping and resilience in oncology and palliative care nurses caring for adult patients with malignancy: a comprehensive systematic review.JBI Database Syst Rev Implement Rep. 2015; 13: 131-204
- How does burnout affect physician productivity? A systematic literature review.BMC Health Serv Res. 2014; 14: 325
- The informal curriculum: what do junior doctors learn from a palliative care rotation?.BMJ Support Palliat Care. 2020; 10: 114-117
- Beyond curriculum reform: confronting medicine's hidden curriculum.Acad Med. 1998; 73: 403-407
- Palliative care in undergraduate medical education. Status report and future directions.JAMA. 1997; 278: 733-738
- Palliative care in Singapore: impacting a Nation.Eur J Palliat Care. 2014; 21: 250-253
- 2015 EIU Quality of Death Index. Issuu.(Available from)https://issuu.com/manuelavendano/docs/2015_eiu_quality_of_death_index_octDate: 2019Date accessed: January 23, 2019
- Singapore takes six steps forward in ‘The Quality of Death Index’ rankings.Asia Pac J Oncol Nurs. 2018; 5: 21-25
- Applied thematic analysis.Sage Publication, Thousand Oaks, CA2012
- Cognitive and situated learning perspectives in theory and practice.Educ Res. 1999; 28: 4-15
- Constructing grounded theory: A practical guide through qualitative analysis.Sage Publications, Thousand Oaks, CA2006
- Qualitative research & evaluation methods.Sage Publications, Thousand Oaks, CA2002
- Approaches to textual analysis.in: Teoksessa Rosengren K. Advances in content analysis. Sage Publications, Beverly Hills, CA1981
- Enhancing the quality and credibility of qualitative analysis.Health Serv Res. 1999; 34: 1189-1208
- Physicians experiencing intense emotions while seeing their patients: what happens?.Perm J. 2016; 20: 15-229
- “It was haunting…”: physicians' descriptions of emotionally powerful patient deaths.Acad Med. 2005; 80: 648-656
- Impact of death work on self: existential and emotional challenges and coping of palliative care professionals.Health Soc Work. 2016; 41: 33-41
- Coping with existential and emotional challenges: development and validation of the self-competence in death work scale.J Pain Symptom Manage. 2015; 50: 99-107
- Calibrating the physician. Personal awareness and effective patient care.JAMA. 1997; 278: 502-509
- Healthy approaches to physician stress.Arch Intern Med. 1990; 150: 1857-1861
- Toward creating physician healers: fostering medical students' self-awareness, personal growth, and well-being.Acad Med. 1999; 74: 516-520
- “What’s important to you?”: the use of narratives to promote self-reflection and to understand the experiences of medical residents.Ann Intern Med. 2002; 137: 220-223
- Teaching the human dimensions of care in clinical settings.JAMA. 2001; 286: 1067-1074
- Educating for professionalism: trainees' emotional experiences on IM and paediatrics inpatient wards.Acad Med. 2003; 78: 730-741
- Nurturing humanism through teaching palliative care.Acad Med. 1998; 73: 763-765
- Developing and evaluating complex interventions: the new Medical Research Council guidance.BMJ. 2008; 337: a1655
- Evaluating complex interventions in End of Life Care: the MORECare Statement on good practice generated by a synthesis of transparent expert consultations and systematic reviews. Developing and evaluating complex interventions: the new Medical Research Council guidance.BMC Med. 2013; 11: 111
Published online: April 07, 2020
Accepted: March 27, 2020
© 2020 Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.