Disturbing and distressing: a mixed methods study on the psychological impact of end of life care on junior doctors

Linane, Hannah; Connolly, Fergal; McVicker, Lyle; Beatty, Sharon E.; Mongan, Orla; Mannion, Edel; Waldron, Dympna; Byrne, Dara

doi:10.1007/s11845-018-1885-z

Cited by 10 publications

(15 citation statements)

References 17 publications

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“…There were a further 10 studies including literature reviews, commentaries, and editorials (Table 1). Study participants included final‐year medical students, 6‐25 junior doctors early in their first postgraduate year, 3,13,14,16‐19,26‐42 junior doctors late in internship (>6 months) or in postgraduate year 2 or above 2,14,16,22,24,35,38,42‐57 (Table 1). Twenty‐one studies incorporated feedback or reports from clinical supervisors or training managers 5,7,13,14,17‐19,22,25,31,35,36,39,43,45,55,58‐61 (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…There were a further 10 studies including literature reviews, commentaries, and editorials (Table 1). Study participants included final-year medical T A B L E 1 Study design and participants in papers included in the review of literature 1998 -2019 Dyar 12 McKenzie 2017 15 Minha 16 Morrow 17 Rothwell 18 Scicluna 19 Stroben 21 Wijnen-Meijer 2015 23 Daly 25 Illing 2013 14 Illing Lightmann Tran 24 Watmough 22 Early internship Abuhusain 26 Bennett 27 Bleakley 28 Cave 29 Heidemann 31 Minha 16 Morrow 17 Prozesky 42 Scicluna 19 Watmough 22 Winn 40 Eley 2 Illing 2013 14 Lundin 32 Monrouxe 2018 35 Muthaura 36 Sturman 3 Walker 39 Gome 30 Illing Kelly 37 Linane 38 McKenzie 41 Miles 33 Minter 34 Rothwell 18 Late or post internship Barr 53 Dean 55 Duns 52 Eley 62 Goldacre 2010 50 Goldacre 2014 57 Hill 56 Kassim 49…”

Section: Descriptive Summarymentioning

confidence: 99%

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Transitioning from university to postgraduate medical training: A narrative review of work readiness of medical graduates

Padley

Boyd

Jones

et al. 2021

Health Science Reports

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Context Work readiness is often described in terms of the clinical competence medical graduates bring to day 1 of internship. Despite being increasingly viewed as a key graduate outcome, work readiness has remained poorly defined. Objective This narrative review draws on the international literature to explore how different research methods provide differing insight into what constitutes work readiness of medical graduates. From this, we explored contributory factors and developed a conceptual framework to better understand work readiness. Methods Databases were searched using the terms including “ready,” “readiness,” “preparedness,” “medical graduates,” “intern,” and “junior doctor.” Information was summarized using a textual description template that included information on study setting, participants, methodologies, limitations, and key result areas (including measures/themes and study conclusions). Consensus discussions between authors led to the naming and understanding of the key themes. Results Seventy studies were included in the review. Study participants included final‐year medical students (n = 20), junior doctors early in internship (n = 24), and junior doctors late in internship or postgraduate year 2 and above (n = 23). Most studies explored work readiness through the retrospective self‐report of the students and/or junior doctor participants. Quantitative research methods elaborated on key skills‐based competencies, whereas qualitative research methods provided insight into key contextual and individual characteristics that contributed to preparedness. Conclusions Different research methods provided insight into competencies, as well as individual and contextual aspects, associated with preparedness for practice. The transition from university to clinical practice is significant and requires personal capability and confidence, as well as a supportive training context. Enabling students to engage authentically in clinical environments enhanced preparedness by promoting understanding of role and responsibility. Individual resilience is important, but contextual factors, including provision of adequate support and feedback, can enhance or subtract from feeling prepared. We propose a novel conceptual framework for better understanding work readiness.

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Section: Resultsmentioning

confidence: 99%

Section: Descriptive Summarymentioning

confidence: 99%

Transitioning from university to postgraduate medical training: A narrative review of work readiness of medical graduates

Padley

Boyd

Jones

et al. 2021

Health Science Reports

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“…This study also revealed that junior physicians have difficulties regarding “discussion of end-of-life care” and “death pronouncement.” Previous qualitative research indicates that “discussion about end-of-life care” and “death pronouncement,” added as domains in this study, are competencies required for residents and are factors related to posttraumatic stress. 36 The “discussion about end-of-life care” includes delivering bad news that the prognosis is limited and there is no curative treatment, which is challenging for junior physicians. 37 , 38 Death pronouncement also involves both knowledge and technical issues (e.g., how to confirm death), as well as communication before and after death (e.g., how to tell the family that the patient has died, how to understand the family's feelings, and how to offer comfort and encouragement).…”

Section: Discussionmentioning

confidence: 99%

Difficulties Facing Junior Physicians and Solutions Toward Delivering End-of-Life Care for Patients with Cancer: A Nationwide Survey in Japan

Okamoto¹,

Uneno

Kawashima

et al. 2022

Palliative Medicine Reports

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Background: Junior physicians' perceived difficulty in end-of-life care of patients with cancer has not been structurally investigated; therefore, current challenges and solutions in this area remain unknown. Objectives: To identify some difficulties junior physicians face in delivering end-of-life care for patients with cancer and to clarify the support required to reduce these difficulties. Design: A nationwide survey was conducted in over 300 institutions selected randomly from 1037 clinical training hospitals in Japan. Participants: From each of these institutions, two resident physicians of postgraduate year (PGY) 1 or 2, two clinical fellows of PGY 3–5, and an attending physician were requested to respond to the survey. Measurements: The survey investigated issues regarding end-of-life care using the palliative care difficulties scale with two additional domains (“discussion about end-of-life care” and “death pronouncement”). Items related to potential solutions for alleviating the difficulties as well were investigated. Results: A total of 198 resident physicians, 134 clinical fellows, and 96 attending physicians responded to the survey (response rate: 33.0%, 22.3%, and 32.0%). The results revealed that junior physicians face difficulties within specific domains of end-of-life care. The most challenging domain comprised communication and end-of-life discussion with patients and family members, symptom alleviation, and death pronouncement. The most favored supportive measure for alleviating these difficulties was mentorship, rather than educational opportunities or resources regarding end-of-life care. Conclusion: The findings of this study reveal the need for further effort to enrich the mentorship and support systems for junior physicians delivering end-of-life care.

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“…Peer support within the multi-disciplinary team has been found helpful (Buschbach et al., 2020; Etkind et al., 2017 and it has been found that emotional support and encouraging reflexivity that involves professionals from different disciplines is very helpful (Manning-Jones et al., 2016). This is also important as studies have found that a negative first experience of EoL care can be particularly damaging to a professional’s development (Linane et al., 2019) and that there is a vital importance for members of the EoL care team be supportive of one another (Chan et al., 2016; Harrison et al., 2017). Our study also reinforces the case for the value for facilitated reflective practice that allows professionals to reflect on stressful situations positively.…”

Section: Discussionmentioning

confidence: 99%

“Challenging Professional Boundaries”: A Grounded Theory Study of Health Professionals’ First Experiences of End-of-Life Care in Hospital

et al. 2020

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Little is known about health professionals first experiences of End-of-Life care in hospital. This study aims to understand the psycho-social process that occurs when hospital-based health professionals engage in caring for a dying patient for the first time. We conducted a Grounded Theory study, with 19 health professionals. Challenging professional boundaries is the core category which explains the overall process. The theoretical model we conceptualized evidenced three phases: 1) building a relationship between patient/family and professionals, 2) the disrupting impact and 3) the reaction phase. Our analysis highlighted the initial strong impact of this experience, which brought professionals to perceive emotional suffering and feelings of inadequacy. The new aspect our grounded theory revealed is that all the categories are pertinent to all the professionals involved, therefore they explain important aspects of interprofessional collaboration in End-of-Life care.

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Disturbing and distressing: a mixed methods study on the psychological impact of end of life care on junior doctors

Abstract: Junior doctors are regularly carrying out tasks related to end of life care, resulting in high levels of psychological distress. Further training and a change in culture are required.

Cited by 10 publications

References 17 publications

Transitioning from university to postgraduate medical training: A narrative review of work readiness of medical graduates

Transitioning from university to postgraduate medical training: A narrative review of work readiness of medical graduates

Difficulties Facing Junior Physicians and Solutions Toward Delivering End-of-Life Care for Patients with Cancer: A Nationwide Survey in Japan

“Challenging Professional Boundaries”: A Grounded Theory Study of Health Professionals’ First Experiences of End-of-Life Care in Hospital

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