Doctors' emotional reactions to recent death of a patient: cross sectional study of hospital doctors

Redinbaugh, Ellen M.; Sullivan, Amy; Block, Susan D.; Gadmer, Nina; Lakoma, Matthew D.; Mitchell, Ann M.; Seltzer, Deborah L.; Wolford, Jennifer; Arnold, Robert M.

doi:10.1136/bmj.327.7408.185

Cited by 251 publications

(213 citation statements)

References 20 publications

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“…Patients were randomly selected from deaths on the medical services at two highly specialized referral medical centers in Boston, Massachusetts, and Pittsburgh, Pennsylvania. 6 Patient deaths were identified by reviewing the charts of all inpatients who died on the internal medicine services during the previous week. An eligible patient case was one in which at least two physicians could be identified who had cared for the patient at the time of death.…”

Section: Selection Of Participantsmentioning

confidence: 99%

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

Jackson

Mack

Matsuyama

et al. 2008

Journal of Palliative Medicine

125

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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

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Section: Selection Of Participantsmentioning

confidence: 99%

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

Jackson

Mack

Matsuyama

et al. 2008

Journal of Palliative Medicine

125

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“…Studies have demonstrated that better communication and more compassionate care reduce patient anxiety and depression, increase a patient's ability to adjust psychologically to the diagnosis, and increase quality of life [18][19][20][21][22][23]. In addition, a close relationship with patients has been found to correlate with physician satisfaction, particularly in care near the end of life [7,24,25]. Thus, a close patient-physician relationship can be beneficial in terms of both patient care and physician satisfaction.…”

Section: How Close Is Too Close?mentioning

confidence: 99%

“…Only 28% of physicians cared for the patients for longer than 7 days, yet 64% of the physicians rated these deaths as moderately or highly powerful, and 45% rated them as moderately or highly disturbing. Longer durations of care and less time as a physician correlated with greater emotional reactions to patients' deaths [7]. A follow-up study evaluated these physicians' most emotionally powerful patient deaths by quantitative survey and qualitative interview.…”

Section: Although I Learned With This Patient and Others That Revealimentioning

confidence: 99%

Learning to Cope: How Far Is Too Close?

et al. 2005

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PRESENTATIONA 44-year-old woman with a 25 pack-year history of smoking presented to her primary care physician with rapidly progressive dyspnea and pleuritic chest discomfort. She had no medical problems and took no medications. At this urgent clinic visit, the patient's physician noted decreased breath The case is presented of a patient with a precipitous decline in health due to rapidly progressive, metastatic non-small cell lung cancer. The discussion at Schwartz Center Rounds centers on oncologists' feelings of failure and coping mechanisms when dealing with patients' deaths. This discussion is followed by a first-year oncology fellow's reaction to caring for this and other terminally ill patients. Then, to provide a broader framework in which to understand these issues, the emotional cost and measurable benefit of close relationships with patients is investigated. To conclude, further educational initiatives are advocated to assist both physiciansin-training and more senior clinicians in dealing with the difficult issues that arise when caring for very ill and dying patients. LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Describe the human aspects of caring for dying patients and the frustrations of futile oncology treatment.2. Explain the importance of addressing how issues of life and death affect caregivers.3. Discuss the advantages and risks of close relationships with patients.

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“…According to Parkes 7 and Redinbaugh et al, 27 the impact of patients' deaths correlates with the following factors: how death occurred, the characteristics of the deceased, professionals' identification with patients and their families, professional performance assessment in providing care for patients, the feeling of responsibility for death, quality of the bond with patients, duration of the bond, individual experience with death and personal history and vulnerabilities.…”

Section: Coping With Death and Dyingmentioning

confidence: 99%

“…The literature discusses measures for facilitating and contributing towards physicians' abilities to process and cope with the emotions and feelings associated with death and dying among their patients. 16,17,[24][25][26][27][28] There are data indicating that workers who do not feel prepared to cope with these situations tend to develop a broad range of reactive feelings, such as: professional loneliness, loss of the sense of mission, cynicism, desperation, frustration and an increased risk of burnout and depression. 16,17 The acknowledgement that medicine is a potentially stressful occupation, has led to increases in prophylactic and/or care measures for physicians and other healthcare workers, over past decades.…”

Section: It Was Clear I Was Conscious Of It: 'I'll Buy That Thing I'mentioning

confidence: 99%

The experience of infectologists faced with death and dying among their patients over the course of the AIDS epidemic in the city of São Paulo: qualitative study

2010

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METHODS:The sample was formed through the snowball process. The sample size was determined using the saturation criterion. To analyze the material obtained from the interviews, the procedure of thematic analysis was used. This consisted of finding the core meaning relating to the study objective, within the set of materials obtained. RESULTS:Analysis of the material obtained from the interviews led to three main themes: 1. The initial context of AIDS and its impact on infectologists; 2. Modifications to the infectologists' attachments to patients after the introduction of highly active antiretroviral therapy (HAART); 3. Coping with death and dying.CONCLUSIONS: This study shows the importance of considering the distress, emotional overload and adaptive mechanisms relating to death and dying among patients, both in training and in professional practice.RESUMO CONTEXTO E OBJETIVO: Com o surgimento da síndrome da imunodeficiência adquirida (aids), em 1981, os infectologistas passaram por grandes modificações em sua prática assistencial. Este estudo tem por objetivo descrever e analisar as vivências de médicos infectologistas frente à morte e ao morrer de seus pacientes ao longo da trajetória da epidemia de aids na cidade de São Paulo. TIPO DE ESTUDO E LOCAL:Adotou-se a abordagem qualitativa. Foram entrevistados 20 médicos infectologistas pertencentes a cinco instituições hospitalares que atendem portadores de vírus da imunodeficiência humana (HIV)/aids no município de São Paulo. MÉTODOS:A composição da amostra foi realizada pelo processo de snowball e o tamanho da amostra determinado pelo critério de saturação. Para a análise do material obtido nas entrevistas, foi utilizado o procedimento da análise temática, que consiste em descobrir os núcleos de sentido existentes no conjunto do material obtido e que têm relação com o objetivo do estudo.RESULTADOS: Da análise do material obtido nas entrevistas resultaram três eixos temáticos: 1. O contexto inicial da aids e o impacto vivido pelos infectologistas; 2. Modificações na vinculação com os pacientes depois da introdução da terapia antirretroviral potente (HAART); 3. Lidando com a morte e o morrer. CONCLUSÕES:O estudo aponta para a importância de considerar, tanto na formação como no exercício profissional, o sofrimento, a sobrecarga emocional e os mecanismos adaptativos relacionados à morte e o morrer de pacientes.

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Doctors' emotional reactions to recent death of a patient: cross sectional study of hospital doctors

Abstract: Objectives: To describe doctors' emotional reactions to the recent death of an "average" patient and to explore the effects of level of training on doctors' reactions.

Cited by 251 publications

References 20 publications

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

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

Learning to Cope: How Far Is Too Close?

The experience of infectologists faced with death and dying among their patients over the course of the AIDS epidemic in the city of São Paulo: qualitative study

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