Relationship between physicians’ death anxiety and medical communication and decision-making: A systematic review

Draper, Emma J.; Hillen, Marij A.; Moors, Marleen; Ket, Hans; Laarhoven, Hanneke W. M. van

doi:10.1016/j.pec.2018.09.019

Cited by 44 publications

(52 citation statements)

References 51 publications

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“…There is a risk that the intuitive sense in the individual HP may not match the readiness of the patient and their relatives. The notion of courage may relate both to interacting with the patient on sensitive matters and also to relate to one’s own anxiety about death, which may be a factor regarding reluctance to addressing EOL matters and caring for the dying [49, 50]. In this study, it was merely expressed as discomfort and unease regarding when to draw the line and knowing when the time was right to stop treatment.…”

Section: Discussionmentioning

confidence: 99%

Talking about end of life in general palliative care – what’s going on? A qualitative study on end-of-life conversations in an acute care hospital in Denmark

2019

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Background End-of-life (EOL) conversations in hospital should serve to give patients the opportunity to consider future treatment options and help them clarify their values and wishes before it becomes relevant to make decisions about treatment. However, it is known that EOL conversations are not performed systematically in hospital. This may mean that patients and their relatives do not address EOL issues. There is a lack of knowledge about who is responsible for conducting these conversations, and when and under what circumstances they are conducted. The aim of this study was to explore the existing practices regarding EOL conversations in an acute care hospital setting. Methods The design was Interpretive Description and the methods for the data collection included: 1. Participatory observational studies in a pulmonary medical and surgical ward (a total of 66 h); 2. Four focus group interviews with healthcare professionals ( n = 14) from the wards. The analysis followed Spradley’s ethnosemantic analysis. Results The results revealed three cultural categories related to: 1. The physical and organizational setting; 2. The timing of EOL conversations and competencies and roles in addressing EOL issues and 3. Topics addressed in EOL conversations. The EOL conversations were part of daily clinical practice, but there was a lack of competencies, roles were unclear and the physical and organizational environment was not conducive to the conversations. The topics of the EOL conversations revolved around a “here-and-now” status of the patient’s disease progression and decisions about the level of treatment. To a lesser extent, the conversations included the patient’s and relatives’ thoughts and wishes concerning EOL, which allowed long-term care planning. Conclusion This study demonstrates that there are several barriers to talking about EOL in an acute care hospital setting, and future strategies must address an overall approach. In order to provide patients and their relatives with better opportunities to express their EOL wishes, there is a need for clearer roles and guidelines in an interdisciplinary approach to EOL conversations, alongside improved staff competencies and changes to the organizational and physical environment.

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Section: Discussionmentioning

confidence: 99%

Talking about end of life in general palliative care – what’s going on? A qualitative study on end-of-life conversations in an acute care hospital in Denmark

2019

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“…According to Kubler-Ross(11) “death remains a terrible and terrifying event, and the fear of death is a universal fear, although we believe that we have mastered it on many levels”(1). Subsequent research in this area has resulted in the concept of death anxiety(12,13).…”

Section: Introductionmentioning

confidence: 99%

“…As a result, doctors who face death on a regular basis may have developed particular views and feelings related to this topic. For many clinicians, discussing death and end-of-life with patients and family members can be both a burden and a challenge(12,22–24). In some cases fear of death, feelings of inadequacy, and frustration may lead the doctor to avoid close contact with the patient(25–27,21,20).…”

Section: Introductionmentioning

confidence: 99%

Fear and death anxiety among Latin American doctors during the Covid-19 pandemic

Indacochea-Cáceda

Torres-Malca

et al. 2021

Preprint

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Introduction: A patient s death elicits various feelings arise in doctors such as impotence and guilt that could trigger physical or psychological symptoms. Despite its impact, few studies have explored anxiety and fear of death among physicians. Objective: To evaluate perceptions and responses to one s mortality among Latin American physicians treating COVID-19 patients. Methodology: This cross-sectional study utilized the Collet-Lester Modified Fear of Death Scale and the Death Anxiety Scale (DAS) to collect data from physicians in Latin America. Results: 219 doctors from Peru, Mexico, Argentina, Colombia, and Bolivia filled out the online questionnaire. Fear of death among the sample population ranged from 56.2% to 90%. Furthermore, the prevalence of "High Anxiety" was 80.8%. A statistically significant association was found between fear according to age and time of graduation (p = 0.010 and p = 0.020, respectively). No differences were found by gender, age, and country of origin or practice. Conclusion: Physicians experience feelings of helplessness and guilt upon the death of a patient and those feelings can trigger physical or psychological symptoms. For these states of fear and anxiety about death, more frequent in times of pandemic, doctors must be prepared, and institutions must provide them with the necessary means to help them overcome these difficult times.

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“…Physician attitudes, such as comfort with medical paternalism, are associated with higher use of chemotherapy and higher numbers of emergency department visits and inpatient admissions, even when researchers control for patient preferences . Physicians' death anxiety may also make end‐of‐life communication and decision making more challenging, and terminal patients of physicians with high death anxiety have longer hospital lengths of stay …”

mentioning

confidence: 99%

“…We, therefore, propose that interventions to improve prognostic understanding should also address these psychological factors, which may be outside everyday awareness but are accessible with guidance, self‐awareness, and reflection as described by Meier et al, with steps including the following: 1) recognizing and naming the feeling, 2) accepting the normalcy of the feeling, 3) reflecting on the emotion and its possible consequences, and 4) consulting a trusted colleague. There have been several studies evaluating psychotherapeutic interventions for reducing death anxiety in patients, and mindfulness‐based approaches may mitigate human tendencies to avoid or become defensive when death is more proximal . Components of these approaches might be adapted for physicians.…”

mentioning

confidence: 99%

Helping patients to understand terrifying news: Addressing the inner lives of physicians and extending beyond what we know

Loh

Mohile

Epstein

et al. 2020

Cancer

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Relationship between physicians’ death anxiety and medical communication and decision-making: A systematic review

Cited by 44 publications

References 51 publications

Talking about end of life in general palliative care – what’s going on? A qualitative study on end-of-life conversations in an acute care hospital in Denmark

Talking about end of life in general palliative care – what’s going on? A qualitative study on end-of-life conversations in an acute care hospital in Denmark

Fear and death anxiety among Latin American doctors during the Covid-19 pandemic

Helping patients to understand terrifying news: Addressing the inner lives of physicians and extending beyond what we know

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