Relationships between personal attitudes about death and communication with terminally ill patients: How oncology clinicians grapple with mortality

Abstract

Objective Clinician discomfort with death may affect care of patients but has not been well-studied. This study explores oncology clinicians’ attitudes surrounding their own death and how these attitudes both affect and are affected by their care of dying patients and their communication with them. Methods Qualitative interviews with physicians (n = 25), nurse practitioners (n = 7), and physician assistants (n = 1) in medical or hematologic oncology clinical practices about communication styles, care of terminally ill patients, and personal perspectives about mortality. Results Clinicians described three communication styles used with patients about death and dying: direct, indirect, or selectively direct. Most reported an acceptance of their mortality that was “conditional,” meaning that that they could not fully know how they would respond if actually terminally ill. For many clinicians, caring for dying patients affected their outlook on life and death, and their own perspectives on life and death affected their approach to caring for dying patients. Conclusion An awareness of personal mortality may help clinicians to discuss death more openly with patients and to provide better care. Practice implications Efforts to promote self-awareness and communication training are key to facilitating clear communication with and compassionate care of terminally ill patients.

Effect of a Patient-Centered Communication Intervention on Oncologist-Patient Communication, Quality of Life, and Health Care Utilization in Advanced Cancer

“…61–64 Oncologists need better training in the provision of information to patients with varying levels of health numeracy and literacy as well as “terror management,” a defense mechanism that may prompt some patients (and physicians) to respond to fear of death through avoidance and selective attention. 65–67 Venues already exist for communication and awareness training during residency and fellowship, 25,68,69 and interventions such as ours are feasible for practicing oncologists.…”

Moving toward the next generation of communication training in oncology: The relevance of findings from qualitative research

“…A key to understanding these findings may be that awareness of structural barriers may not lead to change as long as psychological barriers persist, as suggested by the results of Rodenbach, Rodenbach, Tejani, and Epstein (), who examined how oncology clinicians' perspectives about how their own life and death affect and are affected by their care of and communication with dying patients. These authors conclude that “most oncology clinicians express a conditional acceptance of their own death, and for many, there is a reciprocal relationship between their attitudes toward their own death and their care of dying patients.” This conclusion thus underlines that the way oncologists think about their death (for instance not accepting it) influences their care of dying patients (for instance not accepting the death of their patients).…”

‘Treat them into the grave’: cancer physicians’ attitudes towards the use of high‐cost cancer medicines at the end of life

“…); as well the impact that oncologists’ attitudes towards their own mortality, has on their care of dying patients (Rodenbach et al . ). However, none of these studies have specifically focused on the views and experiences of cancer physicians regarding the use of high‐cost medicines at the end of life.…”

“…, Rodenbach et al . , Willmott et al . ), exploring the strategies and barriers to effective communication at the end of life (Granek et al .…”

“…, Rodenbach et al . , Stevenson and Abbott ). This is based on the view that failure to stop treatment, including high‐cost cancer medicines, and failure to refer to palliative care stems from inadequate communication on the part of cancer physicians – more specifically, a failure to communicate information about the terminal nature of a patient's disease and the potential benefits of palliative care.…”