The experience of providing end‐of‐life care at home: The emotional experiences of young family physicians

Abstract

Background: End-of-life care is now a major issue in Japan as a result of the rapidly aging population; hence, the need for fostering family physicians to be engaged in end-of-life care at home is increasing. Studies in the United States and the United Kingdom have shown that physicians feel emotional and moral distress in end-of-life care, and that they develop detachment and dehumanizing attitudes toward patients as a coping mechanism. However, few studies have explored the emotional experiences that family physicians have during home-based end-of-life care. The aim of this study is to explore the emotional experiences of young family physicians in such situations. Methods:We conducted a qualitative analysis of interviews with family medicine residents or family physicians who had just completed their residency. The interviews were audio-recorded and transcripts were prepared. The coded data were analyzed according to thematic analysis using NVivo 10 software.Results: Study participants were 12 family physicians of PGY 5-11, with experienced end-of-life care cases of 3-20. Thirteen themes were extracted from the data, which were categorized into five domains: difficulties in end-of-life discussion, emotions of physicians, the role of physicians, communicating with the family, and positivity in end-of-life care. The physicians experienced various emotions and struggles within these domains, but they also felt something positive through providing care for the dying patients and their families. Conclusion:Family physicians experience various emotional difficulties during endof-life home care. However, positive emotions at the end of life were also experienced through their care.

Possibility of alleviating difficulties of health and social care professionals engaged in end‐of‐life care through Clinical Art program

“…Previous studies have shown that uncertainty in end‐of‐life care leads to anxiety and stress among healthcare professionals, 18 , 19 which is consistent with the present study. With regard to the communication difficulties with patients and families when providing care at the end‐of‐life, studies have shown challenges in communicating about prognosis 20 and problems in dealing with diverse family opinions about patients' wishes, 21 which are generally consistent with the results of the present study.…”

Family physicians’ moral distress when caring for patients experiencing social inequities: a critical narrative inquiry in primary care

“…The stories of 20 family physicians who care for patients with medical needs related to social inequity highlights how moral distress can be grounded in broader systemic and structural factors. The study findings, to our knowledge, are some of the first to illustrate the moral distress experiences of family physicians, particularly those working with patients experiencing inequities, which builds upon the small body of moral distress scholarship in the primary care literature (63)(64)(65)(66)(67)(68)(69). Our participants' moral distress was associated with remuneration structures and workload demands, and was exacerbated by a lack of social resources such as housing, sufficient and comprehensive mental health and addictions services, which resulted in strict limitations on their ability to provide comprehensive care.…”