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Voices of the Future: Junior Physicians’ Experiences of Discussing Life-Sustaining Treatments With Hospitalized Patients

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Název: Voices of the Future: Junior Physicians’ Experiences of Discussing Life-Sustaining Treatments With Hospitalized Patients
Autoři: Michael Andreas Müller, Claudia Gamondi, Eve Rubli Truchard, Anca-Cristina Sterie
Zdroj: J Med Educ Curric Dev
Journal of Medical Education and Curricular Development, Vol 11 (2024)
Journal of medical education and curricular development, vol. 11, pp. 23821205241277334
Informace o vydavateli: SAGE Publications, 2024.
Rok vydání: 2024
Témata: Medicine (General), R5-920, Life-sustaining treatments, communication, junior physicians, LC8-6691, Original Research Article, Special aspects of education
Popis: OBJECTIVES Life-sustaining treatments (LST) aim to prolong life without reversing the underlying medical condition. Being associated with a high risk of developing unwanted adverse outcomes, decisions about LST are routinely discussed with patients at hospital admission, particularly when it comes to cardiopulmonary resuscitation. Physicians may encounter many challenges when enforcing shared decision-making in this domain. In this study, we map out how junior physicians in Southern Switzerland refer to their experiences when conducting LST discussions with hospitalized patients and their learning strategies related to this. METHODS In this qualitative exploratory study, we conducted semi-directive interviews with junior physicians working at the regional public hospital in Southern Switzerland and analyzed them with an inductive thematic analysis. RESULTS Nine physicians participated. We identified 3 themes: emotional burden, learning strategies and practices for conducting discussions. Participants reported feeling unprepared and often distressed when discussing LST with patients. Factors associated with emotional burden were related to the context and to how physicians developed and managed their emotions. Participants signaled having received insufficient education to prepare for discussing LST. They reported learning to discuss LST essentially through trial and error but particularly appreciated the possibility of mentoring and experiential training. Explanations that physicians gave about LST took into account patients’ frequent misconceptions. Physicians reported feeling under pressure to ensure that decisions documented were medically indicated and being more at ease when patients decided by themselves to limit treatments. Communication was deemed as an important skill. CONCLUSIONS Junior physicians experienced conducting LST discussions as challenging and felt caught between advocating for medically relevant decisions and respecting patients’ autonomy. Participants reported a substantive emotional burden and feeling unprepared for this task, essentially because of a lack of adequate training. Interventions aiming to ameliorate junior physicians’ competency in discussing LST can positively affect their personal experiences and decisional outcomes.
Druh dokumentu: Article
Other literature type
Popis souboru: application/pdf
Jazyk: English
ISSN: 2382-1205
DOI: 10.1177/23821205241277334
Přístupová URL adresa: https://pubmed.ncbi.nlm.nih.gov/39246599
https://doaj.org/article/6de128e99bc44947a8950aebd3d8885b
https://serval.unil.ch/resource/serval:BIB_6588AD0A280B.P001/REF.pdf
http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_6588AD0A280B4
https://serval.unil.ch/notice/serval:BIB_6588AD0A280B
Rights: CC BY
URL: http://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (http://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (http://us.sagepub.com/en-us/nam/open-access-at-sage).
Přístupové číslo: edsair.doi.dedup.....19542b3485fe86d6419d32763132fbd3
Databáze: OpenAIRE
Popis
Abstrakt:OBJECTIVES Life-sustaining treatments (LST) aim to prolong life without reversing the underlying medical condition. Being associated with a high risk of developing unwanted adverse outcomes, decisions about LST are routinely discussed with patients at hospital admission, particularly when it comes to cardiopulmonary resuscitation. Physicians may encounter many challenges when enforcing shared decision-making in this domain. In this study, we map out how junior physicians in Southern Switzerland refer to their experiences when conducting LST discussions with hospitalized patients and their learning strategies related to this. METHODS In this qualitative exploratory study, we conducted semi-directive interviews with junior physicians working at the regional public hospital in Southern Switzerland and analyzed them with an inductive thematic analysis. RESULTS Nine physicians participated. We identified 3 themes: emotional burden, learning strategies and practices for conducting discussions. Participants reported feeling unprepared and often distressed when discussing LST with patients. Factors associated with emotional burden were related to the context and to how physicians developed and managed their emotions. Participants signaled having received insufficient education to prepare for discussing LST. They reported learning to discuss LST essentially through trial and error but particularly appreciated the possibility of mentoring and experiential training. Explanations that physicians gave about LST took into account patients’ frequent misconceptions. Physicians reported feeling under pressure to ensure that decisions documented were medically indicated and being more at ease when patients decided by themselves to limit treatments. Communication was deemed as an important skill. CONCLUSIONS Junior physicians experienced conducting LST discussions as challenging and felt caught between advocating for medically relevant decisions and respecting patients’ autonomy. Participants reported a substantive emotional burden and feeling unprepared for this task, essentially because of a lack of adequate training. Interventions aiming to ameliorate junior physicians’ competency in discussing LST can positively affect their personal experiences and decisional outcomes.
ISSN:23821205
DOI:10.1177/23821205241277334