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Physician emotional experience of communication and decision making with end-of-life patients: qualitative studies systematic review
  1. John S Latham1,
  2. Sarah Butchard1 and
  3. Stephen R Mason2
  1. 1 Department of Clinical Psychology, University of Liverpool, Liverpool, UK
  2. 2 Palliative Care Unit, School of Medicine, University of Liverpool, Liverpool, UK
  1. Correspondence to John S Latham, Department of Clinical Psychology, University of Liverpool, Liverpool L69 3BX, UK; John.latham{at}


Objective To explore the emotional experience of physicians in acute settings when encountering end-of-life conversations and decision making.

Method Thematic synthesis of qualitative studies. Medline, PsychInfo, PubMed, BNI and CIAHL were searched from 1985 to 2021 for studies published in English. Data extraction was informed by a framework created for assessing methodological quality by Polanin, Pigott, Espelage and Grotpeter (2019) and adapted by Draper et al. (2019).

Results Of 8429 papers identified, 17 were selected for review. Two themes containing 10 subthemes described the emotional and psychological factors impacting the experience of end-of-life care, namely: a tension between desire and ability to communicate end-of-life news, and a conflict of hiding versus revealing self across several practical and emotional contexts.

Conclusion Medical training is only a small factor in how well a person copes with end-of-life care and may sometimes feed negative appraisals . Lack of support from senior colleagues, fear of criticism and a sense of perceived failure were linked to lower self-efficacy in end-of-life care. Beyond learning practical skills, physicians benefit from understanding the psychological factors impacting their experience and in building self-efficacy, and observing senior colleagues effectively process strong and difficult emotions.

Practical implications Promoting personal reflection and sharing of the experiences encountered in end-of-life care, especially modelled from senior colleagues, may contribute to improvements in competence and reduce the impact of heroism, feelings of failure and avoidance in practice.

  • Communication
  • Transitional care
  • Psychological care
  • Hospital care
  • End of life care
  • Bereavement

Data availability statement

Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplementary information.

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  • X @Johnnylatham11

  • Correction notice This article has been corrected since it was first published. The title of the article has been updated.

  • Contributors JSL is the primary and corresponding author responsible for the overall content and accepts full responsibility for the the conduct of the study, has access to the data, controlled the decision to publish, and acts as guarantor of the authenticity of the publication. SB is the second author. SRM is the third author.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.