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Palliative and end-of-life care and junior doctors': a systematic review and narrative synthesis
  1. Aamena Bharmal1,2,
  2. Tessa Morgan1,
  3. Isla Kuhn3,
  4. Bee Wee4,5 and
  5. Stephen Barclay1
  1. 1Primary Care Unit, University of Cambridge, Cambridge, UK
  2. 2Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  3. 3Medical Library, University of Cambridge, Cambridge, UK
  4. 4Sir Michael Sobell House Hospice, Oxford, UK
  5. 5University of Oxford Harris Manchester College, Oxford, UK
  1. Correspondence to Dr Aamena Bharmal, University of Cambridge Primary Care Unit, Cambridge CB2 0SR, UK; aamena.bharmal{at}


Background Palliative and end-of-life care is a core competency for doctors and is increasingly recognised as a key clinical skill for junior doctors. There is a growing international movement to embed palliative care education in medical student and junior doctor education. To date there has been no review of the literature concerning the views and experiences of junior doctors delivering this care.

Aim To review the published literature between 2000 and 2019 concerning junior doctors’ experience of palliative and end-of-life care.

Methods Systematic literature review and narrative synthesis.

Results A search of six databases identified 7191 titles; 34 papers met the inclusion criteria, with a further 5 identified from reference searching. Data were extracted into a review-specific extraction sheet and a narrative synthesis undertaken. Three key themes were identified: (1) ‘Significance of death and dying’: all papers found that junior doctors care for many patients approaching the end of life, and this often causes emotional distress and can leave persisting memories for many years afterwards; (2) ‘Thrown in at the deep end’: junior doctors feel unprepared and unsupported in providing palliative and end-of-life care; and (3) ‘Addressing the gaps’: junior doctors often experience a medical culture of disengagement towards dying patients and varying attitudes of senior doctors. Subsequently they have to learn the skills needed through seeking their own opportunities.

Conclusion Medical education needs to change in order to better prepare and support junior doctors for their role in caring for dying patients. This education needs to focus on their knowledge, skills and attitudes.

  • education and training

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  • Contributors AB designed and had the concept of the work. AB and SB planned the study. AB and IK designed the literature search terms, with AB conducting the literature search from January 2000 to January 2018 and IK conducting the database search from January 2018 to August 2019. AB screened the titles, abstracts and full texts, and weighted the papers, with TM completing a sample selection at each stage. AB, TM and SB achieved consensus on any discrepancies in screening decisions. AB, SB and TM analysed and identified the themes. AB wrote the draft of the article. AB, SB and BW contributed to interpretation and critical revision of the article. All the authors approved the final version. AB is guarantor of the paper.

  • Funding SB is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England at Cambridgeshire and Peterborough NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. AB was supported by the Academic Foundation Programme through NIHR funding through the Health Education England East of England Deanery.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

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