Experience of oncology residents with death: a qualitative study in Mexico

Asunción Álvarez-Del-Río,Luis Oñate-Ocaña,Edwin Ortega-García,Ingrid Vargas-Huicochea

doi:10.1186/s12910-019-0432-4

Asunción Álvarez-Del-Río, Luis Oñate-Ocaña + Show 2 more

Open Access

https://doi.org/10.1186/s12910-019-0432-4

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Abstract

BackgroundPhysicians play a fundamental role in the care of patients at the end of life that includes knowing how to accompany patients, alleviate their suffering and inform them about their situation. However, in reality, doctors are part of this society that is reticent to face death and lack the proper education to manage it in their clinical practice. The objective of this study was to explore the residents’ concepts of death and related aspects, their reactions and actions in situations pertaining to death in their practice, and their perceptions about existing and necessary training conditions.MethodsA qualitative approach was used to examine these points in depth based on interviews conducted with seven oncology residents.ResultsParticipants do not have a clear concept of death and, although it is seen as a common phenomenon, they consider it an enemy to beat. The situations to which respondents react more frequently with frustration and sadness after the death of patients were when they felt emotionally involved, if they identify with the patient, in cases of pediatric patients and with patients who refuse treatment. To deal with death, participants raise barriers and attempt to become insensitive. Although residents in this study recognize the importance of training to learn how to better deal with death, it seems they are not fully invested in reaching more of it.ConclusionsParticipants face death in a daily basis without the necessary training, which appears to impact them more than they are willing to accept. They do not achieve their goals managing situations regarding death as well as they assume they do. Despite recognizing the need of more training and support for better coping with death, they prefer to continue to learn from their experience.Trial registrationNot applicable.

Highlights

Physicians play a fundamental role in the care of patients at the end of life that includes knowing how to accompany patients, alleviate their suffering and inform them about their situation
Kale et al [11] conducted the National Health and Aging Trends Study (NHATS), revealing that 40% of the interviewed population had not discussed their preferences in terms of EOL care
In order to delve into the experience of oncology residents, physicians that frequently face death in their practice, we decided to conduct a study with a qualitative design, that has proven to be effective in better understanding personal and collective experiences and behaviors, taking into consideration environmental, social and cultural contexts that influence the way individuals deal with certain situations [19,20,21]. The aims of this project were to determine and analyze 1) the residents’ concepts on death and related aspects; 2) the residentsreactions and actions in situations pertaining to death in their practice, and 3) the residentsperceptions of the existing and necessary training conditions

Summary

Introduction

Physicians play a fundamental role in the care of patients at the end of life that includes knowing how to accompany patients, alleviate their suffering and inform them about their situation. This study revealed that physicians themselves feel uncomfortable fathoming their own death, as only 33% reported have spoken to their families about their EOL wishes and only 57% had a written will [9] This has significant repercussions on patients, many in a terminal stage, who remain unaware of their alternatives in the last moments of their lives. Kale et al [11] conducted the National Health and Aging Trends Study (NHATS), revealing that 40% of the interviewed population had not discussed their preferences in terms of EOL care. These two publications underscore the difficulty that physicians face when attempting to initiate this type of conversation with their patients. Boyd et al [12], showed that these very necessary conversations tend to occur in the very last weeks of a patient’s life, once they have undergone several futile treatments and the need to receive timely palliative care is imminent

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