“Sharing in hopes and worries”—a qualitative analysis of the delivery of compassionate care in palliative care and oncology at end of life

Sarah Bessen,Raina H Jain,W Blair Brooks,Manish Mishra

doi:10.1080/17482631.2019.1622355

Abstract

ABSTRACT Purpose: To explore the methods through which physicians deliver compassionate care during end-of-life (EOL). Compassionate care provides benefits to patients and providers and is particularly important for patients with serious illnesses, yet its practice remains limited. We aim to qualitatively characterize methods utilized by physicians that facilitate the delivery of compassionate care at EOL. Methods: We conducted 13 semi-structured interviews with physicians from palliative care and medical oncology subspecialities at a rural academic medical centre in New Hampshire. Interviews were transcribed and analysed using a qualitative research design. Results: Participants described methods of compassionate care ranging from symptom control to less tangible, non-verbal methods. Primary barriers to the delivery of compassionate care were described as within the broader healthcare system and within the inherent emotional difficulty of EOL care. Physicians from both subspecialities emphasized the importance of successful inter-provider relationships. Conclusions: Methods for delivering compassionate care at EOL are wide ranging, but barriers on a systemic and individual level should be addressed to make its practice more widespread. This can be accomplished, in part, by the standardization of EOL conversations, training physicians how to have meaningful EOL conversations, and integration of such conversations into electronic medical records.

Highlights

The recent movement around patient-centred care in medical practice has been accompanied by an emphasis placed on the integration of compassion as part of standard medical care
Participants described methods of compassionate care ranging from symptom control to less tangible, non-verbal methods
Primary barriers to the delivery of compassionate care were described as within the broader healthcare system and within the inherent emotional difficulty of EOL care. Physicians from both subspecialities emphasized the importance of successful interprovider relationships

Summary

Introduction

The recent movement around patient-centred care in medical practice has been accompanied by an emphasis placed on the integration of compassion as part of standard medical care. Compassionate care, defined by the Schwartz Center for Compassionate Healthcare as that which “addresses the emotional and psychosocial aspects of the patient experience,” improves patient–provider relationships and has been shown to have tangible benefits to patients, providers, and institutions alike (Schwartz Center for Compassionate Healthcare, 2015). Empathy and effective communication, two major components of compassionate care, have been linked to improved outcomes across an array of conditions, including diabetes, cancer, and pain control, in addition to increased patient adherence to their clinical treatment (Lown, Rosen, & Marttila, 2011). Compassionate care is important for patients with advanced disease, given the emotional difficulty of receiving a poor prognosis, worsening symptom burden, and the vulnerability associated with confronting death and dying (Greer, Jackson, & Meier et al, 2013; Palfrey, Armour, & Grubb et al, 2016). Given the sensitive nature of the end-of-life (EOL) care, it is critical to understand the preferences of patients and their caregivers, as well as tailor EOL conversations (Parker, Clayton, & Hancock et al, 2007)

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