Strong emotional reactions for doctors working in palliative care: Causes, management and impact. A qualitative study.

Abstract

Doctors working in palliative care services are exposed to challenging emotional environments almost daily. Strong-emotional reactions experienced in this setting have implications for patient care and doctor wellbeing. Existing research has not focused on doctors working in specialist palliative care. This study aimed to understand what strong emotional reactions are experienced by doctors working in specialist palliative care, the cause of these strong emotional reactions and the impact they have on the lives of palliative care doctors. Qualitative descriptive design included grounded theory techniques. Semi-structured, audio-recorded individual interviews explored doctors' memories of strong emotional reactions and challenging aspects in palliative care work, how emotions were managed and affected doctors' lives. Twenty doctors were recruited from a specialist palliative care service within a public health network in Melbourne, Australia, comprising of two inpatient units, a consult service and outpatient clinic. Palliative care doctors experience a myriad of strong emotions in their line of work. Experiences found to elicit strong emotional reactions included patient, family and staff distress and organizational issues. Strong emotional reactions impacted clinical behaviours, patient care and doctors' personal lives. Strategies developed for managing strong emotional reactions included debrief, setting boundaries, avoidance and self-reflection, along with non-work strategies such as time with family. Whilst emotionally challenging experiences are unavoidable and necessary in a palliative care doctor's development, doctors need to be supported to avoid adversely impacting patient care or their own wellbeing.