Abstract
BackgroundSupporting physicians in Intensive Care Units (ICU)s as they face dying patients at unprecedented levels due to the COVID-19 pandemic is critical. Amidst a dearth of such data and guided by evidence that nurses in ICUs experience personal, professional and existential issues in similar conditions, a systematic scoping review (SSR) is proposed to evaluate prevailing accounts of physicians facing dying patients in ICUs through the lens of Personhood. Such data would enhance understanding and guide the provision of better support for ICU physicians.MethodsAn SSR adopts the Systematic Evidenced Based Approach (SEBA) to map prevailing accounts of caring for dying patients in ICUs. To enhance the transparency and reproducibility of this process, concurrent and independent use of tabulated summaries, thematic analysis and directed content analysis (Split Approach) is adopted.ResultsEight thousand three hundred fifty-eight abstracts were reviewed from four databases, 474 full-text articles were evaluated, 58 articles were included, and the Split Approach revealed six categories/themes centered around the Innate, Individual, Relational and Societal Rings of Personhood, conflicts in providing end of life care and coping mechanisms employed.ConclusionThis SSR suggests that caring for dying patients in ICU impacts how physicians view their personhood. To resolve conflicts within individual concepts of personhood, physicians use prioritization, reframing and rely on accessible, personalized support from colleagues to steer coping strategies. An adapted form of the Ring Theory of Personhood is proposed to direct timely personalized, appropriate and holistic support.
Highlights
Supporting physicians in Intensive Care Units (ICU)s as they face dying patients at unprecedented levels due to the COVID-19 pandemic is critical
The primary research question was determined to be: “what is known of how physicians contend with death and dying in the adult ICU setting?” and the secondary questions: “what is the impact of caring for dying patients on physicians in the adult ICU?” and “how do these effects manifest?”
The data rebuffs the notion that ‘single point interventions’ such as debrief sessions following a difficult case or a meeting with a psychologist or counsellor will sufficiently address the complex effects on their psycho-social, existential, personal and professional self-concepts. Rather this systematic scoping review (SSR) will argue for a more longitudinal and holistic response to the support of ICU physicians that entails careful study of their individual concepts of personhood. Contemplating these effects through the lens of the Ring Theory of Personhood (RToP) suggest that support should be directed at the beliefs, values and principles (Internal Constituents or Internal constituent (IC)) contained within the different rings of the ICU physician’s personhood
Summary
Supporting physicians in Intensive Care Units (ICU)s as they face dying patients at unprecedented levels due to the COVID-19 pandemic is critical. Amidst a dearth of such data and guided by evidence that nurses in ICUs experience personal, professional and existential issues in similar conditions, a systematic scoping review (SSR) is proposed to evaluate prevailing accounts of physicians facing dying patients in ICUs through the lens of Personhood. Received knowledge suggests that these experiences impact the emotional, psychological and physical wellbeing of ICU physicians, though there is little understanding of how these complex, frequently and closely related issues arise, much less are supported [3,4,5] This dearth of data has raised concerns about how ICU physicians cope amidst the COVID-19 pandemic. Better understanding of how ICU physicians cope with death and dying could inform efforts to support them during the pandemic and beyond
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