How individual ethical frameworks shape physician trainees’ experiences providing end-of-life care

A qualitative study

Datos Bibliográficos

ID21515331
AutoresSarah Rosenwohl-Mack (0000-0002-2885-9605, University of California, San Francisco), Daniel Dohan (0000-0002-7052-1288, University of California, San Francisco), Thea Matthews (University of California, San Francisco), Jason N Batten (0000-0002-8891-3693, Stanford University), Elizabeth Dzeng (0000-0001-5235-8053, University of California, San Francisco, autor de correspondencia)
Año2021
Volumen47
Número12
Páginase72-e72
Fecha de publicación2021-12-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaJournal of Medical Ethics (JOURNAL)
Identificadores de la revistaISSN: 0306-6800 • E-ISSN: 1473-4257
EditorialBMJ (PUBLISHER • GB)
DOI10.1136/medethics-2020-106690
PMID33593875
OpenAlexW3132525839
IdiomaEN
Citas recibidas2
Referencias citadas21

OBJECTIVES: The end of life is an ethically challenging time requiring complex decision-making. This study describes ethical frameworks among physician trainees, explores how these frameworks manifest and relates these frameworks to experiences delivering end-of-life care. DESIGN: We conducted semistructured in-depth exploratory qualitative interviews with physician trainees about experiences of end-of-life care and moral distress. We analysed the interviews using thematic analysis. SETTING: Academic teaching hospitals in the United States and United Kingdom. PARTICIPANTS: We interviewed 30 physician trainees. We purposefully sampled across three domains we expected to be associated with individual ethics (stage of training, gender and national healthcare context) in order to elicit a diversity of ethical and experiential perspectives. RESULTS: Some trainees subscribed to a best interest ethical framework, characterised by offering recommendations consistent with the patient's goals and values, presenting only medically appropriate choices and supporting shared decision-making between the patient/family and medical team. Others endorsed an autonomy framework, characterised by presenting all technologically feasible choices, refraining from offering recommendations and prioritising the voice of patient/family as the decision-maker. CONCLUSIONS: This study describes how physician trainees conceptualise their roles as being rooted in an autonomy or best interest framework. Physician trainees have limited clinical experience and decision-making autonomy and may have ethical frameworks that are dynamic and potentially highly influenced by experiences providing end-of-life care. A better understanding of how individual physicians' ethical frameworks influences the care they give provides opportunities to improve patient communication and advance the role of shared decision-making to ensure goal-aligned end-of-life care

Autonomy · End-of-life care · Experiential learning · Health care · Medical education · Palliative care · Pedagogy · Political science · Qualitative research · Sociology · Thematic analysis · Ethics in medical practice · Medicine · Nursing · Palliative Care and End-of-Life Issues · Patient-Provider Communication in Healthcare · Psychology