How individual ethical frameworks shape physician trainees’ experiences providing end-of-life care
A qualitative study
Bibliographic Data
| ID | 21515331 |
|---|---|
| Authors | Sarah 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, corresponding author) |
| Year | 2021 |
| Volume | 47 |
| Issue | 12 |
| Pages | e72-e72 |
| Publication date | 2021-12-01 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | Journal of Medical Ethics (JOURNAL) |
| Journal identifiers | ISSN: 0306-6800 • E-ISSN: 1473-4257 |
| Publisher | BMJ (PUBLISHER • GB) |
| DOI | 10.1136/medethics-2020-106690 |
| PMID | 33593875 |
| OpenAlex | W3132525839 |
| Language | EN |
| Citations received | 2 |
| References cited | 21 |
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
Ethics needs principles—four can encompass the rest—and respect for autonomy should be “first among equals”
Shared Decision Making
The Social Transformation of American Medicine
Using thematic analysis in psychology
Habermasian communication pathologies in do‐not‐resuscitate discussions at the end of life
How Many Interviews Are Enough
| Unique citing works | 2 |
|---|---|
| Citations per year | 2 |
| Citation span | 2025 - 2025 (1) |
| Citation velocity | recent |
| Highly cited | No |
| Citation types | Neutral: 2 |