ASPO Abstracts
Examination of Physicians' Perspectives on Compassion and Cultural Humility in End-of-life (EOL) Care Discussions with Cancer Patients.
Category: Behavioral Science & Health Communication
Conference Year: 2023
Abstract Body:
Purpose: This study aimed to identify barriers that impact a physician's ability to effectively conduct difficult end-of-life (EOL) conversations in a compassionate and culturally sensitive manner with diverse cancer patients in an oncology setting. Methods: Physicians in the UC San Diego Moores Cancer Center were invited to participate in a one-time individual qualitative interview to share their perspectives on EOL discussions, burnout, cultural humility, and other factors that affect their experience and interactions with patients. These confidential interviews utilized a semi-structured guide with open-ended questions and follow-up probes, including when discussions become difficult, what barriers prevent physicians from conducting these conversations empathetically, and their ideas for improving EOL discussions. The interviews were transcribed and coded for thematic analysis. Codes were inputted into Dedoose, a research software designed for qualitative and mixed-methods analyses, and code frequencies were analyzed. This process created a final refinement of codes revealing the most common and recurring themes expressed by participants. Results: Ten physicians enrolled in the study and completed the interview. Multiple themes surfaced which included: 1) Institutional factors (e.g., structural demands on physician's time), communication difficulties (e.g., language differences), physician fatigue, and the COVID-19 pandemic were examples of barriers that influenced EOL conversations, 2) Specific recommendations were provided by physicians for further education and training, 3) Physicians emphasized the importance of offering patient-centered care that includes loved ones' involvement, 4) Physicians highlighted their own unique approaches they found to enhance EOL conversations, and 5) Recognition of the emotional impact EOL conversations have on physicians. Conclusions: The results demonstrate the complexities involved in EOL conversations with cancer patients from the perspective of physicians and highlight specific barriers and recommendations for further education and training to increase their effectiveness.
Keywords: End-of-life care, end-of-life conversations, patient centered care