How individual ethical frameworks shape physician trainees’ experiences providing end-of-life care: a qualitative study
-
Published:2021-02-16
Issue:12
Volume:47
Page:e72-e72
-
ISSN:0306-6800
-
Container-title:Journal of Medical Ethics
-
language:en
-
Short-container-title:J Med Ethics
Author:
Rosenwohl-Mack Sarah,Dohan Daniel,Matthews Thea,Batten Jason Neil,Dzeng Elizabeth
Abstract
ObjectivesThe 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.DesignWe 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.SettingAcademic teaching hospitals in the United States and United Kingdom.ParticipantsWe 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.ResultsSome 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.ConclusionsThis 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.
Funder
UCSF Gibbs Family Medicine Fellowship
California Department of Public Health Alzheimer’s Disease Research Award
National Institute for Aging Grants for Early Medical/Surgical Subspecialty Transition to Aging Research
Subject
Health Policy,Arts and Humanities (miscellaneous),Issues, ethics and legal aspects,Health(social science)
Cited by
1 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献