Features of the Worldview of Pediatric Palliative Care Physicians: an Interpretative Phenomenological Analysis

Abstract

Pediatric palliative care is a multidisciplinary branch of medicine and health care that includes both biomedical techniques of patient care and social and psychological practices. At the same time, its goal differs from that of curative approaches in medicine and is predominantly to alleviate patients’ suffering. We used the qualitative method of Interpretative Phenomenological Analysis (IPA), which allows us to uncover the «inside», emotional and existentially significant dimensions of respondents’ personal and intersubjective experiences. This method provides an «insider» perspective of the community under study. The article presents the results of IP. interviews with nine doctors of pediatric palliative care working in the Russian health care system and taking specialized advanced training courses. The goals of the study were to identify the most subjectively significant factors for physicians of palliative care for children, influencing the ethical and communicative aspects of interaction with patients and their parents, and to identify the most important problems and issues of concern to specialists, with an emphasis on worldview. Semi-structured interviews were conducted using a specially designed questionnaire and mainly addressed the topics and issues of worldview of palliative care physicians (including the role of faith and religion) in the context of communication with patients and their parents. As a result, it was found that doctors typically assess their work as a vocation (in a number of cases — with explicitly religious attribution), and this is used by part of the respondents as a justification of their activities in front of a critically minded environment. A common view of a hospice is that of a place that needs to be comfortable, home-like. Subjectively, the majority of respondents evaluate themselves as Orthodox Christians, but emphasize the «non-fanatical» nature of their faith. At the same time, respondents note the significant influence of parental religiosity on communication patterns and acceptance of inevitable disease outcomes. Most respondents noted a high need for a spiritual counsellor in the hospice. Respondents do not necessarily insist that the counsellor be a priest, but his or her figure in the physicians’ descriptions has distinct confessional features.