“Sharing in hopes and worries”—a qualitative analysis of the delivery of compassionate care in palliative care and oncology at end of life

ABSTRACT

Purpose: To explore the methods through which physicians deliver compassionate care during end-of-life (EOL). Compassionate care provides benefits to patients and providers and is particularly important for patients with serious illnesses, yet its practice remains limited. We aim to qualitatively characterize methods utilized by physicians that facilitate the delivery of compassionate care at EOL.

Methods: We conducted 13 semi-structured interviews with physicians from palliative care and medical oncology subspecialities at a rural academic medical centre in New Hampshire. Interviews were transcribed and analysed using a qualitative research design.

Results: Participants described methods of compassionate care ranging from symptom control to less tangible, non-verbal methods. Primary barriers to the delivery of compassionate care were described as within the broader healthcare system and within the inherent emotional difficulty of EOL care. Physicians from both subspecialities emphasized the importance of successful inter-provider relationships.

Conclusions: Methods for delivering compassionate care at EOL are wide ranging, but barriers on a systemic and individual level should be addressed to make its practice more widespread. This can be accomplished, in part, by the standardization of EOL conversations, training physicians how to have meaningful EOL conversations, and integration of such conversations into electronic medical records.

KEYWORDS:

• Compassionate care
• end of life
• palliative care
• oncology
• compassion fatigue

Authors’ contributions

Bessen Sarah and Jain Raina H. wrote the manuscript. Bessen, Brooks, Jain, and Mishra designed the study protocol. Bessen and Jain collected the data, coded transcripts, and performed the analyses. All authors were involved in reviewing the final transcript and provided final approval. Bessen and Jain contributed equally to this paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The authors have no funding to report.

Notes on contributors

Sarah Bessen

Sarah Bessen and Raina Jain are second year medical students at the Geisel School of Medicine at Dartmouth. Sarah complete her BA in Anthropology at Dartmouth College, and Masters in Public Health at The Dartmouth Institute for Health Policy and Clinical Practice. in Hanover, New Hampshire. Raina completed her BA in Biological Sciences at Columbia University.

Raina H. Jain

W. Blair Brooks is a Associate Professor of Medicine at the Geisel School of Medicine at Dartmouth. He completed his BA at Harvard University in 1975, and medical degree at Dartmouth Medical School in 1979. His research interests include communication skills and end of life care.

Manish Mishra

Manish K. Mishra, MD, MPH is an assistant professor at the Geisel School of Medicine and the Director of Professional and Outreach Education at The Dartmouth Institute. He received his BA from Harvard University, earned his medical degree from Dartmouth Medical School, and completed a Masters in Public Health at The Dartmouth Institute for Health Policy and Clinical Practice.