Journeying with the Dying-Lessons from Palliative Care Physicians

Abstract

Witnessing suffering and death in palliative care can cause moral distress, emotional exhaustion and maladaptive coping strategies. How sense and meaning is made from these experiences influences how physicians think, feel and act as professionals (professional identity formation or PIF). It also determines how they cope with their roles, care for patients and interact with other professionals. Timely, personalised and appropriate support is key as shaping how these physicians develop and contend with sometimes competing beliefs and roles. The Ring Theory of Personhood (RToP) and the Krishna-Pisupati Model (KPM) offer a means of mapping PIF and thus moulding, coping and meaning making. This study uses the RToP and KPM to explore how caring for end-of-life patients impacts the personhood of palliative care physicians. Semi-structured interviews with a purposive sample of 13 palliative care physicians-eleven females and two males aged between 35 and 50 years-at a cancer specialist centre were conducted. Transcripts of the audio-recorded interviews underwent content and thematic analysis where complementary themes and categories identified were combined to form domains that highlighted the physicians' key experience of providing end-of-life care. The domains identified were (1) identity formation, (2) conflicts, (3) KPM elements and (4) support systems. Together, results revealed that palliative care physicians are driven by Innate, Individual, Relational and Societal belief systems that create an intertwined professional and personal identity, enabling them to find meaning in their experiences and adapt to present contexts within cultural norms and professional expectations. However, their failure to recognise their need for support when hampered by evolving personal, existential and clinical factors underlines the exigency for ongoing surveillance and a potential role for a RToP-based tool and portfolio system that can detect and direct timely, appropriate support to in-need physicians.

Supplementary information: The online version contains supplementary material available at 10.1007/s41649-024-00321-5.

Keywords: Death and dying; Doctor-patient relationship; Palliative care; Personhood; Physician–patient relationship; Professional identity formation.

Fig. 1

The Ring Theory of Personhood (RToP) (Radha Krishna and Alsuwaigh 2015)

Fig. 2

The Krishna-Pisupati Model of professional identity formation (KPM)

Fig. 3

The Systematic Evidence-Based Approach (SEBA) (Ho et al. 2022)