Physician-patient boundaries in palliative care

Area of Science:

• Medical Ethics
• Palliative Care
• Psychology

Background:

• Effective physician-patient relationships are crucial for patient-centered care.
• Palliative care physicians may engage in boundary-crossings to foster these relationships.
• Boundary-crossings are individualized and susceptible to ethical violations.

Purpose of the Study:

• To explore the impact of boundary-crossings on palliative care physicians' belief systems.
• To utilize the Ring Theory of Personhood (RToP) to analyze these effects.
• To understand the ethical considerations in physician-patient boundary management.

Main Methods:

• A systematic scoping review using the Systematic Evidence-Based Approach (SEBA) methodology.
• Development of a semi-structured interview questionnaire for palliative care physicians.
• Content and thematic analysis of interview transcripts, integrating findings with the Jigsaw Perspective.

Main Results:

• Identified domains of 'catalysts' and 'boundary-crossings' from 12 interviews.
• Boundary-crossings aim to address threats to physicians' belief systems (catalysts).
• Individualized judgment, reflection, and balancing of considerations influence boundary-crossing actions, with potential for unchecked breaches.

Conclusions:

• The Krishna Model emphasizes longitudinal support, assessment, and oversight for palliative care physicians.
• Findings support the development of a Ring Theory of Personhood (RToP)-based portfolio tool.
• Effective management of boundary-crossings is vital for maintaining professional standards and physician well-being.