Journeying with the Dying-Lessons from Palliative Care Physicians.

Area of Science:

• Medical Ethics
• Psychology
• Sociology

Background:

• Palliative care physicians face moral distress and emotional exhaustion from witnessing suffering and death.
• Professional identity formation (PIF) is significantly influenced by how physicians derive meaning from these experiences.
• Existing models like the Ring Theory of Personhood (RToP) and Krishna-Pisupati Model (KPM) can map PIF and coping mechanisms.

Purpose of the Study:

• To explore the impact of end-of-life patient care on the personhood of palliative care physicians.
• To investigate how physicians make sense of and cope with challenging experiences in palliative care.
• To assess the role of RToP and KPM in understanding physician identity and support needs.

Main Methods:

• Conducted semi-structured interviews with 13 palliative care physicians at a cancer specialist center.
• Employed content and thematic analysis on interview transcripts to identify key experiences and domains.
• Utilized RToP and KPM frameworks to analyze the data related to identity formation, conflicts, and support systems.

Main Results:

• Physicians' identities are shaped by innate, individual, relational, and societal belief systems, integrating personal and professional selves.
• Meaning-making and adaptation to cultural and professional expectations are facilitated by these intertwined identities.
• A significant finding was the physicians' underrecognition of their own support needs amidst evolving personal, existential, and clinical factors.

Conclusions:

• Palliative care physicians develop robust identities enabling them to find meaning in their work.
• There is an urgent need for ongoing surveillance and timely, appropriate support for these physicians.
• A RToP-based tool and portfolio system could help detect and direct support to physicians in need.