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Palliative and end of life care and junior doctors’ a systematic review and narrative synthesis

Abstract:
Background Palliative and end-of-life care is a core competency for doctors and is increasingly recognised as a key clinical skill for junior doctors. There is a growing international movement to embed palliative care education in medical student and junior doctor education. To date there has been no review of the literature concerning the views and experiences of junior doctors delivering this care. Aim To review the published literature between 2000 and 2019 concerning junior doctors’ experience of palliative and end-of-life care. Methods Systematic literature review and narrative synthesis. Results A search of six databases identified 7191 titles; 34 papers met the inclusion criteria, with a further 5 identified from reference searching. Data were extracted into a review-specific extraction sheet and a narrative synthesis undertaken. Three key themes were identified: (1) ‘Significance of death and dying’: all papers found that junior doctors care for many patients approaching the end of life, and this often causes emotional distress and can leave persisting memories for many years afterwards; (2) ‘Thrown in at the deep end’: junior doctors feel unprepared and unsupported in providing palliative and end-of-life care; and (3) ‘Addressing the gaps’: junior doctors often experience a medical culture of disengagement towards dying patients and varying attitudes of senior doctors. Subsequently they have to learn the skills needed through seeking their own opportunities. Conclusion Medical education needs to change in order to better prepare and support junior doctors for their role in caring for dying patients. This education needs to focus on their knowledge, skills and attitudes.
Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.1136/bmjspcare-2019-001954

Authors


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Institution:
University of Oxford
Division:
MSD
Department:
NDM
Oxford college:
Harris Manchester College
Role:
Author


Publisher:
BMJ Publishing Group
Journal:
BMJ Supportive and Palliative Care More from this journal
Volume:
12
Issue:
e6
Pages:
e862-e868
Publication date:
2019-11-13
Acceptance date:
2019-10-28
DOI:
EISSN:
2045-4368
ISSN:
2045-435X


Keywords:
Pubs id:
pubs:1070579
UUID:
uuid:fad24fb8-81b4-424d-9891-2e7fa2de9c31
Local pid:
pubs:1070579
Source identifiers:
1070579
Deposit date:
2019-11-08

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