How do physicians perceive and manage the influence of their personal end-of-life preferences on clinical practice and end-of-life decision-making with patients? An international qualitative study.

Abstract

Background: Physicians are frequently asked what they would do in the position of their patients, and they have significant influence on end-of-life decisions. Therefore, it is crucial to understand the connection between physicians' personal end-of-life preferences and their clinical practice and the impact of this connection on patient care.

Objectives: To explore how physicians perceive and manage the impact of their end-of-life preferences on their clinical practice and end-of-life decision-making.

Design: Exploratory qualitative study using in-depth interviews.

Methods: Forty-five interviews were conducted from January to November 2022 using a semi-structured interview guide. Participants included three types of physicians: general practitioners, palliative care physicians, and other medical specialists in Belgium (Flanders), Italy, and the United States (Wisconsin). Data collection and analysis were informed by the reflexive thematic analysis approach. Audio recordings were transcribed verbatim, and NVivo 12 was used for coding and analysis. Consolidated criteria for reporting qualitative research (COREQ) was followed.

Results: Physicians acknowledge the impact of their personal end-of-life preferences on their clinical practice and emphasize the importance of maintaining objectivity and centering decision-making on patient preferences. Physicians adopt strategies to mitigate potential biases. There is a divergence of opinion about whether it is appropriate to share when asked what they would do in the position of their patients. Most believe focusing on patients' values and priorities is essential and others feel sharing is crucial to maintain trust. Physicians struggle with ethical tensions and moral discomfort, particularly when patients' requests conflict with their beliefs. Physicians experience personal and professional growth through end-of-life discussions and reflection.

Conclusion: Physicians recognize and attempt to manage the impact of their own end-of-life preferences on their clinical practice. Physicians are not in agreement about sharing when asked what they would do in the situation of their patients.