Programme no. 327-OP
“The difficulty of being present” - a focus group study on nursing home doctors` challenges in end-of-life care.
Kristian Jansen*1, Margrethe Aase Schaufel2, Sabine Ruths3
1Research Unit for General Practice,Uni Research Health,Bergen,Norway;Department of Global Public Health and Primary Care,University of Bergen,Bergen,Norway, 2Research Unit for General Practice,Uni Research Health,Bergen,Norway;Department of Thoracic Medicine,Haukeland University Hospital,Bergen,Norway, 3Research Unit for General Practice,Uni Research Health,Bergen,Norway;Department of Global Public Health and Primary Care,University of Bergen,Bergen,Norway
* = Presenting author
Objectives: To explore nursing home physicians` challenging experiences in end-of-life care.
Background: High quality end-of-life care involves a complex assessment of the patients’ physical, cognitive and emotional symptoms, as well as spiritual needs and quality of life. Dealing with patients’ and families’ thoughts and expectations regarding end-of-life care demand good communication and consensus between staff, as well as with the patient and her family.
Results: Participants described the need for skill and consideration in dialogue with patients and next-of-kin, each in their different place in the process of accepting the inevitable end of life. Physicians felt helpless in the failure of treatment, palliation or comforting of the dying and bereaved. Profound meetings with the dying, and reverence for the beauty of life in death, provided strength to endure work.
Material/Methods: We conducted a qualitative study based on three focus group interviews with purposive samples of nursing home doctors (n=17, age span 33-65). The interview guide had the following question as a starting point for discussion: “Could you please tell us about an episode treating seriously ill or dying nursing home patients that made a profound impression on you?” The interviews were taped and transcribed verbatim. Data from the focus groups were analysed following Systematic Text Condensation.
Conclusion: Training for nursing home doctors should encourage awareness of personal involvement and coping in working with the dying, and instruct the advance care dialogue process with patient and next-of-kin.
Points for discussion: 1. Transferability of the results may be discussed, as the study is limited to doctors from relatively urban nursing homes on the west coast of Norway. 2. In Norway, almost half of all deaths occur in nursing homes. 3. As a qualitative study it does not describe distribution of views, but may provide insight into how nursing home doctors think in their work, and which skills they find useful.