The imminent death of a patient is riddled with emotions for a patient and family as well as the medical team. A study based on the reflections of third-year Loyola University Chicago Stritch School of Medicine students is shedding light on the struggle physicians in training often face when trying to control their own emotions while not becoming desensitized to the needs of the dying patient and his or her family.
"Medical students are very aware they are undergoing a socialization process by which they become desensitized to the difficult things they see every day in the hospital. They realize this is necessary to control their emotions and focus on caring for the patients. On the other hand, they are very concerned about becoming insensitive to the spiritual, emotional and personal needs of the patient," said Mark Kuczewski, PhD, leader author and director of the Loyola University Chicago Stritch School of Medicine Neiswanger Institute for Bioethics.
The study published in the January issue of Academic Medicine, a peer-reviewed medical journal, focused on a randomized group of Loyola third-year medical students who were asked to write an essay reflecting on their personal experience as part of a team caring for a dying patient. The students were asked to think about patient care, communication, compassionate presence and personal/professional development.
The assignment was given two months into their clinical rotation and was to be completed five months later allowing the student to complete five of their required clerkships.
The essays were coded using a multistep process and content-analysis approach. A bioethicist, physician and medical school chaplain independently read and coded the essays looking for emerging themes. The team then met together to compare themes and resolve discrepancies. Four themes emerged from the 68 student responses: communication, compassionate presence, patient care and personal and professional development.
The study found that conveying the prognosis of death to patients was understandably difficult-but not just the manner in which it was conveyed, but also who conveyed it.
"Students observed how their teams delivered and explained the prognosis. Conversely they also wrote how teams avoided it," the study reported.
"Students reported no matter how well a physician communicated a prognosis, families and individual family members absorbed and digested the information in their own manner and at their own pace."
The study also pointed out the importance of the medical team having a compassionate presence beyond routine medical interactions, such sharing interests, conveying affection or continuing to show interest in the patient after treatment had ended.
The study affirmed the importance of the medical care team understanding that a patient is body and soul, acknowledging there needs to be emotional and spiritual support for dying patients and their families.
