This study examined hospice physicians' understanding of and attitudes toward existential suffering and palliative sedation, including their understanding of existential suffering, their responses to existential suffering, their use of palliative sedation as a treatment for existential suffering, and the influences on physicians' attitudes and behaviors about palliative sedation. Data were collected through a semi-structured, one-on-one, in-person interview conducted with five physicians employed at one hospice. Each interview was audio-recorded and lasted approximately 60 minutes. The data were examined using thematic analysis. The physicians had consistent views regarding the complex nature of existential suffering and agreed that it is difficult to define and diagnose. They explained that they alleviate existential suffering by helping patients work through it through conversation over time (usually with other hospice team members). The physicians unanimously emphasized that palliative sedation should be a last resort—and typically given only for intractable physical suffering. Examination of the influences on physicians' decisions to administer palliative sedation revealed that their background, training, and experiences, as well as their personal values and beliefs, countertransference, their assessment of patient's actual need, and ethical concerns influenced their decisions about palliative sedation. Four recommendations are offered based on the study results: Increase physicians' comfort and competence with patients' existential suffering, incorporate training in the use of self for physicians, destigmatize the intervention of palliative sedation, and revisit the terminology of palliative sedation. Limitations affecting the study include small sample size as well as possible researcher bias due to her experience as a hospice social worker and views about palliative sedation. Continued qualitative research throughout the medical field is recommended to further build the body of knowledge about physicians' understanding of and response to patients' existential suffering.
|Advisor:||Washburn, Allyson M.|
|Commitee:||Barrett, Carol, Johnson, Zonya|
|School Location:||United States -- California|
|Source:||DAI-B 74/10(E), Dissertation Abstracts International|
|Subjects:||Mental health, Medical Ethics, Medicine|
|Keywords:||Death and dying, Existential suffering, Hospice, Palliative care, Palliative sedation, Physician attitudes|
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