Relationships between personal attitudes about death and communication with terminally ill patients: How oncology clinicians grapple with mortality

• Communication styles with dying patients include direct and indirect approaches.
• Most clinicians express a conditional acceptance of their own mortality.
• A reciprocal relationship exists between personal views about death and patient care.
• Some clinicians’ attitudes facilitate open conversations with patients about death.
• Self-awareness and communication training are key to improving end-of-life care.

ObjectiveClinician discomfort with death may affect care of patients but has not been well-studied. This study explores oncology clinicians’ attitudes surrounding their own death and how these attitudes both affect and are affected by their care of dying patients and their communication with them.MethodsQualitative interviews with physicians (n = 25), nurse practitioners (n = 7), and physician assistants (n = 1) in medical or hematologic oncology clinical practices about communication styles, care of terminally ill patients, and personal perspectives about mortality.ResultsClinicians described three communication styles used with patients about death and dying: direct, indirect, or selectively direct. Most reported an acceptance of their mortality that was “conditional,” meaning that that they could not fully know how they would respond if actually terminally ill. For many clinicians, caring for dying patients affected their outlook on life and death, and their own perspectives on life and death affected their approach to caring for dying patients.ConclusionAn awareness of personal mortality may help clinicians to discuss death more openly with patients and to provide better care.Practice implicationsEfforts to promote self-awareness and communication training are key to facilitating clear communication with and compassionate care of terminally ill patients.