Facilitating Decision Making at End of Life: How Physicians’ Experiences Can Inform the Work of Clinical Ethicists

BACKGROUND: End-of-life treatment decisions can be morally complex and may lead to contention. Clinical ethicists are often consulted to address uncertainty or conflict during end-of-life decision-making. This study explores physicians' perceptions of challenges to end-of-life decision-making to help inform clinical ethics practice. METHODS: Semi-structured interviews were conducted with surgeons, nephrologists, intensivists, emergency physicians, and oncologists regarding challenges and barriers to effective end-of-life decision-making. Interview transcripts were thematically analyzed. RESULTS: We identified seven themes regarding barriers and challenges to end-of-life decision-making, including 1) physicians' emotional discomfort, 2) organizational barriers, 3) differing perceptions of goals and expectations, 4) appeals to hope and miracles, 5) patient and family mistrust, 6) interfamily dynamics, and 7) patient and family psychological factors. CONCLUSIONS: Physician, organizational, patient, and family factors can interact to cause misunderstandings, distress, and mistrust that can delay or stymie communication and decision-making. Clinical ethicists can help physicians identify, acknowledge, and address important but often overlooked factors such as emotional burdens, psychosocial context, and the importance of building trusting relationships.