Navigating end-of-life conversations in an oncology setting: a qualitative study of physician and patient perspectives

Clear communication at the end of life is recognised as essential in oncology, but research highlights persistent challenges in addressing the multiple dimensions of these conversations, including clinical priorities and patients’ emotional needs. This study explores how physicians and patients navigate conversations at the end of life within the context of terminal cancer. Semi structured interviews were conducted with four patients diagnosed with terminal cancer and four oncology physicians, at a busy oncology clinic, in a major UK city. Data was analysed using reflexive thematic analysis. Findings suggest that conversations at the end of life are influenced by the conflicting demands of biomedical priorities and patients’ psychosocial needs. Physicians tended to prioritise clinical issues and often avoided existential topics, while patients placed greater emphasis on emotional and spiritual aspects of their experience. Factors such as perceived patient denial, differing attitudes towards family involvement and cultural or religious influences, contributed to these differences. A further dynamic was identified in relation to empathy. Most patients described physicians as empathetic and attentive, whereas physicians reported the emotional strain of repeated exposure to illness and dying and described experiences of ‘empathy fatigue’. The varying accounts of empathy do not necessarily indicate opposing perspectives, rather they seem to reflect the positions occupied by patients and physicians. Patients evaluated empathy in the context of their individual encounters, while physicians described working in pressurised environments while managing an ongoing emotional load. These findings highlight the need for better education and training to enhance physician awareness and an emphasis on a more holistic approach to end of life care, to include sensitivity to cultural and religious beliefs and familial factors.