Supporting resident and senior doctors as they navigate ethical issues in end-of-life care: a qualitative inquiry informed by co-design.

OBJECTIVE: Literature identifies that doctors struggle in navigating ethical issues at the end of life. Residents look to senior doctors for support. Senior doctors are aware of the latter's needs. However, systemic factors and clinical demands preclude attention being given to the impact on both groups. The question arose as to what both groups working together would identify as the best support. METHOD: Study design was qualitative, informed by the principles of co-design. 12 resident and 15 senior doctors participated in 6 workshops. Senior and resident doctors worked collaboratively to identify the best support. Inductive content analysis of the recorded group discussion followed. RESULTS: Practising medicine was practising ethics-both of which involved human relationships. Senior doctors acknowledged that constraints in the practice context and lack of clinical experience contributed to residents' concerns about patient harm. Lack of support for resident doctors coping with ethical issues when patients were dying was itself an ethical issue. Coping, as a resident in a system under pressure, was challenging. Senior and resident doctors unanimously believed that taking time for support was paramount. Acknowledging human vulnerability was the second most valued strategy. Informal debriefing, either at the time or later, was identified as the third. CONCLUSION: In determining how to support doctors and specifically residents we need to understand the context in which doctors work. Including both groups in identifying the solution, we found that central to any intervention is taking time to acknowledge the human impact and fostering relational support.