Psychological determinants of physician variation in end-of-life treatment intensity: A systematic review and meta-synthesis Review
| Authors: | George, L. S.; Epstein, R. M.; Akincigil, A.; Saraiya, B.; Trevino, K. M.; Kuziemski, A.; Pushparaj, L.; Policano, E.; Prigerson, H. G.; Godwin, K.; Duberstein, P. |
| Review Title: | Psychological determinants of physician variation in end-of-life treatment intensity: A systematic review and meta-synthesis |
| Abstract: | Background: Physicians treating similar patients in similar care-delivery contexts vary in the intensity of life-extending care provided to their patients at the end-of-life. Physician psychological propensities are an important potential determinant of this variability, but the pertinent literature has yet to be synthesized. Objective: Conduct a review of qualitative studies to explicate whether and how psychological propensities could result in some physicians providing more intensive treatment than others. Methods: Systematic searches were conducted in five major electronic databases—MEDLINE ALL (Ovid), Embase (Elsevier), CINAHL (EBSCO), PsycINFO (Ovid), and Cochrane CENTRAL (Wiley)—to identify eligible studies (earliest available date to August 2021). Eligibility criteria included examination of a physician psychological factor as relating to end-of-life care intensity in advanced life-limiting illness. Findings from individual studies were pooled and synthesized using thematic analysis, which identified common, prevalent themes across findings. Results: The search identified 5623 references, of which 28 were included in the final synthesis. Seven psychological propensities were identified as influencing physician judgments regarding whether and when to withhold or de-escalate life-extending treatments resulting in higher treatment intensity: (1) professional identity as someone who extends lifespan, (2) mortality aversion, (3) communication avoidance, (4) conflict avoidance, (5) personal values favoring life extension, (6) decisional avoidance, and (7) over-optimism. Conclusions: Psychological propensities could influence physician judgments regarding whether and when to de-escalate life-extending treatments. Future work should examine how individual and environmental factors combine to create such propensities, and how addressing these propensities could reduce physician-attributed variation in end-of-life care intensity. © 2023, The Author(s), under exclusive licence to Society of General Internal Medicine. |
| Keywords: | mortality; review; psychology; psychological aspect; systematic review; physician; medline; terminal care; end-of-life care; cochrane library; decision making; environmental factor; synthesis; embase; avoidance behavior; decision-making; thematic analysis; optimism; life extension; cinahl; psycinfo; practice variation; human; eligibility criteria; futile care; physician variation; aversion; physician behavior; personal value; low-value care; aggressive care; care intensity; physician psychology |
| Journal Title: | Journal of General Internal Medicine |
| Volume: | 38 |
| Issue: | 6 |
| ISSN: | 0884-8734 |
| Publisher: | Springer |
| Date Published: | 2023-05-01 |
| Start Page: | 1516 |
| End Page: | 1525 |
| Language: | English |
| DOI: | 10.1007/s11606-022-08011-4 |
| PROVIDER: | scopus |
| PMCID: | PMC10160244 |
| PUBMED: | 36732436 |
| DOI/URL: | |
| Notes: | Review -- Export Date: 31 May 2023 -- Source: Scopus |
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