title: Identifying barriers to psychosocial spiritual care at the end of life: a physician group study.
abstract: OBJECTIVE
  The recent literature addresses the need to improve care for dying patients. The purpose of this study was to identify barriers to the psychosocial spiritual care of these patients by their physicians. Psychosocial spiritual care is defined as aspects of care concerning patient emotional state, social support and relationships, and spiritual well-being. The study was an exploratory means for generating hypotheses and identifying directions for interventions, research, and training in care for the dying.
  
  
  METHODS
  The study used a qualitative group discussion format. Seventeen physicians at a university-based health sciences center representing 10 areas of medical specialty--including internal medicine, oncology, pediatrics, and geriatrics met in two groups for 20 75-minute discussion sessions over the course of one year. Discussions were recorded, analyzed, and categorized.
  
  
  RESULTS
  Barriers to psychosocial spiritual care were grouped into three domains and seven themes. The cultural domain included the themes of training, selection, medical practice environment, and debt/delay. Participants believed that medical selection and training combine to marginalize psychosocial spiritual approaches to patient care, while the practice environment and debt/delay augment emotional isolation and dampen idealism. The organizational domain included the themes of dissatisfaction and time/business. Physicians indicated that the current reimbursement climate and time pressures contribute to dissatisfaction and the tendency to avoid patient psychosocial spiritual issues. The clinical domain included the theme of communication. Physicians were concerned about their ability to communicate nonmedical issues effectively and manage the patient s reactions and needs in the psychosocial spiritual arena.
  
  
  CONCLUSIONS
  This study suggests that research and educational approaches to improving the psychosocial spiritual care of the dying by physicians should address barriers at the cultural, organizational, and clinical levels. Suggestions for interventions at various levels are offered.
authors.affiliation: Department of Psychiatry, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Chibnall
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Bennett
authors.forename: Susan D
authors.initials: SD
authors.lastname: Videen
authors.forename: Paul N
authors.initials: PN
authors.lastname: Duckro
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D000739:Anecdotes as Topic; D001291:Attitude of Health Personnel; D003144:Communication Barriers; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods* / Q000523:psychology; D010819:Physician's Role; D010817:Physician-Patient Relations; D029181:Spirituality; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods* / Q000523:psychology; D013997:Time Factors