title: Relationships between personal attitudes about death and communication with terminally ill patients: How oncology clinicians grapple with mortality.
abstract: OBJECTIVE
  Clinician discomfort with death may affect care of patients but has not been well-studied. This study explores oncology clinicians' attitudes surrounding their own death and how these attitudes both affect and are affected by their care of dying patients and their communication with them.
  
  
  METHODS
  Qualitative interviews with physicians (n=25), nurse practitioners (n=7), and physician assistants (n=1) in medical or hematologic oncology clinical practices about communication styles, care of terminally ill patients, and personal perspectives about mortality.
  
  
  RESULTS
  Clinicians described three communication styles used with patients about death and dying: direct, indirect, or selectively direct. Most reported an acceptance of their mortality that was "conditional," meaning that that they could not fully know how they would respond if actually terminally ill. For many clinicians, caring for dying patients affected their outlook on life and death, and their own perspectives on life and death affected their approach to caring for dying patients.
  
  
  CONCLUSIONS
  An awareness of personal mortality may help clinicians to discuss death more openly with patients and to provide better care.
  
  
  CONCLUSIONS
  Efforts to promote self-awareness and communication training are key to facilitating clear communication with and compassionate care of terminally ill patients.
authors.affiliation: University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA. Electronic address: rachel_rodenbach@urmc.rochester.edu.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Rodenbach
authors.affiliation: University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA.
authors.forename: Kyle E
authors.initials: KE
authors.lastname: Rodenbach
authors.affiliation: Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA.
authors.forename: Mohamedtaki A
authors.initials: MA
authors.lastname: Tejani
authors.affiliation: Department of Family Medicine, University of Rochester Medical Center, 1381 South Ave, Rochester, NY 14620, USA.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Epstein
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D003142:Communication; D003643:Death; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000523:psychology; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research; D013727:Terminal Care; D019452:Terminally Ill
keywords: Death and dying; End of life care; Oncology; Physician–patient communication; Qualitative