title: The impact of existential vulnerability for nursing home doctors in end-of-life care: A focus group study.
abstract: Explore the impact of existential vulnerability for nursing home doctors' experiences with dying patients and their families.
  
  
  
  We conducted a qualitative study based on three focus group interviews with purposive samples of 17 nursing home doctors. The interviews were audio-recorded, transcribed, and analyzed with systematic text condensation.
  
  
  
  Nursing home doctors experienced having to balance treatment compromises in order to assist patients' and families' preparation for death, with their sense of professional conduct. This was an arduous process demanding patience and consideration. Existential vulnerability also manifested as powerlessness mastering issues of life and death and families' expectations. Standard phrases could help convey complex messages of uncertainty and graveness. Personal commitment was balanced with protective disengagement on the patient's deathbed, triggering both feelings of wonder and guilt.
  
  
  
  Existential vulnerability is experienced as a burden of powerlessness and guilt in difficult treatment compromises and in the need for protective disengagement, but also as a resource in communication and professional coping.
  
  
  
  End-of-life care training for nursing home doctors should include self-reflective practice, in particular addressing treatment compromises and professional conduct in the dialogue with patient and next-of-kin.
authors.affiliation: Research Unit for General Practice, Uni Research Health, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Norway. Electronic address: jansen.kristian@gmail.com.
authors.forename: Kristian
authors.initials: K
authors.lastname: Jansen
authors.affiliation: Research Unit for General Practice, Uni Research Health, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Norway.
authors.forename: Sabine
authors.initials: S
authors.lastname: Ruths
authors.affiliation: Research Unit for General Practice, Uni Research Health, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Norway; Research Unit for General Practice in Copenhagen, Denmark.
authors.forename: Kirsti
authors.initials: K
authors.lastname: Malterud
authors.affiliation: Research Unit for General Practice, Uni Research Health, Bergen, Norway; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
authors.forename: Margrethe Aase
authors.initials: MA
authors.lastname: Schaufel
mesh_terms: D000368:Aged; D001293:Attitude to Death; D003142:Communication; D005086:Existentialism / Q000523:psychology; D005190:Family; D005260:Female; D017144:Focus Groups; D017051:Hospice Care; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000458:organization & administration*; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011368:Professional-Family Relations; D036301:Qualitative Research; D013727:Terminal Care / Q000379:methods / Q000523:psychology*; D000078329:Workforce
keywords: Doctor; End-of-life care; Existential; Nursing home