The Development Of Death Competency In Healthcare Professionals: The Role Of Patient Death Event Appraisal

This thesis focuses on the development of death competency – a person’s skills and capabilities in dealing with death as well as their beliefs and attitudes about these capabilities (Robbins, 1994) - in healthcare professionals working in both traditional roles (doctors and nurses) and non-traditional, emerging roles (end of life doulas). Death competency is a highly relevant attribute for individuals for whom dealing with death is part of their professional role. It has been argued that death competency development is an ethical imperative due to the demonstrated negative effects of low death competency, namely burnout, compassion fatigue and poor-quality patient-practitioner communication (Chi Ho Chan, 2015; Gamino & Ritter, 2012). As experiencing a death event can be considered a stressful life event, and that responses to a death event may depend on individual appraisal of the event (Kessler, Heron & Dopson, 2012), this thesis explores the role of appraisal of early-career death events and looks at how these appraisals, and subsequent levels of death competency, differ between professional roles.

The studies contained within this thesis begin with a systematic review and meta-synthesis of existing literature related to psychological factors influencing healthcare professionals’ responses to early career patient death events, followed by a mixed methods study which generated qualitative data and quantitative data via an online survey. Qualitative data collected concerned participants appraisal of their first experience of a death event, quantitative data collection involved a measure of appraisal of these events and a measure of death competency. Survey participants were doctors, nurses and end of life doulas working in the UK.

Method triangulation (Polit & Beck, 2012) was used to bring together findings from the three phases of studies – meta-synthesis findings, qualitative data analysed using template analysis, and a multiple regression used to analyse quantitative data to explore possible predictors of death competency. A reflexivity chapter is presented to explore the role of the researcher as an ‘insider-researcher’ from a practising end of life doula perspective.

Key findings were as follows: controllability and challenge aspects of event appraisal were recurring themes throughout the data suggesting that these may be beneficial areas for future research; professional role affected individual appraisals of patient death events and end of life doulas had higher death competency when compared to traditional healthcare roles. Finally, the insider-researcher position provided a unique angle enabling a detailed exploration of possible practice implications of this thesis’ findings including the potential benefits of incorporating aspects of end of life doula training into training for doctors and nurses working in roles which involve supporting patients at the end of life.