Relationship between physicians’ death anxiety and medical communication and decision-making: A systematic review

Objective: To examine the relationship between physicians’ death anxiety and medical communication and decision-making. It was hypothesized that physicians’ death anxiety may lead to the avoidance of end-of-life conversations and a preference for life-prolonging treatments. Methods: PubMed and PsycInfo were systematically searched for empirical studies on the relation between physicians’ death anxiety and medical communication and decision-making. Results: This review included five quantitative and two qualitative studies (N = 7). Over 38 relations between death anxiety and communication were investigated, five were in line with and one contradicted our hypothesis. Physicians’ death anxiety seemes to make end-of-life communication more difficult. Over 40 relations between death anxiety and decision-making were investigated, three were in line with and two contradicted the hypothesis. Death anxiety seemes related to physicians’ guilt or doubt after a patient's death. Conclusions: There was insufficient evidence to confirm that death anxiety is related to more avoidant communication or decision-making. However, death anxiety does seem to make end-of-life communication and decision-making more difficult for physicians. Practice implications: Education focused on death and dying and physicians’ emotions in medical practice may improve the perceived ease with which physicians care for patients at the end of life.