Negotiating emotional and ethical tensions in hospital-based end-of-life cancer care.
TL;DR
The findings indicate that emotional and ethical tensions in end-of-life cancer care cannot be addressed solely at the level of individual healthcare professionals and highlight the need for stronger interdisciplinary collaboration, more inclusive involvement of nurses in decision-making, greater organisational support for emotional labour, and earlier integration of palliative care within acute hospital settings.
Abstract
BackgroundEnd-of-life cancer care is characterised by persistent tensions between curative and palliative approaches, creating emotional and ethical challenges for healthcare professionals.Research aimThis study aimed to explore how healthcare professionals experience and negotiate emotional and ethical tensions in end-of-life cancer care within hospital-based settings, and how these tensions are shaped by clinical, professional, and organisational contexts.Research designA qualitative study using an interpretative design and reflexive thematic analysis was conducted.Participants and research contextSemi-structured interviews were conducted with 25 healthcare professionals, including 15 nurses and 10 physicians, recruited from internal medicine, surgery, and intensive care departments across multiple hospitals in Slovenia. Participants had regular experience caring for patients with advanced cancer at the end-of-life.Ethical considerationsEthical approval was obtained from the Commission of the University of Primorska for Ethics in Human Subjects Research (Approval No: 4264-16-3/2022). Participation was voluntary, written informed consent was obtained from all participants, and confidentiality and anonymity were ensured throughout the study.Findings/resultsFour themes were generated: (1) negotiating the boundaries between life-prolongation and end-of-life care; (2) managing moral responsibility within team and hierarchical structures; (3) regulating emotional engagement to sustain professional functioning; and (4) working within structural constraints shaping care. While physicians primarily framed tensions through clinical decision-making and responsibility, nurses emphasised relational proximity to suffering and constrained professional agency. Emotional and ethical tensions were experienced as continuously produced through the interaction of uncertainty, hierarchy, emotional labour, and organisational conditions.OriginalityThis study provides an integrated interpretative account of how clinical uncertainty, professional hierarchy, emotional labour, and organisational constraints interact in shaping emotional and ethical tensions in hospital-based end-of-life cancer care. It further highlights how these tensions are experienced differently according to professional positioning, particularly the differing relationships between responsibility, relational proximity, and decision-making authority among nurses and physicians.ImpactThe findings indicate that emotional and ethical tensions in end-of-life cancer care cannot be addressed solely at the level of individual healthcare professionals. They highlight the need for stronger interdisciplinary collaboration, more inclusive involvement of nurses in decision-making, greater organisational support for emotional labour, and earlier integration of palliative care within acute hospital settings.ConclusionsEmotional and ethical tensions in end-of-life cancer care are embedded within broader institutional and professional contexts rather than arising solely from individual decision-making. Addressing these tensions requires organisational support, stronger interdisciplinary collaboration, and greater integration of palliative care within hospital practice.