Existential Communication With Patients and Families: A Qualitative Exploration of Multidisciplinary Oncology Clinicians’ Experiences

Abstract

Objectives

Existential concerns are inherent in serious illness and at the end of life, yet communication to address such concerns can be challenging. This study explored multidisciplinary oncology clinicians’ experiences navigating existential communication with patients and families, as well as what makes existential communication meaningful and challenging.

Methods

This qualitative study analyzed responses to open-ended survey questions collected from N = 83 participants (multidisciplinary oncology clinicians, including nurses, social workers, and chaplains) who participated in a communication training course. Data were analyzed using thematic analysis.

Results

Themes across clinicians’ experiences of existential communication with patients and families included existential questions; guilt/regret; fears about the future; grief; preparing for death; values and goals of care; spiritual concerns; and letting go. Meaningful experiences included bearing witness; providing emotional support and information; easing suffering; learning and growing; and the honor of accompanying patients and families through the end of life. Challenges included discomfort when talking about death; facing denial; being unable to “fix it”; resistance to palliative care among oncology team members, patients, and families; fear of saying the wrong thing; navigating conflicting values; responding to spiritual concerns; barriers to inclusive, high-quality care; and struggling with emotions.

Conclusions

Existential communication is a vital yet challenging part of oncology care. Clinicians find deep meaning in this work but face emotional and systemic barriers. Findings highlight the need for training, reflection, and institutional support to help clinicians engage in existential communication with patients and families near the end of life.