How individuals living with myeloma experience an end of life phase during covid-19: An interpretative phenomenological analysis

Systematic Literature Review

Breaking bad news is an occupational hazard for healthcare practitioners. Fourteen papers pertaining to practitioner experience of breaking bad news were identified during a systematic search of the literature and a conceptual overview is provided in this critical interpretative meta synthesis. Analysis elicited four themes: (1) Discomfort, particularly difficult emotional and physical responses to breaking bad news; (2) Relational distress, connected to attachment and identification with patients; (3) Bad clinician, indicating the fear of doing it badly or being bad; and (4) Only human, highlighting a culture of invulnerability where practitioner self-care is deprioritised. Recommendations include reflective practice to support staff, normalisation of difficult experiences around bad news conversations, and inclusion of practitioner needs within breaking bad news protocols.

Research Project

Interpretative Phenomenological Analysis was used to explore six myeloma patient’s experiences of an end of life phase during the COVID-19 pandemic. Three super ordinate themes were identified: (1) Threat is all around, captured an intensified sense uncertainty and risk from others brought about by the pandemic; (2) My world became smaller, illuminated cumulative losses experienced and the adjustment to shielding including reduced social contact, which for some was experienced as an unexpected benefit; and (3) Outside I’m a swan, reflected the pressure participants felt to maintain prior roles and responsibilities and ‘just get on with it’. Findings emphasised the amplification of pre-existing challenges for those with myeloma as a result of the pandemic and the importance of practitioner understanding of patient values and support systems in order to best provide person-centred care.