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Pressimone C, Indralingam R, Metz CD, Levine AS. The Patient-Physician Relationship: Medical Students' Perceptions in a Novel Course. J Gen Intern Med 2024; 39:1492-1495. [PMID: 38600399 PMCID: PMC11169161 DOI: 10.1007/s11606-024-08759-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Abstract
The patient-physician relationship, especially in the case of severely ill patients, is often fraught with anxiety, grief, and guilt in the physician who may come to feel that he or she has failed the patient and thereby becomes a "second victim." This notion was first explored in a 1973 publication (Artiss and Levine N Engl J Med 288(23):1210-4, 1973) that described a novel interactive seminar series for oncology fellows that had been designed to address and possibly remedy the frequent disquiet experienced by young physicians in this setting. Fifty years later, the medical student co-authors of this Perspective enrolled in an elective course that comprised a similar series of interactive seminars, now addressing the contemporary patient-physician relationship. The earlier paper was employed as a historical background, and the framework of the course then broadened such that the students considered the current environmental changes in medical practice (social, cultural, financial, legal, policy) that may be linked to the character of individual patient-physician relationships. This essay reports on the students' perception of such relationships, and on the environmental elements that may be helpful or harmful to the well-being of both patients and physicians.
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Affiliation(s)
| | | | | | - Arthur S Levine
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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2
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Chen C, Chow AYM, Xu K. Bereavement After Patient Deaths Among Chinese Physicians and Nurses: A Qualitative Description Study. OMEGA-JOURNAL OF DEATH AND DYING 2023; 86:788-808. [PMID: 33530890 DOI: 10.1177/0030222821992194] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In order to achieve an in-depth understanding of professional caregivers' experiences of bereavement after patient deaths in Mainland China, qualitative description was employed. 24 physicians and nurses from hospitals in Nanjing, China, participated in one-to-one, semi-structured interviews. Thematic analysis was adopted for data analysis. Five themes were generated: the nature of professional bereavement experiences, the meaning of patient deaths, immediate bereavement reactions, long-term changes, and coping strategies. Each theme included personal and professional dimensions. Professional bereavement experiences in Mainland China were found to be influenced by workplace violence against professional caregivers, traditional Chinese medical ethics, the strong death taboo, and inadequacies of the healthcare system. Professional bereavement experiences are meaning-driven, comprehensive, and usually disenfranchised. They involve multidimensional reactions and have both short-term and long-lasting, both event-specific and accumulated impacts. Cultural and systemic factors could shape professional bereavement experiences.
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Affiliation(s)
- Chuqian Chen
- Department of Medical Humanities, School of Humanities, Southeast University, Nanjing, China
| | - Amy Yin Man Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Ke Xu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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3
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Schmidt V, Kaiser J, Treml J, Kersting A. Factors associated with pre-loss grief and preparedness in relatives of people with cancer during the COVID-19 pandemic: A cross-sectional study. PLoS One 2022; 17:e0278271. [PMID: 36445887 PMCID: PMC9707745 DOI: 10.1371/journal.pone.0278271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/13/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Before the loss of a loved one to cancer, relatives have time to adapt to the impending death. However, due to the current COVID-19 pandemic, adjustment to an imminent death may be more difficult. This study investigates factors related to pre-loss grief and preparedness during the COVID-19 pandemic and their relationship with COVID-19 related fears. METHODS Data of 299 participants from a cross-sectional study was used. Participants were included if they were relatives of people with cancer, spoke German and were at least 18 years. Multivariate linear regression analyses were conducted to measure the relationship between predictors (dysfunctional coping, emotion-focused coping, problem-focused coping, attachment anxiety, attachment avoidance, COVID-19 related fears, prognosis, perceived depth of the relationship, perceived conflict in the relationship, health status) and pre-loss grief, preparedness for caregiving and preparedness for death as the dependent variables. RESULTS Perceived depth (β = .365, p < .001), COVID-19 related fears (β = .141, p = .002), prognosis for death (β = .241, p < .001), dysfunctional coping strategies (β = .281, p < .001) and emotion-focused coping strategies (β = -.320, p < .001) significantly predicted pre-loss grief. Prognosis for death (β = .347, p < .001), dysfunctional coping strategies (β = -.229, p < .001), emotion-focused coping strategies (β = .242, p < .001), COVID-19 related fears (β = -.112, p = .037) and health status (β = .123, p = .025) significantly predicted preparedness for death. Dysfunctional coping (β = -.147, p = .009), problem-focused coping (β = .162, p = .009), emotion-focused coping (β = .148, p = .017), COVID-19 related fears (β = -.151, p = .006), attachment anxiety (β = -.169, p = .003), perceived conflict in the relationship with the patient with cancer (β = -.164, p = .004), perceived depth in the relationship (β = .116, p = .048) and health status (β = .157, p = .003) significantly predicted preparedness for caregiving. CONCLUSIONS This study shows COVID-19 pandemic impacts on the grieving process of relatives of patients with cancer. Consequently, screening for pre-loss grief, preparedness and their associated factors may help provide early support for relatives of people with cancer at need. However, further research is needed to help understand the stability of pre-loss grief and preparedness.
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Affiliation(s)
- Viktoria Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - Julia Kaiser
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
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Du L, Chen C, Yang C. Factors Influencing Chinese Professional Caregivers’ Bereavement Experiences After Patient Deaths: A Secondary Qualitative Study. OMEGA-JOURNAL OF DEATH AND DYING 2022; 85:554-573. [DOI: 10.1177/0030222820948980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to identify the factors that influence Chinese professional caregivers’ bereavement experiences after patient deaths. Through a content analysis, the study reanalyzed the qualitative data initially collected to understand the lived experiences of professional bereavement in Mainland China. Specifically, the study assessed semi-structured interview transcripts conducted with 24 Chinese physicians and nurses and generated 15 open codes, reflecting the influencing factors. These were further categorized into four themes: dying and death conditions, professional caregivers' characteristics, professional caregivers’ involvement, and the bereaved family. The results revealed that professional bereavement experiences and the unveiled factors relate to both the personal and professional lives of the interviewees. Overall, the health care system and cultural backgrounds should be listed as influencing factors for professional bereavement experiences in addition to the aforementioned four.
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Affiliation(s)
- Lina Du
- School of Government, Nanjing University
- Office of Social Work, The First Affiliated Hospital of Nanjing Medical University
| | - Chuqian Chen
- Department of Medical Humanities, Southeast University, Nanjing, China
| | - Changsong Yang
- 4Youth League Committee, Affiliated Hospital of Yangzhou University
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Chen C, Chow AYM, Jiao K. The meaning of patient deaths for professional caregivers: A quantitative construct validation. DEATH STUDIES 2022; 47:440-449. [PMID: 35766266 DOI: 10.1080/07481187.2022.2089776] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The meaning of patient deaths is key to understanding professional bereavement. To validate its construct, we applied partial least square structural equation modeling (PLS-SEM) to online survey data from 563 Chinese physicians and nurses. Both the personal meaning and professional meaning contribute significantly while not interchangeably to the meaning of patient deaths. In addition to the loss of an acquaintance, the loss of a valuable life, and the loss of a professional goal, patient deaths can also mean trauma, bad luck, identity crisis, a warning, a learning opportunity, and a time to empathize with others' sufferings.
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Affiliation(s)
- Chuqian Chen
- Department of Medical Humanities, School of Humanities, Southeast University, Nanjing, China
| | - Amy Yin Man Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Keyuan Jiao
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
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Granek L, Nakash O. Oncology Healthcare Professionals’ Mental Health during the COVID-19 Pandemic. Curr Oncol 2022; 29:4054-4067. [PMID: 35735432 PMCID: PMC9222050 DOI: 10.3390/curroncol29060323] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
The paper begins by reviewing the literature on oncology healthcare professionals’ (HCP) mental health. We summarize and present the current data on HCP mental health in order to understand the baseline state of oncology HCPs’ mental health status prior to the COVID-19 pandemic. At each juncture, we will discuss the implications of these mental health variables on the personal lives of HCPs, the healthcare system, and patient care. We follow by reviewing the literature on these parameters during the COVID-19 pandemic in order to better understand the impact of COVID-19 on the overall mental health of HCPs working in oncology. By reviewing and summarizing the data before and after the start of the pandemic, we will get a fuller picture of the pre-existing stressors facing oncology HCPs and the added burden caused by pandemic-related stresses. The second part of this review paper will discuss the implications for the oncology workforce and offer recommendations based on the research literature in order to improve the lives of HCPs, and in the process, improve patient care.
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Affiliation(s)
- Leeat Granek
- School of Health Policy and Management and Department of Psychology, Faculty of Health, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
- Correspondence: ; Tel.: +1-416-736-2100
| | - Ora Nakash
- School for Social Work, Smith College, Northampton, MA 01063, USA;
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Shi H, Shan B, Zheng J, Zhang Y, Zhang J, Hu X. Grief as a mediator of the relationship between empathy and compassion fatigue. Psychooncology 2022; 31:840-847. [PMID: 34997672 DOI: 10.1002/pon.5875] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/23/2021] [Accepted: 01/14/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Oncology nurses are at high risk of developing compassion fatigue (CF) because of the persistent exposure to patients' suffering and death. Empathy is a prerequisite cognitive reaction for CF. Nurses with greater empathy levels are more prone to develop an emotional connection with patients. However, it is this kind of close bonds that led nurses to experience a deep sense of grief. Cumulative grief may eventually develop into CF. This study examined the levels of grief, empathy and CF, evaluated the correlation among empathy, grief and CF, and verified the role grief as a mediator of the relationship between empathy and CF. METHODS Participants were 794 Chinese oncology nurses in a cross-sectional study. We measures consisted a demographic questionnaire, the Interpersonal Reactivity Index, the Texas Revised Inventory of Grief-Present, and the Professional Quality of Life Scale. RESULTS Oncology nurses showed moderate levels of empathy and grief, moderate to high levels of CF. Perspective taking was negatively related to grief and secondary traumatic stress (STS). Empathic concern was negatively related to burnout (BO). Personal distress was positively related to grief, STS and BO. Grief was positively related to STS and BO. Grief played a partial mediating role between empathy and STS. CONCLUSIONS Oncology nurses commonly experience CF. There is a need to provide interventions and effective supports for oncology nurses to improve their empathy ability, and help them cope with grief and CF.
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Affiliation(s)
- Hongrui Shi
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China.,Department of Nursing, Changzhi Medical College, Changzhi, China.,Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Baifeng Shan
- Department of Clinical Lab, Blood Centre of Taiyuan City, Taiyuan, China
| | - Jianzhong Zheng
- Department of Nursing, Changzhi Medical College, Changzhi, China
| | - Ying Zhang
- Department of Nursing, Changzhi Medical College, Changzhi, China
| | - Jing Zhang
- Department of Nursing, Changzhi Medical College, Changzhi, China
| | - Xiuying Hu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
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Berufliche Trauer. Urologe A 2021; 60:1468-1472. [PMID: 34570243 PMCID: PMC8475454 DOI: 10.1007/s00120-021-01666-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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9
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Qayyum Z, AhnAllen CG, Van Schalkwyk GI, Luff D. "You Really Never Forget It!" Psychiatry Trainee Supervision Needs and Supervisor Experiences Following the Suicide of a Patient. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:279-287. [PMID: 33575964 DOI: 10.1007/s40596-020-01394-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Suicide is the second leading cause of death in children, adolescents, and young adults ages 10-34 and the rates continue to rise in the USA. An estimated 30-60% of Psychiatry Residents experience patient suicide during their training. This study aimed to understand trainee and supervisor experiences after the suicide of a patient in order to better inform the supervision and response to such an event. METHOD Twenty-seven participants were identified by criterion sampling and recruited from General Psychiatry residency, Consultation Liaison fellowship, and Child and Adolescent Psychiatry fellowship training programs in the New England region of the USA. Semi-structured interviews of trainees and supervisors were conducted and analyzed using inductive thematic analysis. RESULTS The death of a patient by suicide was described as a notable event with a significant impact on the professional lives of the participants. The event was typically characterized as having an immediate emotional impact, led to changes in self-efficacy, and a sense of responsibility for the patient's death. Responses to suicide were influenced by modifiable factors such as (1) unpreparedness of individuals, program, and institution and (2) mediating/complicating factors, including the credibility of the supervisor, societal expectations, and specific patient characteristics. CONCLUSIONS The death of a patient is a personal and emotional experience for the psychiatrist, for which they do not consistently feel well prepared. The institutional response may be misaligned, more analytical in character and prioritize assessment of risk. There is significant room to improve supervision and preparedness for the death of a patient by suicide.
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Assessment of professional bereavement: The development and validation of the Professional Bereavement Scale. Palliat Support Care 2021; 20:4-14. [PMID: 33729116 DOI: 10.1017/s1478951521000250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To develop and validate Professional Bereavement Scale (PBS), a specific measurement tool for professional bereavement experiences. METHODS An online cross-sectional survey collected data from 563 physicians and nurses from urban hospitals in Mainland China. Item consistency analysis, component factor analysis, exploratory factor analysis, and confirmatory factor analysis were run to develop and validate the scale. Correlational analysis was conducted to evaluate the psychometric property of the scale. RESULTS Two subscales of the PBS were developed: the 17-item Short-term Bereavement Reactions Subscale (PBS-SBR) and the 15-item Accumulated Global Changes Subscale (PBS-AGC). Four factors, namely, frustration and trauma, guilt, grief, and being moved, are involved in PBS-SBR. Five factors are involved in PBS-AGC, which are new insights, more acceptance of limitations, more death-related anxiety, less influenced by patient deaths, and better coping with patient deaths. Both subscales have good content validity, construct validity, and criterion validity, as well as satisfactory internal consistency and split-half reliability. SIGNIFICANCE OF RESULTS PBS is a specific assessment tool for professional bereavement which is clearly defined, comprehensive, rigorously tested, and generalizable to different professional caregivers from various departments. Unveiled constructs illustrate that professional bereavement experiences contain a professional dimension in addition to a personal dimension both in an event-specific and a global perspective, which distinguishes them from familial bereavement experiences.
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Riordan PA, Price M, Robbins-Welty GA, Leff V, Jones CA, Prigerson HG, Galanos A. Top Ten Tips Palliative Care Clinicians Should Know About Bereavement and Grief. J Palliat Med 2020; 23:1098-1103. [PMID: 32614632 DOI: 10.1089/jpm.2020.0341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Palliative care (PC) focuses on caring for the whole person, from birth to death, while managing symptoms and helping to navigate medical complexities. Care does not stop at the time of death, however, as assisting patients, families, and fellow clinicians through grief and bereavement is within PC's purview. Unfortunately, many clinicians feel unprepared to deal with these topics. In this article, PC and hospice clinicians define and explain bereavement, distinguish normative grief from pathological grief, offer psychometrically sound scales to screen and follow those suffering from grief, and discuss the interaction between grief and bereavement and the physical and mental health of those who are left behind after the death of a loved one.
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Affiliation(s)
- Paul A Riordan
- Division of Psychiatry, Durham VA Medical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Meghan Price
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gregg A Robbins-Welty
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Victoria Leff
- Duke HomeCare and Hospice, Durham, North Carolina, USA
| | - Christopher A Jones
- Department of Medicine and Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Holly G Prigerson
- Department of Medicine and Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, USA
| | - Anthony Galanos
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Palliative Care, Duke University School of Medicine, Durham, North Carolina, USA
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Mano MS, Gomes R, Werutsky G, Barrios CH, Marta GN, Villarreal-Garza C, Frasson AL, Sternberg C, Clara R, Simon SD, Çitaku F, Waldrop M, Violato C, Zillioux D, Khan YH. Cross-Cultural Validity Study of a Medical Education Leadership Competencies Instrument in Latin American Physicians: A Multinational Study. J Glob Oncol 2020; 5:1-9. [PMID: 31770067 PMCID: PMC6882509 DOI: 10.1200/jgo.19.00243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Physicians rarely receive formal training in leadership skills. Çitaku and colleagues have identified a set of leadership competencies (LCs) providing validity evidence in North American (NA) and European Union (EU) medical education institutions. We aim to apply this same survey to a sample of Latin American (LA) medical leaders from the oncology community and related areas, compare the results with those of the previous survey, and perform subgroup analyses within the LA cohort. METHODS The survey was sent to nearly 8,000 physicians of participating professional organizations. In addition to the 63 questions, we also collected data on the type of institution, country, specialty, sex, age, years of experience in oncology, and leadership position. RESULTS The 217 LA respondents placed the highest value on task management competencies (91.37% reported these as important or very important v 87.0% of NA/EU respondents; P < .0001), followed by self-management (87.45% of LA respondents v 87.55% of NA/EU respondents; P = not significant [NS]), social responsibility (86.83% of LA respondents v 87.48% of NA/EU respondents; P = NS), innovation (86.69% of LA respondents v 85.31% of NA/EU respondents; P = NS), and leading others (83.31% of LA respondents v 84.71% of NA/EU respondents; P = NS). Social responsibility, which was first in importance in the NA/EU survey, was only third in the LA survey. Subgroup analyses showed significant variations in the ratings of specific LCs within the LA population. CONCLUSION LCs valued by LA leaders somewhat differ from those valued by their NA and EU counterparts, implying that cultural aspects might influence the perception of desired LCs. We also detected variations in the responses within the LA population. Our data indicate that current physician leadership training programs should be tailored to suit specific needs and cultural aspects of each region. Further validity studies of this instrument with other samples and cultures are warranted.
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Affiliation(s)
- Max S Mano
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil.,Hospital Sírio-Libanês, São Paulo, Brazil
| | - Rafaela Gomes
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | | | | | - Gustavo Nader Marta
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil.,Instituto do Câncer do Estado de São Paulo of the Universidade de São Paulo, Sao Paulo, Brazil
| | - Cynthia Villarreal-Garza
- Hospital Zambrano Hellion-Tecnológico de Monterrey, San Pedro Garza García, Mexico.,Instituto Nacional de Cancerologia, Ciudad de México, México
| | | | | | - Renan Clara
- Brazilian Society of Clinical Oncology, Sao Paulo, Brazil
| | - Sergio D Simon
- Brazilian Society of Clinical Oncology, Sao Paulo, Brazil
| | - Fadil Çitaku
- Academy of Leadership Sciences Switzerland, Zürich, Switzerland
| | | | - Claudio Violato
- Academy of Leadership Sciences Switzerland, Zürich, Switzerland
| | - Don Zillioux
- Academy of Leadership Sciences Switzerland, Zürich, Switzerland
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Back AL. Patient-Clinician Communication Issues in Palliative Care for Patients With Advanced Cancer. J Clin Oncol 2020; 38:866-876. [PMID: 32023153 DOI: 10.1200/jco.19.00128] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The delivery of palliative care to patients with advanced cancer and their families, whether done by oncology clinicians or palliative care clinicians, requires patient-centered communication. Excellent communication can introduce patients and families to palliative care in a nonthreatening way, build patient trust, enable symptom control, strengthen coping, and guide decision making. This review covers deficiencies in the current state of communication, patient preferences for communication about palliative care topics, best practices for communication, and the roles of education and system intervention. Communication is a two-way, relational process that is influenced by context, culture, words, and gestures, and it is one of the most important ways that clinicians influence the quality of medical care that patients and their families receive.
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Álvarez-del-Río A, Ortega-García E, Oñate-Ocaña L, Vargas-Huicochea I. Experience of oncology residents with death: a qualitative study in Mexico. BMC Med Ethics 2019; 20:93. [PMID: 31805925 PMCID: PMC6896685 DOI: 10.1186/s12910-019-0432-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physicians play a fundamental role in the care of patients at the end of life that includes knowing how to accompany patients, alleviate their suffering and inform them about their situation. However, in reality, doctors are part of this society that is reticent to face death and lack the proper education to manage it in their clinical practice. The objective of this study was to explore the residents' concepts of death and related aspects, their reactions and actions in situations pertaining to death in their practice, and their perceptions about existing and necessary training conditions. METHODS A qualitative approach was used to examine these points in depth based on interviews conducted with seven oncology residents. RESULTS Participants do not have a clear concept of death and, although it is seen as a common phenomenon, they consider it an enemy to beat. The situations to which respondents react more frequently with frustration and sadness after the death of patients were when they felt emotionally involved, if they identify with the patient, in cases of pediatric patients and with patients who refuse treatment. To deal with death, participants raise barriers and attempt to become insensitive. Although residents in this study recognize the importance of training to learn how to better deal with death, it seems they are not fully invested in reaching more of it. CONCLUSIONS Participants face death in a daily basis without the necessary training, which appears to impact them more than they are willing to accept. They do not achieve their goals managing situations regarding death as well as they assume they do. Despite recognizing the need of more training and support for better coping with death, they prefer to continue to learn from their experience. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Asunción Álvarez-del-Río
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Edwin Ortega-García
- Internal Medicine Resident, Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Luis Oñate-Ocaña
- Surgical Oncology Consultant, Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Ingrid Vargas-Huicochea
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Oficina 6 de la Coordinación de Investigación del Departamento de Psiquiatría y Salud Mental, Edificio F de la Facultad de Medicina de la UNAM, Colonia Copilco Universidad, Circuito interior y Cerro del Agua s/n, Ciudad Universitaria, Coyoacán, 04510 Ciudad de México, Mexico
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15
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Granek L, Nakash O, Ariad S, Shapira S, Ben-David M. Cancer Patients' Mental Health Distress and Suicidality. CRISIS 2019; 40:429-436. [DOI: 10.1027/0227-5910/a000591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: A substantial number of people with cancer endorse suicidality when compared with the general population. Thus, oncology healthcare workers may experience the death of a patient to suicide over their careers. Aims: To explore the impact of patients' mental health distress and suicidality on oncology personnel with a secondary aim of exploring how personnel cope with these types of events. Method: We interviewed 61 healthcare professionals (HCPs) at two cancer centers. The grounded theory method (GT) was used. Results: The impact of patients' mental health distress and suicidal ideation on oncology HCPs included sadness, depression, worry and concern, and feeling emotionally overwhelmed. The impact of patient suicide on HCPs included trauma, guilt, and surprise. Oncology personnel reported a change in practice, including communication style, being attuned to patient cues, and changing the physical environment. Coping strategies included colleague support, seeking professional help, and setting boundaries between their work and home life. Limitations: It is likely that HCPs who participated in the study represent those who are more willing to discuss issues related to suicide. Thus, the impact of patient suicide on healthcare providers may be even more pronounced among the general oncology HCP community. Conclusion: Given the higher risk of suicide among cancer patients, it is necessary to increase awareness about the impact these events may have on HCPs. Professional guidelines can highlight the need for a balance between ensuring the availability of informal support and more formal methods of help.
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Affiliation(s)
- Leeat Granek
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ora Nakash
- School for Social Work, Smith College, North Hampton, MA, USA
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzilya, Israel
| | - Samuel Ariad
- Department of Oncology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shahar Shapira
- Gender Studies Program, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Merav Ben-David
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Radiation Oncology, Sheba Medical Center, Ramat-Gan, Israel
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16
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Hayuni G, Hasson‐Ohayon I, Goldzweig G, Bar Sela G, Braun M. Between empathy and grief: The mediating effect of compassion fatigue among oncologists. Psychooncology 2019; 28:2344-2350. [DOI: 10.1002/pon.5227] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Gal Hayuni
- The Academic College of Tel Aviv‐Yaffo Tel Aviv Israel
| | | | - Gil Goldzweig
- The Academic College of Tel Aviv‐Yaffo Tel Aviv Israel
| | | | - Michal Braun
- The Academic College of Tel Aviv‐Yaffo Tel Aviv Israel
- The Talya Center for Young Women with Breast CancerShaare Zedek Medical Center Jerusalem Israel
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17
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Granek L, Ben-David M, Bar-Sela G, Shapira S, Ariad S. "Please do not act violently towards the staff": Expressions and causes of anger, violence, and aggression in Israeli cancer patients and their families from the perspective of oncologists. Transcult Psychiatry 2019; 56:1011-1035. [PMID: 30051769 DOI: 10.1177/1363461518786162] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Expressions of anger within the healthcare context are a common occurrence, particularly in clinical situations where patients can experience emotional distress in the face of illness. The purpose of this study was to examine one aspect of this phenomenon by looking at expressions and causes of anger among Israeli cancer patients and their families from the perspective of oncologists who treat them. Twenty-two Israeli oncologists were interviewed from three oncology centers between March 2013 and June 2014. The grounded theory method was used to collect and analyze the data. Our study revealed that oncologists are exposed to and cope with expressions and acts of anger, aggression, and violence from some of their cancer patients and their families. The causes of this anger include physician blame, unrealistic treatment expectations, perceived errors in communication, and lack of follow up with bereaved families. Our study also revealed that the cultural context affected patient-physician interactions, including anger. This context included a culture that has open interpersonal boundaries and is family-oriented; a multicultural society that includes citizens with different cultural norms and expectations around cancer care; and a strained healthcare system that leaves oncologists limited in time and resources, including limited access to palliative care. Policy implications include reducing oncologist workload by hiring more mental health professionals, having translators available on site to help with language barriers, reducing administrative burdens, and incorporating palliative care widely to help with the psychosocial and physical care of patients and families.
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Affiliation(s)
| | | | - Gil Bar-Sela
- Rambam Health Care Campus and Rappaport Faculty of Medicine & The Technion-Israel Institute of Technology
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18
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Laor-Maayany R, Goldzweig G, Hasson-Ohayon I, Bar-Sela G, Engler-Gross A, Braun M. Compassion fatigue among oncologists: the role of grief, sense of failure, and exposure to suffering and death. Support Care Cancer 2019; 28:2025-2031. [PMID: 31392551 PMCID: PMC7223813 DOI: 10.1007/s00520-019-05009-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/24/2019] [Indexed: 01/22/2023]
Abstract
Purpose Oncologists cope with unique work characteristics that increase their risk of developing compassion fatigue—that is, burnout and secondary traumatic stress—and can result in reduced capacity and interest in being empathetic to the suffering of others (Stamm B. The concise ProQOL manual, 2010). At the same time, oncologists can experience compassion satisfaction—that is, the positive aspects of caring. This study explored the associations of compassion fatigue and compassion satisfaction with oncologists’ grief and sense of failure beyond their reported exposure to suffering and death. Methods Seventy-four oncologists completed self-administered questionnaires examining compassion fatigue, compassion satisfaction, grief, exposure to suffering and death, and sense of failure. Results The oncologists reported that they face the loss of approximately 50% of their patients, and that their patients suffer from profound emotional and physical pain. High levels of compassion fatigue and grief, and moderate levels of sense of failure, were reported. Findings showed a lack of association between exposure to suffering and death and compassion fatigue and satisfaction. However, grief and sense of failure were found to predict both aspects of compassion fatigue: secondary traumatic stress (p < 0.001, p < 0.003, respectively) and burnout (p < 0.002, p < 0.025, respectively). Conclusions These results highlight the importance of the oncologists’ subjective experiences of grief and sense of failure, beyond their reports of exposure to suffering and death, in terms of their levels of compassion fatigue. Implications of these findings include the need to develop interventions for oncologists that will allow them to acknowledge, process, and overcome negative experiences of failure and grief.
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Affiliation(s)
| | - Gil Goldzweig
- The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | | | | | | | - Michal Braun
- The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel.
- The Talya Center for Young Women with Breast Cancer, Shaare Zedek Medical Center, Jerusalem, Israel.
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19
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Fujita A, Hamada Y. Bereavement care in Japanese pediatrics: Pediatrician awareness in practice. Pediatr Int 2019; 61:658-663. [PMID: 31102485 DOI: 10.1111/ped.13891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/21/2019] [Accepted: 05/15/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND A child's death affects not only family members but also the health-care professionals involved in patient care. The education system for bereavement care in Japan, however, is not set up in a systematic way, and the care provided is based on the individual experience of the health-care professional. The aim of this study was to investigate pediatrician awareness of and actual circumstances involved in bereavement care in Japan. METHODS A qualitative descriptive study was conducted at four facilities in Japan. Data collected using semi-structured interviews of 11 pediatricians were assessed using inductive qualitative analysis. RESULTS Pediatrician recognition of the elements of bereavement care was categorized as follows: (i) developing relationships with families before a child's death is important in bereavement care; (ii) after the child dies, family involvement is left to the doctor's discretion; (iii) coping with a child's death myself through past experience is essential; (iv) doctors involved in a child's death also experience mental burden; and (v) a system for the family's bereavement care must be established. Two categories were established according to actual circumstances involved in bereavement care: (i) attention must be given to the emotions of the families who lost a child; and (ii) doctor involvement with bereaved families depends on doctor awareness and expertise. CONCLUSION Japanese pediatricians provided bereavement care to families who lost their children in a non-systematic manner. This is necessitates improvement of the self-care of health-care professionals with regard to grief by improving bereavement care-related education. Additionally, health-care professionals must be trained, and a national-level provision system must be established to provide high-quality bereavement care to families who lose a child.
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Affiliation(s)
- Ayaka Fujita
- Division of Nursing Science, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuko Hamada
- Division of Nursing Science, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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20
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Tutelman PR, Drake EK, Urquhart R. "It Could Have Been Me": An Interpretive Phenomenological Analysis of Health Care Providers' Experiences Caring for Adolescents and Young Adults with Terminal Cancer. J Adolesc Young Adult Oncol 2019; 8:587-592. [PMID: 31259657 DOI: 10.1089/jayao.2019.0015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: Adolescents and young adults (AYAs) with terminal cancer are a marginalized population with unique medical and psychosocial needs. AYAs commonly report challenges with their health care experiences, however, little is known about the experiences of the health care providers (HCPs) who deliver this specialized care. The purpose of the current study was to understand HCPs' experiences caring for AYAs with terminal cancer. Methods: Nine HCPs (four nurses and five physicians) took part in in-depth semistructured interviews. Participants were eligible if they were a nurse or physician in Atlantic Canada; cared for at least one AYA patient with terminal cancer in the past 3 years; and were able to speak and understand English. Data were analyzed using interpretive phenomenological analysis. Results: Analyses revealed four superordinate themes present in the data: (1) many unknowns and uncertainties associated with providing care for AYAs compounded by minimal or no training specifically concerning this population; (2) an intense emotional experience compared with caring for patients with terminal cancer of other ages; (3) personal identification with patients and their families; and (4) attempts to make sense of the circumstance thwarted by feelings of injustice and unfairness. Conclusions: HCPs experienced unique emotional and logistical challenges when caring for AYAs with terminal cancer, which can influence the care they provide. HCPs' experiences highlight the need for training to support clinicians in caring for AYAs with terminal cancer to optimize their own well-being and delivery of health care services to this population.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
| | - Emily K Drake
- Faculty of Health, Dalhousie University, Halifax, Canada.,Cancer Outcomes Research Program, Nova Scotia Health Authority, Halifax, Canada
| | - Robin Urquhart
- Faculty of Health, Dalhousie University, Halifax, Canada.,Cancer Outcomes Research Program, Nova Scotia Health Authority, Halifax, Canada.,Department of Surgery, Dalhousie University, Halifax, Canada
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21
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Chen C, Chow AYM, Tang S. Bereavement process of professional caregivers after deaths of their patients: A meta-ethnographic synthesis of qualitative studies and an integrated model. Int J Nurs Stud 2018; 88:104-113. [PMID: 30227279 DOI: 10.1016/j.ijnurstu.2018.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 08/10/2018] [Accepted: 08/23/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Professional caregivers bereave after patients' deaths. Such bereavement can exert considerable influences on huge numbers of professional caregivers and their clients. No study, however, has synthesized scattered evidence on the core process of such bereavement, and no corresponding model exists. AIM To systematically review and synthesize the experience of bereavement after patients' deaths, and in particular, its core process, in professional caregivers' own descriptions in existing literature, and to propose an integrated model on that basis. DESIGN A review was conducted following Enhancing Transparency in Reporting the Synthesis of Qualitative Research Statement (ENTREQ). DATA SOURCE CINAHL Plus, PubMed, PsycINFO, Scopus, Embase, and Web of Science were searched in April 2018 with keywords as combinations of "professional caregiver" and "bereavement". References of eligible studies from pre-planned searches were manually screened. REVIEW METHODS Full-text and English-written qualitative studies published in peer-reviewed journals in or after 1980 were included. Their qualities were assessed by two of the authors independently. Meta-ethnography was employed to synthesize findings from previous studies. RESULTS Twenty-three studies met the inclusion criteria, the majority conducted in Western and developed regions of the world. Three core concepts were identified in the core professional bereavement process: (1) perceived nature of patients' deaths; (2) bereavement reactions; (3) accumulated changes. Each concept consists of both a personal dimension and a professional dimension. Risk and protective factors and coping methods were unveiled to influence the core process. An integrated, process-oriented and multi-dimensional model was proposed on the basis of these findings. CONCLUSIONS Patients' deaths are significant events for professional caregivers, and they bring both personal and professional, both temporal and long-lasting impacts. Professional bereavement is distinctive from familial bereavement and deserves serious attention for its own sake. Attention, acknowledgment, and in-time support must be given to professional caregivers when they encounter patients' deaths.
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Affiliation(s)
- Chuqian Chen
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Amy Y M Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong, China.
| | - Suqin Tang
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong, China
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22
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Granek L, Barbera L, Nakash O, Cohen M, Krzyzanowska MK. Experiences of Canadian oncologists with difficult patient deaths and coping strategies used. ACTA ACUST UNITED AC 2017; 24:e277-e284. [PMID: 28874898 DOI: 10.3747/co.24.3527] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We aimed to explore and identify what makes patient death more emotionally difficult for oncologists and how oncologists cope with patient death. METHODS A convenience sample of 98 Canadian oncologists (50 men, 48 women) completed an online survey that included a demographics section and a section about patient death. RESULTS More than 80% of oncologists reported that patient age, long-term management of a patient, and unexpected disease outcomes contributed to difficult patient loss. Other factors included the doctor-patient relationship, identification with the patient, caregiver-related factors, oncologist-related factors, and "bad deaths." Oncologists reported varying strategies to cope with patient death. Most prevalent was peer support from colleagues, including nurses and other oncologists. Additional strategies included social support, exercise and meditation, faith, vacations, and use of alcohol and medications. CONCLUSIONS Oncologists listed a number of interpersonal and structural factors that make patient death challenging for them to cope with. Oncologists reported a number of coping strategies in responding to patient death, including peer support, particularly from nursing colleagues. No single intervention will be suitable for all oncologists, and institutions wishing to help their staff cope with the emotional difficulty of patient loss should offer a variety of interventions to maximize the likelihood of oncologist participation.
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Affiliation(s)
- L Granek
- Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - L Barbera
- Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - O Nakash
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - M Cohen
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - M K Krzyzanowska
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON
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23
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Granek L, Ben-David M, Nakash O, Cohen M, Barbera L, Ariad S, Krzyzanowska MK. Oncologists' negative attitudes towards expressing emotion over patient death and burnout. Support Care Cancer 2017; 25:1607-1614. [PMID: 28084531 DOI: 10.1007/s00520-016-3562-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The aims of this study were to examine the relationship between negative attitudes towards expressing emotion following patient death and burnout in oncologists and to explore oncologists' preferences for institutional interventions to deal with patient death. METHODS The participants included a convenience sample of 177 oncologists from Israel and Canada. Oncologists completed a questionnaire package that included a sociodemographic survey, a burnout measure, a survey assessing negative attitudes towards expressing emotion, and a survey assessing desired interventions to cope with patient death. To examine the association between burnout and negative attitudes while controlling for the effect of sociodemographic variables, a hierarchical linear regression was computed. RESULTS Higher burnout scores were related to higher negative attitudes towards perceived expressed emotion (partial r = .25, p < .01) of those who viewed this affect as a weakness and as a sign of unprofessionalism. Approximately half of the oncologists found each of the five categories of institutional interventions (pedagogical strategies, emotional support, group/peer support, taking time off, and research and training) helpful in coping with patient death. CONCLUSIONS Our findings suggest that high burnout scores are associated with negative attitudes towards expressing emotion and that there is a wide variation in oncologist preferences in coping with patient death. Institutions should promote interventions that are varied and that focus on the needs of oncologists in order to reduce burnout. Interventions that legitimize expression of emotion about patient death may be useful. Another way to reduce stigma would be to require oncologists to "opt out" rather than "opt in" to accessing a selection of social and/or individual interventions.
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Affiliation(s)
- Leeat Granek
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, 84105, Beer-Sheva, Israel.
| | - Merav Ben-David
- Radiation Oncology Department, Sheba Medical Center, Ramat-Gan, Israel & The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ora Nakash
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel
| | - Michal Cohen
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel
| | - Lisa Barbera
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Samuel Ariad
- Department of Oncology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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24
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Granek L, Nakash O, Cohen M, Ben-David M, Ariad S. Oncologists' communication about end of life: the relationship among secondary traumatic stress, compassion satisfaction, and approach and avoidance communication. Psychooncology 2016; 26:1980-1986. [DOI: 10.1002/pon.4289] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 09/19/2016] [Accepted: 09/29/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Leeat Granek
- Department of Public Health, Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer Sheva Israel
| | - Ora Nakash
- Baruch Ivcher School of Psychology; Interdisciplinary Center; Herzliya Israel
| | - Michal Cohen
- Baruch Ivcher School of Psychology; Interdisciplinary Center; Herzliya Israel
| | - Merav Ben-David
- Radiation Oncology Department, Sheba Medical Center, Ramat-Gan, Israel & The Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Samuel Ariad
- Department of Oncology; Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev; Beer Sheva Israel
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25
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Granek L, Krzyzanowska MK, Nakash O, Cohen M, Ariad S, Barbera L, Levy R, Ben-David M. Gender differences in the effect of grief reactions and burnout on emotional distress among clinical oncologists. Cancer 2016; 122:3705-3714. [DOI: 10.1002/cncr.30236] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/25/2016] [Accepted: 07/05/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Leeat Granek
- Department of Public Health; Ben-Gurion University of the Negev; Beer Sheva Israel
| | - Monika K. Krzyzanowska
- Division of Medical Oncology and Hematology; Princess Margaret Cancer Centre; Toronto Ontario Canada
| | - Ora Nakash
- Baruch Ivcher School of Psychology, Interdisciplinary Center, (IDC) Herzliya, Israel
| | - Michal Cohen
- Baruch Ivcher School of Psychology, Interdisciplinary Center, (IDC) Herzliya, Israel
| | - Samuel Ariad
- Department of Oncology, Soroka University Medical Center; Ben-Gurion University of the Negev; Beer Sheva Israel
| | - Lisa Barbera
- Department of Radiation Oncology; University of Toronto; Toronto Ontario Canada
| | - Rotem Levy
- Medical School; Ben-Gurion University of the Negev; Beer Sheva Israel
| | - Merav Ben-David
- Department of Radiation Oncology; Sheba Medical Center; Ramat-Gan Tel-Aviv Israel
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