Can a stressed oncologist be good in a consultation? A qualitative study on the oncologists' perception

Oncologists' psychological flourishing: A driving force for positive attitudes at work

OBJECTIVE

Oncologists' psychological health is a major challenge due to the consequential concerning the quality of the care they provide. However, only critical states of their health have been really examined by scientists. This study sought to plug this gap by investigating the mediating role of psychological flourishing in the relationship between the perception of the professional social context (i.e., perceived workplace isolation and organizational support) and positive attitudes at work among oncologists (i.e., work engagement, task adjustment and empathy).

METHODS

The study was a cross-sectional, including 541 French oncologists. Participants completed a self-report questionnaire. Structural Equation Modeling was employed to test the hypotheses.

RESULTS

The analysis revealed that workplace isolation and organizational support perceptions were related to oncologists' work engagement, task adjustment and empathy. Additionally, psychological flourishing acted as a partial mediator between these perceptions of professional social context and oncologists' work-related attitudes.

CONCLUSIONS

This research underlined the potential of enhancing the psychological flourishing of oncologists by improving organizational support and mitigating their sense of isolation, and in turn, to enhance some dimensions of their positive attitudes at work.

"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

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.

Patients' Trust in Physician, Patient Enablement, and Health-Related Quality of Life During Colon Cancer Treatment

In cancer care, where patients and their families experience significant emotional distress and patients have to deal with complex medical information, patient centeredness is an important aspect of quality of care. The aim of this study is to examine the impact of patients' trust in their oncologists and patients' enablement on changes in health-related quality of life of colon cancer patients during follow-up care. We conducted a prospective study in a representative sample of private practices of German oncologists (N = 44). Patients (N = 131) filled out a standardized questionnaire prior to their first consultation (T0), directly after the first consultation (T1) and after two months (T2). Data were analyzed by structural equation modeling. Significant associations were found between trust in physician and changes in physical functioning between T1 and T2, and between trust in physician and patient enablement. Patient enablement is significantly associated with changes in physical functioning between T1 and T2. The results underline the importance of building a close and trustful patient-physician relationship in the oncology encounter. A central mechanism of the association between the quality of the relationship and health outcomes seems to be patient enablement. To enable patients to cope with their situation by making them understand their diagnosis, treatments, and side effects can impact health-related quality of life in physical domains.

Patient satisfaction and alliance as a function of the physician's self-regulation, the physician's stress, and the content of consultation in cancer care

OBJECTIVE

To investigate which characteristics of the physician and of the consultation are related to patient satisfaction with communication and working alliance.

METHODS

Real-life consultations (N = 134) between patients (n = 134) and their physicians (n = 24) were audiotaped. All of the patients were aware of their cancer diagnosis and consulted their physician to discuss the results of tests (CT scans, magnetic resonance imaging, or tumor markers) and the progression of their cancer. The consultations were transcribed and coded with the "Defense Mechanisms Rating Scale-Clinician." The patients and physicians completed questionnaires about stress, satisfaction, and alliance, and the data were analyzed using robust linear modeling.

RESULTS

Patient satisfaction with communication and working alliance was high. Both were significantly (negatively) related to the physician's neurotic and action defenses-in particular to the defenses of displacement, self-devaluation, acting out, and hypochondriasis-as well as to the physician's stress level. The content of the consultation was not significantly related to the patient outcomes.

CONCLUSIONS

Our study shows that patient satisfaction with communication and working alliance is not influenced by the content of the consultation but is significantly associated with the physician's self-regulation (defense mechanisms) and stress. The results of this study might contribute to optimizing communication skills training and to improving communication and working alliance in cancer care.