While all [Health Care Professionals]can potentially experience grief over patient loss, oncologists face unique pressures because they are legally responsible for the patients? care and may be blamed when patients die. Editor's Note: We have edited some of this editorial letter*.
Despite the evidence that grief over patient loss is an intrinsic part of clinical oncology, there are no qualitative studies examining the nature and extent of oncologists?grief over patient loss nor the impact of this grief on oncologists?lives. The objectives of our study were to explore and identify oncologists? grief over patient loss and the ways in which this grief may affect their personal and professional lives.
Methods. A grounded theory approach was used. We recruited and interviewed 20 oncologists between November 2010 and July 2011 from 3 adult oncology centers in Ontario, Canada. We interviewed 3 groups of oncologists who were at different stages in their careers (ie, trainees and junior and senior oncologists) and varied in subspecialty, sex, and ethnicity. Exclusion criteria were the inability to speak English and never having had a patient die in their care. Approvals were obtained from the research ethics board at each participating center. Participants signed a consent form and agreed to the interview being audio-recorded.
Results.
Nature of Oncologists? Grief. In addition to sadness, crying,and loss of sleep, oncologists? grief had unique elements related to their sense of responsibility for their patients? lives. These feelings could begin before the death of the patient, arising from holding hard medical knowledge such as awareness of poor test results or likely patient death before revealing this information to the patient himself or herself. Oncologists? grief also included feelings of powerlessness, self-doubt, guilt, and failure.
The Impact of Patient Loss on Oncologists. While oncologists spoke about burnout, the single most consistent and recurrent finding in the interviews was the description of compartmentalization resulting from patient loss. Oncologists? compartmentalization involved their ability to separate feelings of grief about patient loss from other aspects of their lives and practices and was described as both a coping strategy and an impact of continual patient loss. Physicians used phrases such as ?denial? and ?dissociation? in describing this process as patients died.
The Impact of Patient Loss on Affect. The theme of balancing emotional boundaries captured the tension between growing close enough to care about the patients but remaining distant enough to avoid the pain of the loss when the patient died. Few oncologists felt they had been able to do this entirely effectively, although they recognized that the inability to balance these boundaries might be problematic for them.
Impact of Patient Loss on Other Patients. Oncologists talked about the impact of patient loss on their treatment decisions, on their level of distraction with patients, and on their motivation to improve care for subsequent patients. Another impact was the strategy oncologists used to distance or withdraw themselves from patients and their families as the patients got closer to dying, including fewer visits in the hospital, fewer bedside visits, and less overall energy expended toward the dying patient.
Personal Impact of Patient Loss.Oncologists spoke about grief spillover as having difficulty separating their work life from their personal lives when the grieving came home with them. Many also talked about having a better perspective on life as a result of frequent exposure to patient loss.
Comment. To our knowledge, this study is the first qualitative exploration of the nature and impact of grief in oncologists.
We found that for oncologists, patient loss was a unique affective experience that had a smokelike quality.
Photo from Wikipedia: Thomas Eakins, The Gross Clinic, 1875, on display in Ward One of the US Army Post Hospital, 1876 Centennial Exposition in Philadelphia.
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