This article is more than 5 years old. Information may no longer be current.
Education could help oncologists better cope with grief
Click Here to Manage Email Alerts
Stephanie M. Harman
As a palliative care physician and an internist, I watch with awe how my oncology colleagues manage intense practices while caring for a certain percentage of patients they know will die despite the medical team’s best efforts.
A recent Archives of Internal Medicine research letter highlighted the grief oncologists experience.
Leeat Granek, PhD, and colleagues performed semi-structured interviews of trainees, junior oncologists and senior oncologists at three sites.
Not surprisingly, the grief oncologists feel resembles the grief non-physicians experience after a loved one’s death. However, Granek and colleagues noted themes unique to oncologists.
In an Archives interview, Granek highlighted the sense of responsibility oncologists feel. The study revealed themes related to this sense of responsibility, such as guilt, self-doubt, powerlessness and failure. The researchers categorized the impact of oncologists’ grief into several domains, including professional, personal and patient care.
The professional impact of grief was described in terms of the normalization of death, burnout and compartmentalization. The oncologists interviewed mentioned how they separate their feelings of grief from the other parts of their professional lives. Grief also affected how close oncologists got to patients emotionally, and it made the balance difficult.
On a personal level, the oncologists mentioned how their feelings of grief would spill over into their time away from their practice.
Granek and colleagues also suggested a relationship between grief and subsequent quality of patient care. They shared multiple examples in which oncologists noted their decision-making was affected by the deaths of their patients, they were distracted during clinical encounters, and they distanced themselves by conducting fewer visits with patients when they were closer to death.
The primary finding prompts further questions about how to mitigate the effects of grief in order to prevent the more deleterious effects on patient care and oncologists themselves. The authors recommend education about managing grief and other difficult emotions beginning in residency and continuing throughout physicians’ careers.
An invited commentary by Michelle Shayne, MD, and Timothy E. Quill, MD, of the University of Rochester highlighted one such intervention. Their university has a staff support group for hematology/oncology fellows and other staff who care for patients with cancer. Group members meet about six times a year, sharing their experiences and strategies for self-awareness and self-care.
In reviewing the Accreditation Council for Graduate Medical Education’s program requirements for oncology fellowship training, programs are required to teach “personal development, attitudes and coping skills of physicians who care for critically-ill patients.” However, there is no specific mention of teaching strategies or support for the grief oncology trainees will inevitably encounter.
Granek and colleagues made a compelling case for more investment in the education and support of oncologists and oncologists-in-training.
References:
For more information:
Disclosure: Harman reports no relevant financial disclosures.