Oncologists deal with grief

AUSTRALIA has strong but informal support networks for oncologists to help them deal with their grief when one of their patients dies.

Oncologists agree that learning to deal with the impact of grief when a patient dies comes with experience, but support networks are a vital part of coping. However, they also stress the importance of medical students and trainees receiving education on dealing with the death of patients.

A research letter published in Archives of Internal Medicine, which assessed the impact of patient loss on oncologists in Canada, found that few oncologist felt they had been able to balance the emotional boundaries between being close enough to care about their patients but distant enough to avoid pain when they died. (1)

The authors of the small study said oncologists’ grief “had unique elements related to their sense of responsibility for their patients’ lives”.

They said to their knowledge theirs was the first qualitative exploration of the nature and impact of grief on oncologists.

“Of greatest significance to our health care system is that some of the oncologists’ reactions to grief reported in our study (eg, altered treatment decisions, mental distraction, emotional and physical withdrawal from patients) suggest that the failure of oncologists to deal appropriately with grief from patient loss many negatively affect not only oncologists personally but also patients and their families”, the authors said.

An accompanying commentary said unaddressed grief over time could clearly contribute to burnout. (2)

The commentary authors, from Rochester Medical Center in New York, said that in response to significant burnout rates among practising oncologists at the centre, mandatory staff support meetings had been established, allowing oncology staff to share their loss and grief with others who had common experiences and values.

Dr David Goldstein, a medical oncologist at the Prince of Wales Hospital, Sydney, said the situation in the US was quite different to Australia, as oncologists there were more likely to work in isolated practices. In Australia, most oncologists worked in larger institutions where regular group practice meetings were held to discuss patients, providing an opportunity to support colleagues.

“In Australia, we recognise our role to be empathic [towards patients] rather than involved at a very personal level”, Dr Goldstein said, although he acknowledged that with some patients the line was blurred making it more difficult when “things go bad for the patient”.

Professor Martin Tattersall, professor of cancer medicine at the University of Sydney, said although there had been research into the effects of burnout on Australian oncologists, he was not aware of research on the impact of grief on their professional and private lives.

The largest study into the prevalence and predictors of burnout in the Australian oncology workforce was published in 2007, finding that nursing, medical and other oncology staff experienced considerable occupational distress, while possessing high levels of personal accomplishment. (3)

Clinical haematologist and medical oncologist Dr Paul Eliadis said although he had not been taught to deal with the grief of patient death, “we each learn to deal with it in our own way”.

Dr Eliadis, based at the Wesley Hospital, Brisbane, and a member of Haematology and Oncology Clinics of Australia, agreed that informal networks provided the support oncologists often needed.

“My own strategy is to define success as helping the patient to achieve goals, such as having one more Christmas or attending a special family event”, Dr Eliadis said. “If you achieve that with the patient before they die, then that’s a success, not a failure.”

Dr Goldstein and Professor Tattersall emphasised that communication workshops were a required part of the training program for oncologists and that trainees always had a mentor to talk to when a patient died.

- Kath Ryan

1. Arch Int Med 2012: Online 21 May
2. Arch Int Med 2012: Online 21 May
3. Clinical Oncological Society of Australia & Cancer Australia 2007

Posted 28 May 2012