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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
I agree with Dr Goldstein that in large public institutions, the specialist haematologists/oncologists are much more detached from their patients and are therefore less likely to suffer burnout. The day to day emotional issues of the patients and their relatives tend to be delegated to junior doctors and paramedical staff. In private practice, the specialist has greater contact with their patients and have a greater understanding of the emotional issues involved in their care. I work in both sectors and there are good and bad sides. I would like to have a greater hands on involvement in the care of my public patients although this is difficult in a multi doctor hierarchical system. On the other hand, I carry a high emotional burden dealing with the ups and downs of cancer care with my private patients. Personally, I feel privileged that patients entrust me with their care which not only involves medical decisions but also addressing emotional issues as well. Large institutions are fine for those who prefer to avoid uncomfortable patient contact, perform lab research, and sit atop a medical hierarchy but does not suit everyone.
A valuable and important study; let’s hope it leads to something positive. I have memories of loosing three young (<30 yr old) patients in one week some years ago which traumatised the ward staff. I was surprised at how difficult it was to convince the hospital administration to make one of the Clinical Psychologists available to council the affected staff over the following weeks.
For those of us who work as surgical oncologists it’s a bit easier as we don’t often have patients cared for terminally on our wards. However, one of the unfortunate spin-offs with all this is the tendency to try and help at any cost especially when patients are asymptomatic. Patients at times have treatment that is not warranted and of no proven value; rather because of the belief that one “has to do something” and it “might help”. I think before we put patients through months of morbid treatment we should have a good idea that it is likely to add those months onto the end of their lives but in good quality.