They are the bearers of bad news, those who guide patients through painful cancer treatments and often help families say goodbye. But a new Ontario-based study suggests that oncologists struggle with grief of their own when patients die, an issue that researchers say affects both their personal lives and the quality of care they provide.
The peer-reviewed study, published online this month in Archives of Internal Medicine, was conducted last year on 20 oncologists at three hospitals in Toronto and Hamilton.
Many of those surveyed said they felt not just grief when a patient died, but also a sense of powerlessness, self-doubt and failure — and those feelings often go untreated, as they remain taboo within the profession, said lead researcher Leeat Granek.
“There is this really strange paradox about the fact that we know oncology is riddled with loss and yet there isn’t a lot of opportunity to talk about it,” said Granek, a health psychologist and post-doctoral fellow at Toronto’s Hospital for Sick Children.
Grief affects both physicians’ well-being and their ability to provide care, the study said. More than half of those surveyed said grief could affect their treatment decisions — say, for example, providing aggressive chemotherapy treatment when palliative care is a better option.
“In order to cope, you always have to have a little bit of denial,” said one oncologist quoted in the study.
Granek said her study, though limited in scope, points to a dire need for grief training and resources to improve both physician well-being and patient care.
Most Canadian medical schools incorporate grief training into general communications courses. But it’s not enough, said Dr. Derek Puddester, director of the University of Ottawa’s Faculty of Medicine Wellness Program.
“The reality is that we don’t teach doctors how to cope with the death of their patients,” Puddester said. “It happens in every single specialty. It’s painful and it’s a difficult subject for healers.”
Dr. Glenn Bauman, chair of Western University’s oncology department, said oncologists practise a team approach and rely on each other for support when needed. “Physicians can also turn to social workers and the spiritual care offered through hospitals,” he said.
Other institutions, such as New York’s University of Rochester Medical Center, have taken a more structured approach. In 2008, the centre established a support group (mandatory for hematology and oncology fellows) to provide support and help prevent burnout.
It’s that kind of support that’s needed across the system to help oncologists cope with loss, said Granek. “It’s a very obvious thing that isn’t being dealt with.”
Toronto Star
Niamh Scallan