Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You and Your Team.

Learn More →

Oncologists Responding to Grief: Comment on “Nature and Impact of Grief Over Patient Loss on Oncologists' Personal and Professional Lives”

Oncologists Responding to Grief: Comment on “Nature and Impact of Grief Over Patient Loss on... The practice of oncology can be stressful. While some stress can be motivating and challenging, in its extremes, stress can lead to emotional exhaustion, depersonalization, and self-perception of incompetence, all of which are considered hallmarks of burnout. Stress and burnout should not be confused with grief. Grief is deep mental anguish arising from loss.1 Since death and loss are intrinsic aspects of oncologists' practice, grief is common, whether it be over the physical absence of a patient or the more abstract surrender of a meaningful joint struggle. Unaddressed grief over time can clearly contribute to burnout, which is an occupational hazard for physicians in general and oncologists in particular. The undermining effects of stress, burnout, and depression among physicians have been studied.2 Healthy coping strategies have also been elucidated, including maintaining interests and friendships outside of medicine, allowing sufficient time for sleep, meals, and solitary contemplation, attending to routine medical and dental care, protecting time for family and friends with attention to scheduling, and acknowledging emotional responses in the context of the physician-patient experience.3 The recognition, expression, and exploration of grief in itself may be considered a coping strategy. Based on the model described by Kubler-Ross,4 the 5 stages of grief include denial, anger, bargaining, depression, and ultimately, acceptance. Therefore, a constructive approach to lessening the isolation associated with grief can be pursued, providing opportunities for sharing such feelings. Granek et al5 systematically explore oncologists' grief over patient loss and its potential personal and professional impact. Their results show some positives that emerge from these experiences, including a perceived “better perspective on life as a result of frequent exposure to patient loss.” Conversely, they also find negative effects such as physician distraction and withdrawal from patients. One suggestion that they and others1 have made to ameliorate the adverse effects of grief is to provide education on recognizing and working through the grief process, along with learning strategies that emphasize self-care, starting in the training years and continuing throughout their careers. At the University of Rochester Medical Center, we have initiated a process that does just that. In response to reports of significant burnout rates in practicing oncologists of approximately 56%6 and in oncology physician trainees of about 30%,7 a staff support group meeting was established in 2008 at the Wilmot Cancer Center. The group meeting is mandatory for hematology/oncology fellows and strongly recommended for all other team members who regularly interface with cancer patients, including hematology/oncology attending physicians, nurses, secretaries, and social workers. The group is cofacilitated by a palliative care expert, a medical oncologist, and a clergyman. The group meets on average 6 times per year. In addition to sharing stories and experiences about responses to patient loss and grief, participants routinely dedicate time to reflection on self-care strategies. Sessions will sometimes commence with mindfulness meditation exercises encouraging self-awareness by focusing exclusively on the process of gentle breathing.8 Participants are then invited to voice whatever work-related personal experiences are on their minds. Feelings of frustration, anger, loss, isolation, and insecurity often emerge in a setting that is nonjudgmental and supportive. At the end of each 1-hour session, a moment of silence is observed in remembrance of patients who have recently died, and the opportunity to remember and honor a patient who has died by saying his or her first name is offered. Over the past few years, we have witnessed each others tears and laughter—all while confidentially discussing our day-to-day impressions about, and personal reactions to, patients, their families, treatments, and death. This approach allows oncology staff and trainees to systematically share their loss and grief with others who have common experiences and values. While providers of oncology care can certainly experience their losses and grief in isolation, studies such as this one by Granek et al5 reveal the potential for withdrawal from other dying patients, distraction, and self-doubt. Ongoing study and development of optimized coping strategies for oncologists not only to survive but also to potentially experience personal growth from their work are needed, but experiences such as our oncology support group seem to be a big step in the right direction. Back to top Article Information Correspondence: Dr Quill, Division of Palliative Care, Hematology Oncology, University of Rochester Medical Center, 601 Elmwood Ave, PO Box 704, Rochester, New York 14642 (timothy_quill@urmc.rochester.edu). Published Online: May 21, 2012. doi:10.1001/archinternmed.2012.2035 Financial Disclosure: None reported. References 1. Moon PJ. Untaming grief? for palliative care physicians. Am J Hosp Palliat Care. 2011;28(8):569-57221504998PubMedGoogle ScholarCrossref 2. Shanafelt T, Dyrbye L. Oncologist burnout: causes, consequences, and responses. J Clin Oncol. 2012;30(11):1235-124122412138PubMedGoogle ScholarCrossref 3. Quill TE, Williamson PR. Healthy approaches to physician stress. Arch Intern Med. 1990;150(9):1857-18612393317PubMedGoogle ScholarCrossref 4. Kubler-Ross E. On Death and Dying. New York, NY: Macmillan; 1969 5. Granek L, Tozer R, Mazzotta P, Ramjaun A, Krzyzanowska M. Nature and impact of grief over patient loss on oncologists' personal and professional lives [published online May 21, 2012]. Arch Intern Med. 2012;172(12):964-966Google Scholar 6. Whippen DA, Canellos GP. Burnout syndrome in the practice of oncology: results of a random survey of 1,000 oncologists. J Clin Oncol. 1991;9(10):1916-19201919641PubMedGoogle Scholar 7. Lesson DS, Buss MK, Panagopoulos G, et al. Burnout and associated characteristics in oncology fellows [abstract]. J Clin Oncol. 2005;23(16S):8168Google Scholar 8. Ludwig DS, Kabat-Zinn J. Mindfulness in medicine. JAMA. 2008;300(11):1350-135218799450PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Oncologists Responding to Grief: Comment on “Nature and Impact of Grief Over Patient Loss on Oncologists' Personal and Professional Lives”

Loading next page...
 
/lp/american-medical-association/oncologists-responding-to-grief-comment-on-nature-and-impact-of-grief-atbrL975YS
Publisher
American Medical Association
Copyright
Copyright © 2012 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinternmed.2012.2035
Publisher site
See Article on Publisher Site

Abstract

The practice of oncology can be stressful. While some stress can be motivating and challenging, in its extremes, stress can lead to emotional exhaustion, depersonalization, and self-perception of incompetence, all of which are considered hallmarks of burnout. Stress and burnout should not be confused with grief. Grief is deep mental anguish arising from loss.1 Since death and loss are intrinsic aspects of oncologists' practice, grief is common, whether it be over the physical absence of a patient or the more abstract surrender of a meaningful joint struggle. Unaddressed grief over time can clearly contribute to burnout, which is an occupational hazard for physicians in general and oncologists in particular. The undermining effects of stress, burnout, and depression among physicians have been studied.2 Healthy coping strategies have also been elucidated, including maintaining interests and friendships outside of medicine, allowing sufficient time for sleep, meals, and solitary contemplation, attending to routine medical and dental care, protecting time for family and friends with attention to scheduling, and acknowledging emotional responses in the context of the physician-patient experience.3 The recognition, expression, and exploration of grief in itself may be considered a coping strategy. Based on the model described by Kubler-Ross,4 the 5 stages of grief include denial, anger, bargaining, depression, and ultimately, acceptance. Therefore, a constructive approach to lessening the isolation associated with grief can be pursued, providing opportunities for sharing such feelings. Granek et al5 systematically explore oncologists' grief over patient loss and its potential personal and professional impact. Their results show some positives that emerge from these experiences, including a perceived “better perspective on life as a result of frequent exposure to patient loss.” Conversely, they also find negative effects such as physician distraction and withdrawal from patients. One suggestion that they and others1 have made to ameliorate the adverse effects of grief is to provide education on recognizing and working through the grief process, along with learning strategies that emphasize self-care, starting in the training years and continuing throughout their careers. At the University of Rochester Medical Center, we have initiated a process that does just that. In response to reports of significant burnout rates in practicing oncologists of approximately 56%6 and in oncology physician trainees of about 30%,7 a staff support group meeting was established in 2008 at the Wilmot Cancer Center. The group meeting is mandatory for hematology/oncology fellows and strongly recommended for all other team members who regularly interface with cancer patients, including hematology/oncology attending physicians, nurses, secretaries, and social workers. The group is cofacilitated by a palliative care expert, a medical oncologist, and a clergyman. The group meets on average 6 times per year. In addition to sharing stories and experiences about responses to patient loss and grief, participants routinely dedicate time to reflection on self-care strategies. Sessions will sometimes commence with mindfulness meditation exercises encouraging self-awareness by focusing exclusively on the process of gentle breathing.8 Participants are then invited to voice whatever work-related personal experiences are on their minds. Feelings of frustration, anger, loss, isolation, and insecurity often emerge in a setting that is nonjudgmental and supportive. At the end of each 1-hour session, a moment of silence is observed in remembrance of patients who have recently died, and the opportunity to remember and honor a patient who has died by saying his or her first name is offered. Over the past few years, we have witnessed each others tears and laughter—all while confidentially discussing our day-to-day impressions about, and personal reactions to, patients, their families, treatments, and death. This approach allows oncology staff and trainees to systematically share their loss and grief with others who have common experiences and values. While providers of oncology care can certainly experience their losses and grief in isolation, studies such as this one by Granek et al5 reveal the potential for withdrawal from other dying patients, distraction, and self-doubt. Ongoing study and development of optimized coping strategies for oncologists not only to survive but also to potentially experience personal growth from their work are needed, but experiences such as our oncology support group seem to be a big step in the right direction. Back to top Article Information Correspondence: Dr Quill, Division of Palliative Care, Hematology Oncology, University of Rochester Medical Center, 601 Elmwood Ave, PO Box 704, Rochester, New York 14642 (timothy_quill@urmc.rochester.edu). Published Online: May 21, 2012. doi:10.1001/archinternmed.2012.2035 Financial Disclosure: None reported. References 1. Moon PJ. Untaming grief? for palliative care physicians. Am J Hosp Palliat Care. 2011;28(8):569-57221504998PubMedGoogle ScholarCrossref 2. Shanafelt T, Dyrbye L. Oncologist burnout: causes, consequences, and responses. J Clin Oncol. 2012;30(11):1235-124122412138PubMedGoogle ScholarCrossref 3. Quill TE, Williamson PR. Healthy approaches to physician stress. Arch Intern Med. 1990;150(9):1857-18612393317PubMedGoogle ScholarCrossref 4. Kubler-Ross E. On Death and Dying. New York, NY: Macmillan; 1969 5. Granek L, Tozer R, Mazzotta P, Ramjaun A, Krzyzanowska M. Nature and impact of grief over patient loss on oncologists' personal and professional lives [published online May 21, 2012]. Arch Intern Med. 2012;172(12):964-966Google Scholar 6. Whippen DA, Canellos GP. Burnout syndrome in the practice of oncology: results of a random survey of 1,000 oncologists. J Clin Oncol. 1991;9(10):1916-19201919641PubMedGoogle Scholar 7. Lesson DS, Buss MK, Panagopoulos G, et al. Burnout and associated characteristics in oncology fellows [abstract]. J Clin Oncol. 2005;23(16S):8168Google Scholar 8. Ludwig DS, Kabat-Zinn J. Mindfulness in medicine. JAMA. 2008;300(11):1350-135218799450PubMedGoogle ScholarCrossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jun 25, 2012

Keywords: grief

References