Barriers and facilitators in coping with patient death in clinical oncology

Purpose: The purpose of this study was to explore barriers and facilitators in coping with patient death in the oncology context. Methods: The grounded theory method was used to collect and analyze the data. Twenty-two oncologists were interviewed between March 2013 and June 2014 from three adult oncology centers. Oncologists were at different stages of their careers and varied in their sub-specialties, gender, and personal and professional backgrounds. Results: The analysis revealed that facilitators to coping with patient death included cognitive, behavioral, relational, professional, and spiritual coping strategies. Behavioral coping strategies included sports, hobbies, entertainment, and taking vacations. Cognitive strategies included accepting and normalizing death and focusing on the positive, and on successes in the practice of oncology. Relational coping strategies included accessing social support from family, friends, and colleagues. Professional coping strategies included focusing on work, withdrawing from patients at end of life, and compartmentalization. Spiritual coping strategies included turning to faith and religious coping. Oncologists also reported a number of challenges and barriers in coping effectively with patient deaths. These included challenges in accessing social support, challenges that were related to gender and expression of emotion, and challenges in maintaining emotional boundaries when patients died. Conclusions: Oncologists turn to a number of diverse coping strategies in dealing with patient death, but many obstacles to accessing this support were reported. Targeted interventions for managing and coping with grief related to patient death need to be developed to support oncologists in their emotionally difficult work.