Department of Sociology of Health, Ben Gurion University of the Negev, Be'er Sheva, Israel.
J Palliat Med. 2012 Nov;15(11):1254-60. doi: 10.1089/jpm.2012.0245. Epub 2012 Sep 27.
While caring for critically ill and terminal patients can elicit grief symptoms in health care professionals, few studies have examined oncologists' grief over patient loss using a qualitative approach to inquiry.
To explore what makes patient loss difficult for oncologists and to explore the context in which these losses were occurring.
Twenty oncologists were interviewed at three oncology centers in Canada about their experiences of grief over patient loss. Exclusion criteria included never having lost a patient in their care and being unable to speak English. Data was analyzed using the grounded theory method.
Oncologists found patient loss particularly difficult for relational reasons including instances where they felt close to patients and their families, when they had a transference to the patient, when patients died young, when they had long-term patients, and when deaths were unexpected. Contextual reasons included when patients and their families were unprepared for death, had unrealistic expectations about cure, when excessive treatments were perceived to be used, when physicians were blamed for the loss, or when families were chaotic or had high needs. Findings further revealed that these losses were occurring within a physician culture that had a stigma around death and dying, viewed emotion as weakness, was focused on cure, and was gendered.
Effective interventions to help oncologists cope with grief must identify the expectation gaps between physicians and patients when it comes to end-of-life care.
在照顾病危和终末期患者时，医护人员可能会出现悲伤症状，但很少有研究采用定性方法探讨肿瘤医生对患者死亡的悲伤。
探讨是什么让肿瘤医生感到患者死亡困难，并探讨这些损失发生的背景。
在加拿大的三个肿瘤中心，对 20 名肿瘤医生进行了关于他们对患者死亡的悲伤经历的访谈。排除标准包括从未在护理中失去过患者且无法讲英语的医生。使用扎根理论方法对数据进行分析。
肿瘤医生发现，由于关系原因，患者死亡尤其困难，包括他们与患者及其家属关系密切的情况，当他们对患者产生移情时，当患者年轻死亡时，当他们有长期患者时，以及当死亡出乎意料时。背景原因包括患者及其家属对死亡没有准备，对治愈抱有不切实际的期望，当被认为使用了过多的治疗方法时，当医生因失去患者而受到指责时，或者当家庭混乱或需求较高时。研究结果进一步表明，这些损失发生在一种医生文化中，这种文化对死亡和临终存在污名化，将情感视为弱点，关注治愈，并具有性别差异。
为帮助肿瘤医生应对悲伤而采取的有效干预措施，必须确定在临终关怀方面，医生和患者之间的期望差距。
