2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

telephone call to the family, sending a sympathy card, or
attending a funeral. Approximately 33.3% (95% CI 29.3–
37.4%) reported usually or always, 30.5% (95% CI 26.5–
34.4%) reported sometimes, and 36.2% (95% CI 32.1–40.3%)
reported rarely or never. The most common practice was a
phone call whereas attending a funeral was rare. A small
number of physicians, approximately 9% (95% CI 6.6–
11.5%), felt that sending a condolence note was the responsibility
of the physician.
The most common identified barrier to contacting the
patient’s family was lack of time and resources, although
some felt uncomfortable and were not certain whom to
contact. Multivariate analysis revealed that more frequent
bereavement practice was associated with female sex, working
in an academic center, conviction that physicians have
a responsibility to write a condolence card, and absence of a
Author’s Disclosure of Potential Conflicts of Interest
Author
Teresa Gilewski*
*No relevant relationships to disclose.
Employment or
Leadership
Positions
Consultant or
Advisory Role
1. Dickinson, E. The Complete Poems of Emily Dickinson. Boston: Little
Brown; 1924.
2. Merriam-Webster. www.merriam-webster.com. Accessed February 6,
2012.
3. Emanuel LL, Ferris FD, von Gunten DF, Von Roenn J. Education in
Palliative and End-of-Life Care - Oncology (EPEC-O): Participant’s Handbook.
Module 4: Loss, Grief and Bereavement. EPEC Project. Chicago, IL:
2005;M4-1-M4-24.
4. Emmanuel EJ, Fairclough DL, Slutsman J, et al. Understanding economic
and other burdens of terminal illness: The experience of patients and
their caregivers. Ann Inter Med. 2000;132:451-459.
5. Casarett D, Kutner JS, Abrahm J, et al. Life after death: A practical
approach to grief and bereavement. Ann Intern Med. 2001;134:208-215.
6. Woof WR, Carter YH. The grieving adult and the general practitioner:
A literature review in two parts (Part 1). Br J Gen Pract. 1997;47:443-448.
7. Kübler-Ross E. On Death and Dying. New York, NY, Macmillan, 1969.
8. Macicjewski PK, Zhang B, Block SD, et al. An empirical examination of
the stage theory of grief. JAMA. 2007;297:716-723.
9. Tomarken A, Holland J, Schachter S, et al. Factors of complicated grief
pre-death in caregivers of cancer patients. Psychooncology. 2008;17:105-111.
10. Holland JC. Management of grief and loss: Medicine’s obligation and
challenge. J Am Med Womens Assoc. 2002;57:95-96.
11. Gorlin R, Zucker HD. Physicians’ reactions to patients: A key to
teaching humanistic medicine. N Engl J Med. 1983;308:1059-1063.
12. Novack DH, Suchman AL, Clark W, et al. Calibrating the physician:
Personal awareness and effective patient care. JAMA. 1997;278:502-509.
13. Meier DE, Back AL, Morrison RS. The inner life of physicians and care
of the seriously ill. JAMA. 2001;286:3007-3014.
14. Redinbaugh EM, Sullivan AM, Block SD, et al. Doctors’ emotional
reactions to recent death of a patient: Cross sectional study of hospital
doctors. BMJ. 2003;327:185-189.
15. Moores TS, Castle KL, Shaw KL, et al. ‘Memorable patient deaths’:
reactions of hospital doctors and their need for support. Med Edu. 2007;41:
942-946.
16. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol.
2001;52:397-422.
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palliative care program, with the most significant being a
palliative care specialty.
For some patient’s families, it may also be meaningful to
visit with them in person. Physicians may not recognize the
importance of these bereavement practices because of limited
feedback from the patient’s loved ones.
Conclusion
Grief is a normal response to loss and a fundamental
component of the field of oncology. Health care workers in
oncology face the challenge of repeated exposure to serious
illness and death. Enhanced acknowledgment and recognition
of the indicators of grief and reasons for grief are
essential to providing sustainable compassionate care. Engaging
one’s grief may result in considerable insight into the
essence of patient care and the soul of medicine.
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Ownership Honoraria
REFERENCES
Research
Funding
Expert
Testimony
TERESA GILEWSKI
Other
Remuneration
17. Whippen DA, Canellos GP. Burnout syndrome in the practice of
oncology: Results of a random survey of 1,000 oncologists. J Clin Oncol.
1991;9:1916-1921.
18. Kash KM, Holland JC, Breitbart W, et al. Stress and burnout in
oncology. Oncology. 2000;14:1621-1633.
19. Mount BM. Dealing with our losses. J Clin Oncol. 1986;4:1127-1134.
20. Lyckholm L. Dealing with stress, burnout, and grief in the practice of
oncology. Lancet Oncol. 2001;2:750-755.
21. Ramirez AJ, Graham J, Richards MA, et al. Mental health of hospital
consultants: The effects of stress and satisfaction at work. Lancet. 1996;347:
724-728.
22. Block SD. Psychological considerations, growth, and transcendence at
the end of life: the art of the possible. JAMA. 2001;285:2898-2905.
23. Kearney MK, Weininger RB, Vachon MLS, et al. Self-care of physicians
caring for patients at the end of life: “Being connected . . . a key to my
survival”. JAMA. 2009;301:1155-1164.
24. Brown SL, Nesse RM, Vinokur AD, et al. Providing social support may
be more beneficial than receiving it: Results from a prospective study of
mortality. Psychol Sci. 2003;14:320-327.
25. Prigerson HG, Jacobs SC. Caring for bereaved patients: “All the
Doctors Just Suddenly Go”. JAMA. 2001;286:1369-1376.
26. Smith L, Hough CL. Using death rounds to improve end-of-life education
for internal medicine residents. J Palliative Medicine. 2011;14:55–58.
27. Charon R. Narrative medicine: a model for empathy, reflection, profession,
and trust. JAMA. 2001;286:1897-1902.
28. Siegel B, Schultz S. Crying in stairwells: How should we grieve for
dying patients? JAMA. 1994;272:659.
29. Gilewski T. The subtle power of compassion. JAMA. 2001;286:3052-
3053.
30. Penson RT, Green KM, Chabner BA, et al. When does the responsibility
of our care end: Bereavement. Oncologist. 2002;7:251-258.
31. Bedell SE, Cadenhead K, Graboys TB. The doctor’s letter of condolence.
N Engl J Med. 2001;344:1162-1164.
32. Chau NG, Zimmermann C, Ma C, et al. Bereavement practices of
physicians in oncology and palliative care. Arch Intern Med. 2009;169:963-
971.