Exploring the Psychological Experience amongst Oncologist Caring for Children with Cancer

INTRODUCTION

Caring for children with cancer can be an immensely fulfilling yet emotionally challenging experience for pediatric oncologists. These healthcare professionals face unique stressors and psychological burdens as they navigate the difficulties of treating young patients with life[1]threatening illnesses. The trust between patients and oncologists is delicate and it is a critical factor that can impact the psychological well-being of the oncologist [1]

Building and sustaining strong therapeutic relationships is essential, but the integral uncertainty and potential loss of the patient can cause a emotional burden. Oncologists must balance between providing hope with being realistic about prognoses, which requires skill and resilience. Pediatric oncologists often develop coping strategies to deal with patient deaths, such as classifying their emotions, seeking support from colleagues, and finding meaning in their work [2]

However, these strategies are not always sufficient to prevent burnout, a significant problem in the field. Studies have found high rates of burnout, psychiatric morbidity, and work-related stress among pediatric oncology staff [3][4]bFactors contributing to burnout include heavy workloads, emotional demands, lack of control, and insufficient support [4]

Pediatric oncologists may experience feelings of helplessness, guilt, and grief when patients die, which can heel over time [2]. Organizational factors like inadequate staffing and resources can exacerbate these stressors [4]. Guidelines have been developed to help recognize, prevent, and remediate burnout in pediatric oncology professionals[5]

Research indicates that pediatric oncologists in India face substantial emotional and psychological burdens due to more patients and the diverse range of conditions they treat. Factors such as inadequate staffing, limited resources, and the intense emotional demands of their work contribute to high levels of burnout and stress among these healthcare professionals[6]

Additionally, the cultural context, including societal attitudes towards illness and death, further complicates the experiences of oncologists. For instance, communication gaps between healthcare providers, patients, and families, and the emotional strain of dealing with pediatric cancer cases are prominent issues that exacerbate stress[7]

The psychological impact on healthcare providers in similar settings, such as those addresses the burden of palliative care in pediatric oncology within low and middle-income countries[6] These sources can provide a broader understanding of the contextual factors affecting pediatric oncologists in India. Factors influencing psychological well-being is influenced by a combination of personal factors, work-related stressors, and support systems. These personal factors include maintaining open communication with colleagues, balancing professional and private life, and engaging in activities that provide relaxation and mental distraction from work. Work-related stressors encompass a high workload, inadequate organizational support, poor working relationships with colleagues, the emotional burden of dealing with patient deaths, the length of relationships with child patients, and individual coping styles. Support systems such as participation in sensitivity training sessions on burnout, relaxation training, and stress management are also crucial. This study will identify these factors specifically as they influence the psychological well-being of pediatric oncologists [1] [2] [3] [4]

.Fostering a supportive work culture, providing mental health resources for coping strategies are essential steps toward addressing the psychological needs of pediatric oncologists. To comprehensively understand these needs, further research is crucial. This study aims to explore into the lived experiences and psychological challenges faced by pediatric oncologists. By intensifying their subjective experiences, this research helps to illuminate these significant issues and inform initiatives to support the well-being of these professionals.

LITERATURE REVIEW

Dealing with pediatric cancer not only burdens the children with cancer and family but also it leads to the insightful understanding of the emotional aspects experienced by the oncologists treating those children. In this review of literature, I investigate the psychological aspects that impact the oncologists treating children with cancer and their families.

The psychological experiences of the oncologists is multidimensional. Other than providing the treatment, they cope with their individual emotional reactions and social connections associated with the children and their families. In reviewing the literature , the emotional dimensions can be identified in both positive and negative emotions, this study aims to the understand about the psychological experiences and challenges relevant

to the pediatric oncologists.

Frachebout et.al, studied on the dynamics of trust in patient-oncologist relationships: Insights from a multiple case study which explores into understanding trust dynamics in oncology consultations within a naturalistic setting. The methodology involved purposively selecting cases to study the trust in these consultations. The research explores various dimensions of trust, including the relational vulnerability of the patient, the role of past positive experiences in nurturing trust, and the distinction between trust and satisfaction. The study highlights the fragile nature of trust, influenced by contextual, interpersonal and intrapersonal factors. It reveals that trust can coexist with distrust in the same consultation and emphasizes the importance of trust in the patient-oncologist relationship. The research highlights the complexity of trust as a core element during the treatment, shaped by a various factor that can either enhance the trust [1]

Granek et.al, examine the coping strategies of Pediatric Oncologists experiencing the loss of the patient. This study explores the multifaceted approaches of healthcare providers to navigate the emotional challenges allied with patient loss. The methodology involved qualitative research methods to explore the coping strategies utilized by pediatric oncologists, including themes such as disengagement coping, spiritual coping, and professional coping strategies were identified. The research emphasized the diverse range of responses experienced by oncologists following patient death, such as sadness, exhaustion, and physical symptoms. It underlined the importance of understanding and supporting healthcare providers in managing the emotional impact of patient loss, shedding light on the coping mechanisms employed by pediatric oncologists to navigate these difficult situations effectively [2]

.

Roth et.al, conducted the study to explore the Career burnout among pediatric oncologists. This study was conducted by a survey sent among 1,047 Pediatric Oncologists in practice, with 410 respondents. The methodology involved utilizing the Maslach Burnout Inventory (MBI) and assessing work-related burnout-linked lifestyle factors among professionals. The research revealed that 38% of pediatric oncologist s experienced high levels of burnout, with 72% reporting at least moderate levels. Factors such as gender, years of practice, and satisfaction with life outside work were associat ed with varying rates of burnout. Debriefing sessions and services help to reduce the burnout rates among pediatric oncologist. The study emphasized the need for further research on interventions to prevent work-related burnout among Pediatric Oncologists [3]

.

Mukherje et.al, highlighted on the “Burnout, psychiatric morbidity, and work-relat ed sources of stress in paediatric oncology staff: a review of the literature " they used a mixed-method approach to investigate the prevalence, causes, and consequences of burnout among pediatric oncologist. Using surveys and interviews, they assessed the levels of burnout and identified contributing factors such as heavy workload, emotional exhaustion witnessing from patient suffering, and difficulties in balancing work and personal life. The study revealed the rates of burnout among pediatric oncologists, highlighting its negative effects on job satisfaction, quality of patient care, and overall well-being. These findings helps the need for targeted interventions to mitigate burnout and promote the resilience among pediatric oncologists [4].

Spinetta et.al, explores on the Emotional Landscape of Psychological Experiences among Pediatric oncologists it is a systematic review aimed to provide a comprehensive understanding about the emotional experiences and psychological well-being of oncologists caring for children with cancer. The review examined the factors such as emotional responses, coping mechanisms, ethical challenges, and sources of professional fulfillment experienced by oncologists in this specialized field. The findings revealed the multifaceted nature of the psychological experiences of these healthcare providers, highlighting the profound impact of caring for children with cancer. The review emphasized the need for targeted interventions and support systems to address the emotional difficulties and mitigate the risk of burnout among oncologists, ultimately enhancing their well-being and the quality of care provided to children with cancer [5]

.

RESEARCH GAPS IDENTIFIED

From the above literature review, it is identified that pediatric oncologists experience significant psychological burdens that can impact their well-being and the quality of care they provide to children with cancer. The emotional challenges of treating young patients with cancer, involves the strong therapeutic relationships. Existing literature explores the negative emotions and psychological challenges faced by pediatric oncologists, such as burnout, psychiatric morbidity, work-related stress, complexity of trust in patient[1]oncologist relationships and the diverse emotional responses experienced by oncologists during the patient deaths.

However, there is a gap in the literature concerning about the positive emotions and sources of fulfillment experienced by pediatric oncologists and the factors influencing the psychological well-being. There is a lack of comprehensive understanding of how positive emotions and professional fulfillment contribute to the overall psychological well-being of these professionals. This study aims to fill this gap by exploring both the negative and positive psychological experiences of pediatric oncologists through qualitative analysis. By investigating the lived experiences and psychological challenges faced by pediatric oncologists, this research will provide a more holistic understanding of their emotional experiences.

The novelty of this study explores both negative and positive emotions, through the qualitative analysis, this research will be help to understand the subjective experiences of these professionals, understanding the challenges and the coping mechanisms they used to maintain resilience. By providing a comprehensive understanding of the psychological experiences of pediatric oncologists, this study aims to explore the factors of psychological well-being which in turn can be related to the quality of care they provide to children with cancer.

OBJECTIVES

1. To explore the psychological experiences including emotional responses, stressors, and sources of fulfillment, among oncologists caring for children with cancer.

2. To identify factors influencing the psychological well-being of oncologists caring for children with cancer.

DETAILED METHODOLOGY

Research Question:

What are the psychological experiences of oncologists encounter while providing care for children with cancer?

Research Design:

For this study, a qualitative approach will be employed using the In-Depth Interviewguide (IDI). This approach will be mainly focused to understanding complex, subjective experiences and gaining deep insights into participants’ perspectives, emotions andpsychological well-being.

Study setting:

The study will be conducted in pediatric oncology units within hospitals. The participant s will include pediatric oncologists who work in these units. This will include a range of professionals with minimum two years of experience. Interviews will be conducted in a quiet room within the hospital to ensure confidentiality and comfort for the participants. The study will be conducted in accordance with ethical guidelines to protect participants’ privacy and emotional well-being. Informed consent will be obtained, and support will be available for participants who may experience distress during the study.In case of online interview participants can choose a quiet location for the interview, such as their office or home, to ensure they are comfortable and free from interruptions. Participants will need a computer or laptop or mobile device with a reliable internet connection, and a microphone to participate in the online interviews. Participants will receive detailed information about the study’s purpose, procedures, and their rights via email prior to the interview. They will provide informed consent electronically. Measures will be taken to ensure confidentiality, such as anonymizing data and securely storing interview recordings and transcripts. Secure, encrypted video conferencing platforms will be used to protect participants’ privacy. With participants’ consent, interviews will be video or audio recorded to ensure accurate data collection. Notes will also be taken during the interviews to capture non-verbal cues and immediate reflections. A secure and user-friendly video conferencing platform (e.g., Zoom, Microsoft Teams) will be chosen for conducting the interviews.

Study population:

Inclusion Criteria:

1. Individuals who are trained and licensed medical doctors specializing in pediatric

oncology.

2. Pediatric oncologist caring for children with cancer with minimum 2 years of

experience.

3 Pediatric oncologists working in Corporate and non-corporate healthcare setups.

Exclusion Criteria:

1 Oncologists not involved in pediatric oncology care or those who do not consent to

participate.

2 Oncologists with less than 2 years of experience in pediatric oncology and primarily

treat adult patients.

3 Individuals who are not formally trained and licensed as pediatric oncologists.

Sampling Method:

Purposive sampling method will be used to select participants.

Sample Size:

The study aims to include approximately 30 - 40 pediatric oncologists. This range is considered sufficient for qualitative research to achieve data saturation, where no new themes or insights are emerging from the interviews. The final sample size may be adjusted based on the point of data saturation.

Participant recruitment:

Collaboration with hospitals and pediatric oncology units to identify and invite eligible participants. Hospital administrators and department heads may assist in identifying potential participants. Potential participants will be invited via email or in-person communication, providing them with detailed information about the study, its purpose, procedures, and ethical considerations. Participation will be entirely voluntary decision to participate.

6. Participant Characteristics:

Information on participants’ age, gender, years of experience, and specific roles within the pediatric oncology unit will be collected to provide context to their experiences. Details about their educational background, professional training, and any specializations within pediatric oncology will also be gathered.

Qualitative approach:

1. Data Collection Method: In this study, interview will be conducted with the In depth Interview Guide with pediatric oncologists to investigate their psychological experiences. These interviews will be audio-recorded and transcribed verbatim to facilitate analysis. It is conducted in the both methods face to face and online mode.

 3.Phases of Semi Structured Interviews:

a. Pre-Interview phase:

1 Selection of participants based on inclusion criteria.

2 Distribution of flyer with the relevant details of the study by directly approaching the

participants or via email.

1 Deciding about the convenient time and place with the participants.

2 Participant Informant Sheet and Informed consent will be sent in advance to the

participants in online mode and in case of face-to-face interview consent and details

will be collected during the interview.

b. Interview Phase:

1 Interview will be audio recorded with due consent of the participant. Each

participant will be given unique code anonymizing the participant details during

the audio recording the interview.

2 Clear instruction will be given along with ensuring the minimal interruptions to

maintain a smooth flow of conversation and focus on the discussion.

3 The interview will aim to maintain an ideal duration of 60 minutes, allowing ample

time for comprehensive discussion with ensuring efficiency. Research log book will

be maintained to note the themes.

4 If any distress is encounter during the interview, distress protocols will be used,

stopping the recording if necessary, and potentially suspending the interview to

ensure the well-being of participants involved.

5 In the end of the interview, it will be summarized with the key points and

ensuring that all topics have been adequately covered. Post interview feedbacks

will be taken from the participants.

c. Post Interview Phase:

Transcription of data:

1 NVIVO software will be used to organize, analyze and visualize qualitative data of

the interviews, it allows for the efficient coding, categorizing and exploring the data,

it helps to find the patterns, themes, and insights of the data.

Data Analysis:

2 Thematic analysis will be utilized to discern patterns, themes, and categories within

the interview data. Through coding and interpretation, the data will be analyzed to

reveal insightful findings.

Ethical Considerations:

Applied for the ethical approval from the institutional ethical committee (IEC) at

Kasturba Medical College, Manipal before proceeding with data collection. Finally

ensuring the participants’ confidentiality and privacy are protected throughout the

study, and obtain informed consent from all participants during the interview.

EXPECTED OUTCOME

1. Explore the Range of Psychological Experiences:

1 Investigate the positive and negative emotional responses unveiled by

pediatric oncologists, including empathy, grief, frustration, and fulfilment.

This qualitative study aims to provide a deeper understanding of oncologists’

psychological experiences during their interactions with children with cancer

and their families, informing strategies to enhance support and improve the

quality of care.

2 Examine the stressors and challenges encountered by pediatric oncologists in

the course of their work, including patient mortality, treatment decisions, and

ethical dilemmas.

3 Identify the various sources of fulfillment and satisfaction experienced by

pediatric oncologists, elucidating the aspects of their work that contribute

positively to their psychological well-being.

Identify Factors Influencing Psychological Well-being:

1 Investigate individual factors, such as personal coping mechanisms and

resilience that influence the psychological well-being of pediatric

oncologists.

2 Explore organizational factors, including institutional support systems,

workload, and work-life balance, that impact the psychological well-being

of pediatric oncologists.

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