"We are a transit station here": The role of Israeli oncology social workers in responding to mental health distress and suicidality in patients with cancer.

Social workers have a prominent role in responding to cancer patients' mental health needs. Given the risk of mental health distress in cancer patients, and given that social workers are responsible for responding to these needs, the purpose of this study was to explore how social workers describe their role in responding to mental health distress and suicidality in people with cancer. The Grounded Theory method of data collection and analysis was used. Eighteen social workers were recruited and interviewed. Social workers saw themselves and acted as an interprofessional hub for their patients. This approach was based on the values of holistic care, multiple treatment modalities, interpersonal consultation, and continuity of care. From this standpoint, social workers offered their patients (and at times, their families) comprehensive services providing emotional, behavioral and practical support within the hospital setting, but also outside of it in the patient's communities. Consideration should be paid to promote systemic changes to acknowledge and compensate oncology socials workers' invisible labor that includes both emotional carryover and continuous engagement in their role as liaison and intermediaries for their patients.

Parental spirituality in life-threatening pediatric cancer.

This study addressed parental spirituality in the context of pediatric cancer with a poor prognosis. Drawing upon previous research implementing a longitudinal grounded theory design examining parental hope, 35 parents were interviewed regarding their experiences with an emergent description of the role of spirituality in parents' daily lives. Spirituality included religious beliefs and practices, notions of a higher force or cosmos, relationship with a divine being, as well as elements emerging from meaning-making and relationships. Parental expectations of spirituality remained relatively constant across data collection time points (3-9 months postdiagnosis), although limited variation occurred relative to shifting circumstance (e.g., deterioration of the child's condition). Spirituality appeared to offer: greater acceptance of parents' inability to protect their child from harm related to her/his life-threatening illness, guidance and emotion decompression, and support from one's faith community. Recommendations for integrating spiritual assessment in clinical care practice are offered.

Grief reactions and impact of patient death on pediatric oncologists.

BACKGROUND: To examine pediatric oncologists' grief reactions to patient death, and the impact patient death has on their personal and professional lives. PROCEDURE: The grounded theory method was used. Data was collected between March 2012 and July 2012 at two academic centres in Canada. Twenty-one out of 34 eligible pediatric oncologists at different stages of their career were recruited and interviewed about their experiences with patient death. Inclusion criteria were: being able to speak English and having had a patient die in their care. The participants formed three groups of oncologists at different stages of career including: fellows, junior oncologists, and senior oncologists who varied in sub-specialties, gender, and ethnicities. RESULTS: Pediatric oncologists reported a range of reactions to patient death including sadness, crying, sleep loss, exhaustion, feeling physically ill, and a sense of personal loss. They also reported self-questioning, guilt, feelings of failure and helplessness. The impact of these deaths had personal consequences that ranged from irritability at home, feeling disconnected from family members and friends, and becoming more desensitized towards death, to gaining a greater and more appreciative perspective on life. Professional impacts included concern about turnover or burnout at work and improving holistic care as a result of patient deaths. CONCLUSIONS: Grief over patient death and the emotional labour involved in these losses are a robust part of the pediatric oncology workplace and have major impacts on pediatric oncologist's personal and professional lives. Interventions that focus on how to help pediatric oncologists deal with these reactions are needed.

Early exposure to a clinical oncology course during the preclinical second year of medical school.

PROBLEM: Although only some medical students pursue a career in oncology, all should have a basic understanding of the issues surrounding cancer and its treatment. The authors designed and implemented a one-week introductory clinical oncology course for second-year medical students at Ben Gurion University of the Negev. The course presents a holistic approach to caring for patients with cancer that goes beyond the biological aspects of the disease. APPROACH: In 2013, the authors interviewed four former students and surveyed all current students before and after they completed the course to evaluate its reception and effectiveness. OUTCOMES: Of the 86 students in the course, 77 (90%) completed both the pre- and postcourse surveys. After taking the course, more students reported being concerned about ethical issues, being emotionally stirred by the course, being comfortable speaking with a cancer patient about death and dying, and being comfortable with the fact that the course dealt with issues of death and loss and with "how to live with cancer." In addition, more students reported a fear of causing a cancer patient suffering because of a treatment yet viewed cancer optimistically. Finally, more students considered specializing in oncology. NEXT STEPS: That students reported increased empathy toward cancer patients despite increased trepidation about causing them suffering is promising. Such courses may be one way to counteract the decrease in empathy among students as they progress through medical school. As such, medical schools might consider including this type of curriculum in their preclinical oncology studies.

The tenacity and tenuousness of hope: parental experiences of hope when their child has a poor cancer prognosis.

BACKGROUND: The meaning and role of hope in parents of children with life-threatening illnesses remain relatively unstudied. OBJECTIVE: The objectives of this study were to explore parental hope when a child is being treated for a malignancy resistant to treatment and to identify facilitators and barriers to maintaining hope in this context. METHODS: Thirty-five parents of children with difficult-to-treat cancer were interviewed 3 months after diagnosis. Line-by-line coding of transcripts was used to establish categories and themes. Constant comparison was used to examine relationships within and across codes and categories. RESULTS: Parental hope was related to the child's cure and future. The concept, however, oscillated between being tenacious and robust, and tenuous and elusive, depending on how the child was responding to treatment and the psychosocial context. Focusing on positive outcomes and experiences, spirituality, and social support facilitated being hopeful. Awareness of negative outcomes, information overload, physical and emotional depletion, and fear and uncertainty challenged parental hope. CONCLUSIONS: Developing a model that identifies the nature of parental hope as well as barriers and facilitators to maintaining hope shortly after childhood cancer diagnosis may assist healthcare professionals in supporting parents. IMPLICATIONS FOR PRACTICE: Understanding parental hope may assist healthcare professionals to avoid overloading parents with too much information at once. Healthcare professionals can also ensure that social support from family, community, and the medical center is available for parents and that their physical and emotional needs are being met to ensure that they maintain hope to best care for their child with cancer.