Being a messenger of life-threatening conditions: experiences of pediatric oncologists.

BACKGROUND: A nationwide population-based study with questionnaires involving 90 pediatric oncologists was performed in Sweden in 2006/2007. On the basis of this quantitative study, a qualitative study was performed. The aim of this qualitative study was to focus on the main concern of these physicians facing malignant disorders, psychosocial issues, and existential provocation. Furthermore, the strategies for handling these challenges were also studied. METHOD: Interviews were conducted in 2007 with ten physicians of both genders, with more than 10 years' experience, who were active and previously active in pediatric oncology, and were working at academic and non-academic medical centers. The interviews were analyzed according to the inductive general research method of classical grounded theory. Every oncologist was selected from the nationwide study. RESULTS: A core category, that is, their main concern, labeled being a messenger of life-threatening conditions, was identified. To manage this difficult task of acting like a messenger breaking bad news, five handling categories were used: obtaining knowledge and information, saving one's strength and resources, building a close relationship, avoiding identification, and dealing with one's attitude to central life issues. All the categories and strategies used are described in the text. CONCLUSIONS: The challenge of making difficult decisions and delivering difficult news is an inevitable part of the patient-physician relationship in pediatric oncology. This qualitative study highlights the psychological aspects of being a pediatric oncologist. The study presents some practical implications in the daily work and physician-related recommendations on how to overcome the demanding role of messenger.

Life satisfaction of Swedish pediatric oncologists: The role of personality, work-related aspects, and emotional distress.

BACKGROUND: The first nationwide, population-based study of Swedish pediatric oncologists was conducted in 2006 and it revealed that various aspects of their life satisfaction obviously influenced their stress-resilience. This second part of the study, with a response rate of 89% in the target group, therefore, focused on their life satisfaction and the role of personality, work-related aspects, and emotional distress related to type of medical center and gender. PROCEDURE: This descriptive study was based on a cross-sectional mail survey with questionnaires involving 90 pediatric oncologists. Using hierarchical regression models, their total, present, past, and future life satisfaction was analyzed. RESULTS: The vast majority (76.7%) stated that working in this medical field was very stimulating for their personal development. Male pediatricians were more satisfied with their present lives and physicians working at academic medical centers were more confident about the future. Some oncologists (13.4%), in particular females at non-academic medical centers, needed professional help dealing with work-related psychological problems. Personality trait (Hedonic Capacity) and low levels of depression contributed to every aspect of overall life satisfaction. Work-related aspects influenced present and future life satisfaction. The models explained between 5% and 43% of the variance in life satisfaction in the whole group. CONCLUSIONS: Pediatric oncologists face life-threatening conditions and psychosocial issues factors that may negatively influence their life satisfaction. This study group, a single population of physicians, is characterized by an optimistic attitude and stable emotional status pointing to a high level of satisfaction, which is probably a main basic condition when meeting seriously ill children.

Stress-resilience capacity of pediatric oncologists: a Swedish nationwide and population-based study of motivation, emotional distress, and overall life satisfaction.

BACKGROUND: Pediatric oncology is an area with heavy emotional distress. In balancing the daily challenges motivational factors might play a key role and could be examined by studying an individual's stress-resilience capacity. This first nationwide population-based study of 89 Swedish pediatric oncologists presents aspects of motivation related to experience and number of patients cared. PROCEDURE: In 2006, a cross-sectional mail survey with questionnaires dealing with motivation, coping resources, life satisfaction and emotional distress was performed. The response rate in the target group was 88%. RESULTS: The physicians wanted to be well informed (98%) and updated at national (93%) and international (90%) level. Established routines gave them security managing different diagnoses (97%). Optimal pediatric oncology included several colleagues (98%) and a multi-professional healthcare team (95%). Time pressure was a reality for every participant. Meeting seriously ill children was a way of being aware of essential issues of life (90%). More experienced pediatricians reported higher impact from motivational factors, past overall life satisfaction and a lower degree of somatization. The future overall life satisfaction was higher among physicians meeting more pediatric oncology patients. Between 8% and 45% of the variance in the stress-resilience capacity of the whole group was explained by low levels of depression, future overall life satisfaction and aspects of motivation. CONCLUSIONS: Pediatric oncologists continuously meet families in crisis. Knowledge of the physicians' stress-resilience capacity is expected to be useful in improving the physician-patient relationship, retaining experienced physicians and recruiting new specialists in this medical field.

Stress related factors among primary and part-time caregiving grandmothers of Kenyan grandchildren.

The present study examined whether the total stress experienced by 241 caregiving grandmothers was linked to levels of care provided, child behavioral difficulty, and perceived availability of emotional and instrumental support. One hundred and twenty eight of these participants adopted their orphaned grandchildren on full-time basis. The rest (n = 113) were grandmothers providing partial parenting roles in households that also included one of these children's biological parents. The results indicated that the full-time grandmothers experienced significantly higher levels of stress than did the part-time caregivers. The total stress experienced was related to these participants' perception of child behavioral difficulty and limited instrumental support.

Physical discipline and children's adjustment: cultural normativeness as a moderator.

Interviews were conducted with 336 mother-child dyads (children's ages ranged from 6 to 17 years; mothers' ages ranged from 20 to 59 years) in China, India, Italy, Kenya, the Philippines, and Thailand to examine whether normativeness of physical discipline moderates the link between mothers' use of physical discipline and children's adjustment. Multilevel regression analyses revealed that physical discipline was less strongly associated with adverse child outcomes in conditions of greater perceived normativeness, but physical discipline was also associated with more adverse outcomes regardless of its perceived normativeness. Countries with the lowest use of physical discipline showed the strongest association between mothers' use and children's behavior problems, but in all countries higher use of physical discipline was associated with more aggression and anxiety.