Being a Pediatric Oncologist: A Nationwide Study of Personal Resources and Difficulties When Working with Children with Cancer

Abstract: Being a pediatric oncologist involves facing medical challenges, life-threatening conditions, psychosocial issues and existential provocation. The first nationwide study of 90 Swedish pediatric oncologists focuses on the psychological aspects for physicians meeting children with cancer, as well as physician-related factors promoting health and well-being. The experiences of the study population cover a period of more than 40 years. The thesis aims to study the everyday life of pediatric oncologists, i.e. their motivating factors, stress-resilience capacity, life satisfaction and work-related difficulties, in relation to relevant background characteristics, length of experience (more/less than 10 years) and type of medical center (academic/non-academic). The study design was cross-sectional and used both quantitative and qualitative methods. Paper I presents the development of a study-specific questionnaire. Papers II and III present the background characteristics for 89/90 physicians, working at academic medical centers with 25-90 new cancer patients every year and non-academic centers with 3-20 new patients. The response rate was 88/89% in the target group. The study-specific questionnaire and five psychometric instruments measuring coping resources, sense of coherence, life satisfaction, emotional distress and personality were used. Optimal pediatric oncology included several colleagues and a multi-professional healthcare team and the work was regarded as very stimulating for personal development. Time pressure was a reality for every participant, as were a wide range of coping resources, high sense of coherence, average overall life satisfaction and low levels of emotional distress. More experienced pediatricians reported a higher impact by motivating factors, past overall life satisfaction and a lower degree of somatization. Future overall life satisfaction was higher among physicians who met more pediatric oncology patients. Their personality traits showed low levels of negative affectivity and high levels of positive affectivity (Hedonic Capacity). Male pediatricians were more satisfied with their present lives and physicians working at academic medical centers were more confident about the future. One in ten needed professional help to deal with work-related psychological problems. Personality traits (Hedonic Capacity) and low levels of depression contributed to every aspect of overall life satisfaction. Work-related aspects influenced present and future life satisfaction. Paper IV, a grounded theory analysis of in-depth interviews with 10 experienced physicians, focused on their main concern, the demanding role of breaking bad news. Strategies for handling the challenges were related to seeking knowledge and support, building a close relationship with the patients and families, having reflected on central life issues but avoiding identification. Practical implications and physician-related recommendations are presented. The overall picture of this study group reveals an optimistic attitude and stable emotional status, pointing to a high level of satisfaction. The impediments are particularly related to time pressure, risk of emotional distress, having less experience and the need for colleagues, plus a multi-professional team. The role of messenger requires strategies to handle the challenges. Knowledge acquired from the present study is expected to be useful in improving the physician-patient relationship, thereby helping to retain experienced physicians and recruit new specialists in pediatric oncology.