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. Pediatr Blood Cancer. 2010;55:478-484. (C), 2010 Wiley-Liss, Inc.