Leeat Granek

Nature and Impact of Grief Over Patient Loss on Oncologists' Personal and Professional Lives

and eating environments: policy and environmental approaches. Annu Rev Public Health. 2008;29:253-272. 2. Wansink B, Tal A, Shimizu M. First foods most: after 18-hour fast, people drawn to starches first and vegetables last. Arch Intern Med. 2012;172(12): 961-963. 3. Coleman-Jensen A, Nord M, Andrews MS, Carlson S. Household Food Security in the United States in 2010. Washington, DC: USDA Economic Research Service; 2011. 4. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010;303(3):235-241. 5. Dietz WH. Does hunger cause obesity? Pediatrics. 1995;95(5):766-767. 6. Finney Rutten L, Yaroch AL, Colon-Ramos U, Johnson-Askew W, Story M. Poverty, food insecurity, and obesity: a conceptual framework for research, practice, and policy. J Health Environ Nutr. 2010;5:403-415. 7. Larson NI, Story MT. Food insecurity and weight status among U.S. children and families: a review of the literature. Am J Prev Med. 2011;40(2):166-173. 8. Institute of Medicine Workshop Presenters. Hunger and obesity: understanding a food insecurity paradigm. http: //www .iom .edu /Reports /2011 /Hunger -and-Obesity-Understanding-a-Food-Insecurity-Paradigm .aspx. Accessed March 22, 2012. 9. Drewnowski A, Specter SE. Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr. 2004;79(1):6-16.

Trajectory of parental hope when a child has difficult-to-treat cancer: a prospective qualitative study

This prospective and longitudinal study was designed to further our understanding of parental hope when a child is being treated for a malignancy resistant to treatment over three time points during the first year after diagnosis using a qualitative approach to inquiry.

Psychological factors impacting transition from paediatric to adult care by childhood cancer survivors

PurposeChildhood cancer survivors require life-long care focused on the specific late effects that may arise from their cancer and its treatment. In many centers, survivors are required to transition from follow-up care in a paediatric cancer center, to care provided in an adult care setting. The purpose of this study was to identify the psychological factors involved in this transition to adult care long-term follow-up clinics.MethodsQualitative interviews were conducted with ten paediatric survivors still in paediatric care, as well as 28 adult survivors of whom 11 had transitioned successfully to adult care (attended three long-term follow-up (LTFU) appointments consecutively); ten who failed to transition (attended at least one LTFU appointment as an adult, but were inconsistent with subsequent attendance); and seven who had never transitioned (did not attend any LTFU care as an adult). Line-by-line coding was used to establish categories and themes. Constant comparison was used to examine relationships within and across codes and categories.ResultsTwo overall categories and four subthemes were identified: (1) Identification with being a cancer survivor included the subthemes of ‘cancer identity’ and ‘cancer a thing of the past’ and; (2) Emotional components included the subthemes of ‘fear and anxiety’ and ‘gratitude and gaining perspective’. The analysis revealed that the same factor could act as either a motivator or a hindrance to successful transition in different survivors (e.g., fear of recurrence of cancer might be a barrier or a facilitator depending on the survivor’s life experience).ConclusionsPsychological factors are an important consideration when preparing cancer survivors for transition to adult long-term follow-up care. Identifying and addressing the individual psychological needs of childhood cancer survivors may improve the likelihood of their successful transition to adult care.

Caregiving, single parents and cumulative stresses when caring for a child with cancer

BACKGROUND Single parents whose children have cancer are a marginalized group who report less family centred care, and therefore, less quality cancer care for their children. As such, the aims of this study were to explore how single parents of children with cancer describe their caregiving experiences and to understand their contextual life stressors. METHODS A constructivist grounded theory method was used. Qualitative interviews with 29 single parents of children with cancer who were at least 6 months post-diagnosis were recruited between November 2009 and April 2011 from four hospitals across Canada. Line-by-line coding was used to establish codes and themes and constant comparison was used to establish relationships among emerging codes and conceptual themes. RESULTS The first set of findings report on caregiving duties including: emotional tasks, informational tasks and physical tasks. The second set of findings report on the contextual picture of parents lives including their living conditions, their physical and mental health and their family histories of disruption, trauma and disease. CONCLUSIONS Single parents caring for children with cancer were found to experience several cumulative stressors in addition to the current strain of caring for a child with cancer. The synergy of these cumulative stresses with the added strain of caregiving for a child with cancer may have long-term health and financial implications for parents. Broad-based policy interventions should focus on relieving the chronic strains associated with being a single parent of a child with cancer.

Oncologists’ Protocol and Coping Strategies in Dealing with Patient Loss

To identify what protocol and coping strategies oncologists turn to cope with patient loss, the authors interviewed 20 oncologists at 3 hospitals. Using the grounded theory method, findings revealed that their protocol may include meeting with families, participating in bereavement rituals, making a phone call, or sending a condolence card. Coping strategies included social support, activity-oriented coping, turning to faith, compartmentalization, and withdrawing from patients and families. The authors conclude by offering implications from this research on how to address oncologists’ grief over patient loss in institutional settings in order to improve bereavement care for families and enhance oncologists’ quality of life.

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.

Barriers and Facilitators of Transition from Pediatric to Adult Long-Term Follow-Up Care in Childhood Cancer Survivors.

PURPOSE Despite the risk for late effects in adult survivors of cancer in childhood or adolescence, many survivors fail to transition from pediatric to adult long-term follow-up (LTFU) care. The purpose of this study was to identify the barriers and facilitators of transition from pediatric to adult LTFU care. METHODS In this qualitative study, 38 Canadian survivors of cancer in childhood or adolescence, currently aged 15-26 years, were interviewed using semi-structured, open-ended questions. Participants belonged to one of four groups: pre-transition (n=10), successful transition (n=11), failed to transition (n=7), and transitioned to an adult center but then dropped out of adult care (n=10). A constructivist grounded theory approach was used to analyze the interview data. This approach consisted of coding transcripts line by line to develop categories and using constant comparison to examine relationships within and across codes and categories. Interviewing continued until saturation was reached. RESULTS Three interrelated themes were identified that affected the transition process: micro-level patient factors (e.g., due diligence, anxiety), meso-level support factors (e.g., family, friends), and macro-level system factors (e.g., appointments, communication, healthcare providers). Factors could act as facilitators to transition (e.g., family support), barriers to transition (e.g., difficulty booking appointments), or as both a barrier and a facilitator (e.g., anxiety). CONCLUSION This study illustrates the interaction between multiple factors that facilitate and/or prevent transition from pediatric to adult LTFU cancer care. A number of recommendations are presented to address potential macro-level system barriers to successful transition.

What do oncologists want

PurposeThe purpose of the study was to explore what institutional support(s) oncologists want to help them cope with patient loss.MethodsThe grounded theory method was used. Twenty oncologists were recruited and interviewed between November 2010 and July 2011 from three adult oncology centers in Ontario. Data collection and analysis took place concurrently. Analysis involved line-by-line coding, and was inductive, with codes and categories emerging from participants’ narratives.ResultsOncologists suggested institutional supports that fit under four categories that included: (1) training, information and education including fellowship training, grand rounds and the availability of fact sheets; (2) acknowledgment and validation of grief including normalizing grief, having forums to share experiences, supportive mentorship and group debriefing sessions; (3) institutional psychosocial support including access to professional help and the nursing care model; and (4) vacations and sabbaticals.ConclusionsInstitutions such as medical schools and hospitals have both the opportunity and the obligation to support oncologists with this difficult aspect of their work. In addition to offering ongoing education and forums to share experiences, medical institutions can also provide supportive mentorship models to junior oncologists on how to cope with patient loss.

What’s Love Got to Do With It? The Relational Nature of Depressive Experiences:

Clinical depression is a condition that involves depressed mood and intense sadness that lasts for more than a “normal” span of time. Depression has been considered a medical disorder by psychiatry and as such has been researched through “objective” positivist empirical methods. Very few in-depth qualitative studies on depression have been undertaken. This study looked at the depressive experience from a subjective perspective and found that depression is a complex process that involves relationships. Using methodical hermeneutical approach, (revised version of grounded theory), this study found that depression was largely a relational phenomenon. Under this category, three findings arose: self in relation, self-criticism and self-loathing, and loneliness and disconnection. Further conclusions suggest that the traditional medical “objective” conceptualization of depression is inadequate for understanding the totality of the depressed experience and that more emphasis should be placed on the “subjective” aspect of the condition.

The development of scales to measure childhood cancer survivors' readiness for transition to long-term follow-up care as adults

To develop and validate scales to measure constructs that survivors of childhood cancer report as barriers and/or facilitators to the process of transitioning from paediatric to adult‐oriented long‐term follow‐up (LTFU) care.