Abstract
Little is known regarding memorable cases and their impact on the personal and professional well-being of medical health professionals (MHP). As part of a survey focusing on professional burnout, 1123 MHP working at a leading tertiary pediatric medical center in Israel were approached, out of which 163 MHP answered and open-ended question recalling a memorable case and the influence it had on them. Mixed-methods integrating data collected from the larger study were employed to assess both quantitative and qualitative aspects of the memories recalled. Three key findings are presented: (1) the prominence of End-of-Life care among the memorable cases (n = 163, 58.28%) and its cross-disciplinary impact among professionals, (2) the importance of social support for professionals providing End-of-Life care, and (3) the high influence (mean impact = 4.27, from a scale of 1–5, 5 reflecting highest impact) attributed by the MHP to their memorable case resulting in multiple short (e.g., emotional reactions) and long-term effects (e.g., perspective changes), negative and positive, effecting quality of life and professional performance. In conclusion, recognizing and addressing End-of-Life related memories is noteworthy and bears direct clinical implications for developing interventions intended to mitigate patient care strain and promote MHP well-being personally and professionally.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Beasley, T. M., & Schumacker, R. E. (1995). Multiple regression approach to analyzing contingency tables: Post hoc and planned comparison procedures. The Journal of Experimental Education, 64(1), 79–93. https://doi.org/10.1080/00220973.1995.9943797
Boyle, D. A., & Bush, N. J. (2018). Reflections on the emotional hazards of pediatric oncology nursing: Four decades of perspectives and potential. Journal of Pediatric Nursing, 40, 63–73. https://doi.org/10.1016/j.pedn.2018.03.007
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Bride, B. E., Robinson, M. M., Yegidis, B., & Figley, C. R. (2004). Development and validation of the secondary traumatic stress scale. Research on Social Work Practice, 14(1), 27–35. https://doi.org/10.1177/1049731503254106
Brom, D., Stokar, Y., Lawi, C., Nuriel-Porat, V., Ziv, Y., Lerner, K., & Ross, G. (2017). Somatic experiencing for posttraumatic stress disorder: A randomized controlled outcome study. Journal of Traumatic Stress, 30(3), 304–312. https://doi.org/10.1002/jts.22189
Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357. https://doi.org/10.1037/0033-2909.98.2.310
Creswell, J. W., & Clark, V. L. P. (2011). Designing and conducting mixed methods research (pp. 1–25). Sage publications.
Davidson, P. R., & Parker, K. C. (2001). Eye movement desensitization and reprocessing (EMDR): A meta-analysis. Journal of Consulting and Clinical Psychology, 69(2), 305. https://doi.org/10.1037/0022-006X.69.2.305
Feeley, T., Crowe, S., & Doherty, E. M. (2019). Grief reactions and coping strategies of trainee doctors working in paediatric intensive care. British Journal of Anaesthesia, 123(1), 74–80. https://doi.org/10.1016/j.bja.2019.01.034
Figley, C. R. (1995). Compassion fatigue: Toward a new understanding of the costs of caring. In B. H. Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators (pp. 3–28). The Sidran Press.
Foa, E. B. (2011). Prolonged exposure therapy: Past, present, and future. Depression and Anxiety, 28(12), 1043–1047. https://doi.org/10.1002/da.20907
Geller, G., Bernhardt, B. A., Carrese, J., Rushton, C. H., & Kolodner, K. (2008). What do clinicians derive from partnering with their patients?: A reliable and valid measure of “personal meaning in patient care”. Patient Education and Counseling, 72(2), 293–300. https://doi.org/10.1016/j.pec.2008.03.025
Hamama, L., Hamama-Raz, Y., Stokar, Y. N., Pat-Horenczyk, R., Brom, D., & Bron-Harlev, E. (2019). Burnout and perceived social support: The mediating role of secondary traumatization in nurses vs. physicians. Journal of Advanced Nursing, 75(11), 2742–2752. https://doi.org/10.1111/jan.14122
Hamama-Raz, Y., Hamama, L., Pat-Horenczyk, R., Stokar, Y. N., Zilberstein, T., & Bron-Harlev, E. (2020). Posttraumatic growth and burnout in pediatric nurses: The mediating role of secondary traumatization and the moderating role of meaning in work. Stress and Health. https://doi.org/10.1002/smi.3007
House, J. S. (1981). Work stress and social support. Addison-Wesley.
IBM, C. (2017). IBM SPSS statistics for windows (version 25). IBM Corp.
Jackson, V. A., Sullivan, A. M., Gadmer, N. M., Seltzer, D., Mitchell, A. M., Lakoma, M. D., et al. (2005). “It was haunting…”: Physicians’ descriptions of emotionally powerful patient deaths. Academic Medicine, 80(7), 648–656.
Kanaan, R. A., Armstrong, D., & Wessely, S. C. (2011). Neurologists' understanding and management of conversion disorder. Journal of Neurology, Neurosurgery & Psychiatry, 82(9), 961–966. https://doi.org/10.1136/jnnp.2010.233114
Kearney, M. K., Weininger, R. B., Vachon, M. L., Harrison, R. L., & Mount, B. M. (2009). Self-care of physicians caring for patients at the end of life:“being connected... A key to my survival”. Jama, 301(11), 1155–1164. https://doi.org/10.1001/jama.2009.352
Krans, J., Näring, G., Becker, E. S., & Holmes, E. A. (2009). Intrusive trauma memory: A review and functional analysis. Applied Cognitive Psychology: The Official Journal of the Society for Applied Research in Memory and Cognition, 23(8), 1076–1088. https://doi.org/10.1002/acp.1611
Kromrey, B., “Encountering Death: A Training Proposal for Psychologists Addressing Death Anxiety and End-of-Life Care” (2021). Graduate School of Professional Psychology: Doctoral Papers and Masters Projects. 415. https://digitalcommons.du.edu/capstone_masters/415
Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2(2), 99–113. https://doi.org/10.1002/job.4030020205
Mills, J., & Chapman, M. (2016). Compassion and self-compassion in medicine: Self-care for the caregiver. The Australasian Medical Journal, 9(5), 87–91. https://doi.org/10.4066/AMJ.2016.2583
Moores, T. S., Castle, K. L., Shaw, K. L., Stockton, M. R., & Bennett, M. I. (2007). ‘Memorable patient deaths’: Reactions of hospital doctors and their need for support. Medical Education, 41(10), 942–946. https://doi.org/10.1111/j.1365-2923.2007.02836.x
Muriel, A. C., Tarquini, S., & Morris, S. E. (2018). The" liaison" in consultation-liaison psychiatry: Helping medical staff cope with pediatric death. Child and Adolescent Psychiatric Clinics of North America, 27(4), 591–598. https://doi.org/10.1016/j.chc.2018.05.005
Myint, P. K., Rivas, C. A., & Bowker, L. K. (2010). In-hospital cardiopulmonary resuscitation: Trainees’ worst and most memorable experiences. QJM: An International Journal of Medicine, 103(11), 865–873. https://doi.org/10.1093/qjmed/hcq129
Ogińska-Bulik, N., Gurowiec, P. J., Michalska, P., & Kędra, E. (2021). Prevalence and determinants of secondary posttraumatic growth following trauma work among medical personnel: A cross sectional study. European Journal of Psychotraumatology, 12(1), 1876382. https://doi.org/10.1080/20008198.2021.1876382
Orgambídez-Ramos, A., & de Almeida, H. (2017). Work engagement, social support, and job satisfaction in Portuguese nursing staff: A winning combination. Applied Nursing Research, 36, 37–41. https://doi.org/10.1016/j.apnr.2017.05.012
Peters, L., Cant, R., Payne, S., O’connor, M., McDermott, F., Hood, K., et al. (2013). How death anxiety impacts nurses’ caring for patients at the end of life: A review of literature. The open nursing journal, 7, 14. https://doi.org/10.2174/1874434601307010014
Plante, J., & Cyr, C. (2011). Health care professionals' grief after the death of a child. Paediatrics & Child Health, 16(4), 213–216. https://doi.org/10.1093/pch/16.4.213
Poon, E. G., Trent Rosenbloom, S., & Zheng, K. (2021). Health information technology and clinician burnout: Current understanding, emerging solutions, and future directions. Journal of the American Medical Informatics Association, 28(5), 895–898. https://doi.org/10.1093/jamia/ocab058
Popping, R. (2015). Analyzing open-ended questions by means of text analysis procedures. Bulletin of Sociological Methodology/Bulletin de Méthodologie Sociologique, 128(1), 23–39. https://doi.org/10.1177/0759106315597389
Portoghese, I., Galletta, M., Coppola, R. C., Finco, G., & Campagna, M. (2014). Burnout and workload among health care workers: The moderating role of job control. Safety and Health at Work, 5(3), 152–157. https://doi.org/10.1016/j.shaw.2014.05.004
Redinbaugh, E. M., Sullivan, A. M., Block, S. D., Gadmer, N. M., Lakoma, M., Mitchell, A. M., et al. (2003). Doctors' emotional reactions to recent death of a patient: Cross sectional study of hospital doctors. Bmj, 327(7408), 185. https://doi.org/10.1136/bmj.327.7408.185
Rhodes-Kropf, J., Carmody, S. S., Seltzer, D., Redinbaugh, E., Gadmer, N., Block, S. D., & Arnold, R. M. (2005). “This is just too awful; I just can’t believe I experienced that…”: Medical students’ reactions to their “most memorable” patient death. Academic Medicine, 80(7), 634–640.
Rich, J. L., Chojenta, C., & Loxton, D. (2013). Quality, rigour and usefulness of free-text comments collected by a large population based longitudinal study-ALSWH. PLoS One, 8(7), e68832. https://doi.org/10.1371/journal.pone.0068832
Rietjens, J. A., Hauser, J., Van der Heide, A., & Emanuel, L. (2007). Having a difficult time leaving: experiences and attitudes of nurses with palliative sedation. Palliative medicine, 21(7), 643–649. https://doi.org/10.1177/0269216307081186
Riiskjær, E., Ammentorp, J., & Kofoed, P. E. (2012). The value of open-ended questions in surveys on patient experience: Number of comments and perceived usefulness from a hospital perspective. International Journal for Quality in Health Care, 24(5), 509–516. https://doi.org/10.1093/intqhc/mzs039
Rodríguez-Rey, R., Palacios, A., Alonso-Tapia, J., Pérez, E., Álvarez, E., Coca, A., et al. (2019). Are pediatric critical personnel satisfied with their lives? Prediction of satisfaction with life from burnout, posttraumatic stress, and posttraumatic growth, and comparison with noncritical pediatric staff. Pediatric Critical Care Medicine, 20(3), e160–e169. https://doi.org/10.1097/PCC.0000000000001861
Rothenberger, D. A. (2017). Physician burnout and well-being: A systematic review and framework for action. Diseases of the Colon & Rectum, 60(6), 567–576. https://doi.org/10.1097/DCR.0000000000000844
Salyers, M. P., Bonfils, K. A., Luther, L., Firmin, R. L., White, D. A., Adams, E. L., & Rollins, A. L. (2017). The relationship between professional burnout and quality and safety in healthcare: A meta-analysis. Journal of General Internal Medicine, 32(4), 475–482. https://doi.org/10.1007/s11606-016-3886-9
Shahin, H. (2021). Assessing physician wellness: Preventing burnout and promoting well–being (doctoral dissertation, Wichita State University).
Sorenson, C., Bolick, B., Wright, K., & Hamilton, R. (2016). Understanding compassion fatigue in healthcare providers: A review of current literature. Journal of Nursing Scholarship, 48(5), 456–465. https://doi.org/10.1111/jnu.12229
Stamm, B. H. (2002). Measuring compassion satisfaction as well as fatigue: Developmental history of the compassion satisfaction and fatigue test. In Figley CR (Ed.), 107–119. Treating Compassion Fatigue, NewYork: Brunner Mazel.
Stamm, B. H. (2010). The concise ProQOL manual. In (2nd ed.): Pocatello, ID: proqol. org.
Stokar, Y. N., & Pat-Horenczyk, R. (2021). Effects of end-of-life care on medical health professionals: A dialectical approach. Palliative & Supportive Care, 1–8,. https://doi.org/10.1017/S1478951521000365
Tedeschi, R. G., & Calhoun, L. G. (1995). Trauma and transformation: Growing in the aftermath of suffering. Sage.
Tedeschi, R. G., & Calhoun, L. G. (1996). The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9(3), 455–471. https://doi.org/10.1007/BF02103658
Thiel, M., Mattison, D., Goudie, E., Licata, S., Brewster, J., & Montagnini, M. (2021). Social work training in palliative care: Addressing the gap. American Journal of Hospice and Palliative Medicine®, 38(8), 893–898. https://doi.org/10.1177/1049909120960709
VERBI Software. (2019). MAXQDA 2020 [computer software]. VERBI Software. Available from maxqda.com.
Zannini, L., Ghitti, M. G., Martin, S., Palese, A., & Saiani, L. (2015). Narratives, memorable cases and metaphors of night nursing: Findings from an interpretative phenomenological study. Nursing Inquiry, 22(3), 261–272. https://doi.org/10.1111/nin.12091
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52(1), 30–41. https://doi.org/10.1207/s15327752jpa5201_2
Acknowledgments
The authors thank the Center for Dignified End of Life at the Hebrew University of Jerusalem for their generous support of this study. This research would not have been possible without the initiative and continuous support of Dr. Cathy Lawi of the International Trauma Healing Institute and Prof. Danny Brom of Metiv, the Israel Psychotrauma Center in Jerusalem. We thank the team at Schneider Children’s Medical Center led by Dr. Efrat Bron-Harlev, Maskit Shochat and Tal Zilberstein and to Prof. Yaira Hamama-Raz and Prof. Liat Hamama for their partnership in this study.
Availability of Data and Material
The data that supports the findings of this study are available on request from the corresponding author Y.N.S.
Funding
The authors disclosed receipt of the following financial support for the research of this article: This work was supported by the Center for Dignified End of Life at the Hebrew University of Jerusalem, Jerusalem, Israel.
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Yaffa N. Stokar and Ruth Pat-Horenczyk. The first draft of the manuscript was written by Yaffa N. Stokar and Ruth Pat-Horenczyk commented on previous versions of the manuscript, read and approved the final manuscript.
Corresponding author
Ethics declarations
Informed Consent
The Study was granted an Institutional Review Board and Ethics Committee exemption on grounds of a one-time anonymous survey.
Ethics Approval
The Study was granted an Institutional Review Board and Ethics Committee exemption on grounds of a one-time anonymous survey.
Conflicts of Interest/Competing Interests
The Authors declare that there is no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Stokar, Y.N., Pat-Horenczyk, R. Themes of end-of-life care in memorable cases of medical health professionals: A mixed methods approach. Curr Psychol 42, 13721–13732 (2023). https://doi.org/10.1007/s12144-021-02566-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12144-021-02566-x