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Last Days of Life (PDQ®)

Health Professional Version

Challenges to the Professional Caregiver

Oncologists and nurses caring for terminally ill cancer patients are at risk for personal suffering, owing to the clinical intensity and chronic loss inherent in their work. Lack of training in advance care planning and communication can leave oncologists vulnerable to burnout, depression, and professional dissatisfaction.[1] One group of investigators studied oncologists’ grief related to patient death and found strong impact in both the personal and professional realms. Negative effects included a sense of distraction and withdrawal from patients.[2]

One study made an important conceptual distinction, explaining that while grief is healthy for oncologists, stress and burnout can be counterproductive.[3] Other terms used to describe professional suffering are moral distress, emotional exhaustion, and depersonalization.[4] Moral distress was measured in a descriptive pilot study involving 29 physicians and 196 nurses caring for dying patients in intensive care units. Both groups of professionals experienced moral distress related to pressure to continue aggressive treatment they considered futile. Nurses experienced more moral distress than did physicians, and perceived less collaboration than did their physician colleagues.[5]

Several strategies have been recommended to help professionals manage the emotional toll of working with advanced and terminally ill cancer patients, including self-care, teamwork, professional mentorship, reflective writing, mindfulness techniques, and working through the grief process.[6]


  1. Meier DE, Back AL, Morrison RS: The inner life of physicians and care of the seriously ill. JAMA 286 (23): 3007-14, 2001. [PUBMED Abstract]
  2. Granek L, Tozer R, Mazzotta P, et al.: Nature and impact of grief over patient loss on oncologists' personal and professional lives. Arch Intern Med 172 (12): 964-6, 2012. [PUBMED Abstract]
  3. Shayne M, Quill TE: Oncologists responding to grief. Arch Intern Med 172 (12): 966-7, 2012. [PUBMED Abstract]
  4. Edmonds C, Lockwood GM, Bezjak A, et al.: Alleviating emotional exhaustion in oncology nurses: an evaluation of Wellspring's "Care for the Professional Caregiver Program". J Cancer Educ 27 (1): 27-36, 2012. [PUBMED Abstract]
  5. Hamric AB, Blackhall LJ: Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate. Crit Care Med 35 (2): 422-9, 2007. [PUBMED Abstract]
  6. Sanchez-Reilly S, Morrison LJ, Carey E, et al.: Caring for oneself to care for others: physicians and their self-care. J Support Oncol 11 (2): 75-81, 2013. [PUBMED Abstract]
  • Updated: April 16, 2015