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Walsh CA, Currin-McCulloch J, Faris NR, Nguyen TST, Al Achkar M. "Living with Loss": A qualitative exploration of existential fears among people with advanced lung cancer in online lung cancer support groups. Palliat Support Care 2024:1-6. [PMID: 38420708 DOI: 10.1017/s147895152400004x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVES With targeted therapies, people are surviving longer with advanced lung cancer and engaging in online lung cancer support communities. While these groups provide a sense of community, witnessing the death of peers can lead to emotional distress. This qualitative study aims to (1) explore the experience of witnessing death in online cancer support groups; (2) identify factors that contribute to the emotional struggles of witnessing the death of peers; and (3) identify strategies/options for dealing with losses in the cancer community. METHODS We conducted a cross-sectional analysis of qualitative interviews exploring existential concerns with participants (n = 25) from oncogene-specific online lung cancer support groups. The principal investigator conducted study interviews between August 2018 and March 2019 where participants were asked about their cancer experiences and existential concerns. We used thematic analysis and NVIVO 11 software to examine and store the de-identified interview data. RESULTS Participants indicated that they had often witnessed their peers die and felt the pain of the loss. Factors that played a part in their struggle with witnessing others' death included the closeness of the relationship with the person, the age of the person who died, seeing oneself in the experience of the other dying, disparities in care, and losing touch in the final stages. Participants used varied coping strategies such as celebrating the life of the individual who died, engaging in advocacy efforts, not focusing on the loss, participating in therapy, and bringing self-preserving thoughts. SIGNIFICANCE OF RESULTS Our study highlights the importance of addressing existential fears in online lung cancer support groups and incorporating conversations about death in spaces that deal with cancer.
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Affiliation(s)
- Casey A Walsh
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Nicholas R Faris
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Thu Suong Thi Nguyen
- School of Education, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, WA, USA
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Chammas D. Different Than Me. J Pain Symptom Manage 2024; 67:e111-e112. [PMID: 36933750 DOI: 10.1016/j.jpainsymman.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/09/2023] [Indexed: 03/17/2023]
Affiliation(s)
- Danielle Chammas
- Division of Palliative Medicine (D.C.), University of California, San Francisco, California, USA.
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Scott HM, Coombes L, Braybrook D, Roach A, Harðardóttir D, Bristowe K, Ellis-Smith C, Downing J, Murtagh FE, Farsides B, Fraser LK, Bluebond-Langner M, Harding R. Spiritual, religious, and existential concerns of children and young people with life-limiting and life-threatening conditions: A qualitative interview study. Palliat Med 2023; 37:856-865. [PMID: 36978266 DOI: 10.1177/02692163231165101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Despite being a core domain of palliative care, primary data on spiritual and existential concerns has rarely been collected among children with life-limiting and life-threatening conditions and their families. Existing evidence has tended to focus on the religious aspects among children with cancer. AIM To identify the spiritual needs of children with life-limiting and life-threatening conditions. DESIGN Cross-sectional semi-structured, qualitative interview study with children, families and health and social care professionals. Verbatim transcripts were analysed using Framework analysis. SETTING/PARTICIPANTS Purposively sampled children with life-limiting and life-threatening conditions, their parents and siblings, health and social care professionals recruited from six hospitals and three children's hospices in the UK, and commissioners of paediatric palliative care services recruited through networks and a national charity. RESULTS One hundred six participants were interviewed: 26 children (5-17 years), 53 family members (parents/carers of children 0-17 years and siblings (5-17 years)), 27 professionals (health and social care professionals and commissioners of paediatric palliative care). Themes included: living life to the fullest, meaning of life and leaving a legacy, uncertainty about the future, determination to survive, accepting or fighting the future and role of religion. Children as young as 5 years old identified needs or concerns in the spiritual domain of care. CONCLUSIONS Addressing spiritual concerns is essential to providing child- and family-centred palliative care. Eliciting spiritual concerns may enable health and social care professionals to identify the things that can support and enhance a meaningful life and legacy for children and their families.
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Affiliation(s)
- Hannah May Scott
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Lucy Coombes
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Debbie Braybrook
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Anna Roach
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
- Louis Dundas Centre for Children's Palliative Care, University College London, London, UK
| | - Daney Harðardóttir
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Katherine Bristowe
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Clare Ellis-Smith
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Julia Downing
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
- International Children's Palliative Care Network, Kampala, Uganda
| | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Bobbie Farsides
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Lorna K Fraser
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children's Palliative Care, University College London, London, UK
- Rutgers University, New Brunswick, NJ, USA
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
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Haga BM, Furnes B, Ueland V. Health professionals' reflections on existential concerns among people with obesity. Scand J Caring Sci 2023; 37:185-195. [PMID: 35789028 DOI: 10.1111/scs.13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE This study aimed to describe health professionals' reflections on existential concerns among people with obesity when attempting to support them in their lifestyle change processes. For many of those affected by obesity, the condition becomes lifelong and causes existential concerns. The health professionals' reflections on existential concerns among people with obesity may influence central aspects of their practice and their patients' well-being. METHODS Eighteen health professionals with relevant health education working in three different treatment programmes for people with obesity were recruited for three focus group interviews. The interviews were analysed and interpreted using a model for interpretation of meaning at three levels with a phenomenological-hermeneutical approach. FINDINGS The analysis identified three themes. The health professionals reflected on existential concerns among people with obesity in terms of patients' repressed emotional difficulties and lack of self-respect. In addition, they reflected on their own experiences of powerlessness when presented with people with obesity's existential concerns. CONCLUSION The present study provides valuable insights into reflections on existential concerns among people with obesity, based on health professionals' descriptions. We believe that these insights add to the existing literature and have consequences for how people with obesity are met and cared for.
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Affiliation(s)
- Britt Marit Haga
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Bodil Furnes
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Venke Ueland
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Franchina V, Bonfanti RC, Lo Coco G, Salerno L. The Role of Existential Concerns in the Individual's Decisions regarding COVID-19 Vaccine Uptake: A Survey among Non-Vaccinated Italian Adults during the Third Wave of the Pandemic. Vaccines (Basel) 2022; 10:1079. [PMID: 35891243 PMCID: PMC9319079 DOI: 10.3390/vaccines10071079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022] Open
Abstract
Recent studies have suggested that health constructs embraced by the Terror Management Theory (TMT) and the Basic Psychological Needs Theory (BPNT) may drive individuals' COVID-19 health-related decisions. This study examines the relationships between existential concerns (ECs; within the TMT), basic psychological needs (BPNs; within the BPNT) and COVID-19 vaccine hesitancy (VH), as well as the mediating role of negative attitudes toward COVID-19 vaccines. A cross-sectional survey was carried out from April to May 2021 on a sample of two hundred and eighty-seven adults (Mage = 36.04 ± 12.07; 59.9% females). Participants provided information regarding existential concerns, basic psychological needs, attitudes toward COVID-19 vaccines and vaccine hesitancy for Pfizer-BioNTech and AstraZeneca vaccines separately. Higher vaccine hesitancy (32.1%) and vaccine resistance (32.8%) rates were found for AstraZeneca than for Pfizer-BioNTech COVID-19 vaccine (22.3% and 10.1%, respectively). Structural equation modeling showed that existential concerns were related to Pfizer-BioNTech and AstraZeneca vaccine hesitancy both directly and indirectly through negative attitudes toward potential side effects of COVID-19 vaccines. The findings of the study confirm that the TMT is efficient in explaining COVID-19 vaccine hesitancy. Targeted efforts are needed to increase the acceptance of COVID-19 vaccines.
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Affiliation(s)
- Vittoria Franchina
- Department of Psychology, University of Salzburg, 5020 Salzburg, Austria;
| | - Rubinia Celeste Bonfanti
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Viale delle Scienze, Edificio 15, 90128 Palermo, Italy; (R.C.B.); (G.L.C.)
| | - Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Viale delle Scienze, Edificio 15, 90128 Palermo, Italy; (R.C.B.); (G.L.C.)
| | - Laura Salerno
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Viale delle Scienze, Edificio 15, 90128 Palermo, Italy; (R.C.B.); (G.L.C.)
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Lehto RH, Miller M, Sender J. The Role of Psilocybin-Assisted Psychotherapy to Support Patients With Cancer: A Critical Scoping Review of the Research. J Holist Nurs 2021; 40:265-280. [PMID: 34482761 DOI: 10.1177/08980101211039086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treatments for addressing psychiatric mental health issues in vulnerable patients with cancer are established. Yet, many patients persist with unrelenting psychological difficulties despite intervention. There is growing interest in the role of psilocybin-assisted psychotherapy for managing treatment-resistant mental health challenges in patients with cancer. Psilocybin is a naturally occurring compound derived from certain mushroom species that can induce entheogenic experiences or an altered state of consciousness. Reed's Self-Transcendence Theory provides a holistic lens to examine existential concerns and mental health in individuals who perceive their illness as potentially life threatening, such as those with cancer. This scoping literature review used Arksey and O'Malley's template to evaluate research examining psilocybin-assisted psychotherapy for patients with cancer. Eight articles met inclusion/exclusion criteria (four quantitative, two mixed methods, and two qualitative). Review findings indicated that the majority of patient experiences were positive, centering on themes of death acceptance, reflection, and broadened spirituality. Although psilocybin-assisted psychotherapy is in early stages of clinical testing, it thus shows promise for carefully screened patients with cancer who have persistent existential suffering. It will be critical for investigators to tailor this emerging intervention to select patients and for clinicians to be engaged in assessment of outcomes and efficacy.
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Affiliation(s)
| | - Megan Miller
- 5228University of Wisconsin Madison College of Nursing
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Ferrell B, Chung V, Koczywas M, Borneman T, Irish TL, Ruel NH, Azad NS, Cooper RS, Smith TJ. Spirituality in cancer patients on phase 1 clinical trials. Psychooncology 2020; 29:1077-1083. [PMID: 32227382 DOI: 10.1002/pon.5380] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/05/2020] [Accepted: 03/17/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Patients with cancer who are at a transition to Phase I investigational treatments have been identified as an underserved population with regard to palliative care. This disease transition is often accompanied by spiritual and existential concerns. The study objective was to conduct a secondary analysis of data from a larger study testing a palliative care intervention. This paper reports the findings of this secondary focus on the spiritual needs of this population. METHODS Patients (n = 479) were accrued to this study prior to initiating a Phase I clinical trial with data collected at baseline, and 4, 12, and 24 week follow-up. RESULTS Qualitative data revealed that the transition to Phase 1 trial participation is a time of balancing hope for extended life with the reality of advancing disease. Quantitative results demonstrated increased spirituality over time in both religious- and non-religious-affiliated patients. CONCLUSIONS Patients entering Phase I trials have important spiritual needs as they face treatment decisions, advancing disease, and often mortality. Spiritual care should be provided to seriously ill patients as a component of quality care.
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Affiliation(s)
- Betty Ferrell
- Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, California, USA
| | - Vincent Chung
- Department of Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Marianna Koczywas
- Department of Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Tami Borneman
- Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, California, USA
| | - Terry L Irish
- City of Hope National Medical Center, Duarte, California, USA
| | - Nora H Ruel
- Beckman Research Institute, City of Hope National Medical Center, Duarte, California, USA
| | - Nilofer S Azad
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Rhonda S Cooper
- Chaplain of the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Thomas J Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
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Russo-Netzer P, Littman-Ovadia H. "Something to Live for": Experiences, Resources, and Personal Strengths in Late Adulthood. Front Psychol 2019; 10:2452. [PMID: 31736839 PMCID: PMC6834683 DOI: 10.3389/fpsyg.2019.02452] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/15/2019] [Indexed: 11/13/2022] Open
Abstract
Due to increased life expectancy, the population segment of older adults has grown the fastest. The global phenomenon of population aging raises important questions regarding successful, positive, active, and meaningful aging. Given that aging is often characterized by declines in physical and mental health and increased risk for social isolation and depression, and given that the concept of well-being in old age is both elusive and complex, the present study explored how aging is experienced through a "bottom-up," open-ended approach. Thirty-one in-depth semi-structured personal interviews were conducted with adults aged 60 and above in order to explore the question: what concerns older adults in their day-to-day living, and what are their perceived resources? The findings illuminated three prominent themes: (1) central concerns described by the participants as characterizing their experience at this life stage; (2) strategies employed by the participants to cope with concerns and to live a meaningful life in old age; and (3) resources and character strengths that facilitate coping strategies and enable thriving. Theoretical and practical implications of the findings are discussed.
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Affiliation(s)
- Pninit Russo-Netzer
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel
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Lundvall M, Lindberg E, Hörberg U, Carlsson G, Palmér L. Lost in an unknown terrain: a phenomenological contribution to the understanding of existential concerns as experienced by young women in Sweden. Int J Qual Stud Health Well-being 2019; 14:1658843. [PMID: 31451104 PMCID: PMC6720016 DOI: 10.1080/17482631.2019.1658843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose: The aim of this study is to describe young women's (16-25 years old) experiences of living with existential concerns for which they have sought support from healthcare professionals, teachers, family, or friends, among others. Methods: This phenomenological study is based on a reflective lifeworld research (RLR) approach. Nine young women were interviewed about their experience of living with existential concerns. Results: The results show the essential meaning of the phenomenon of "existential concerns" that can be described as living a life that is marked in a profound way by a feeling of being lost in an unknown terrain. To further understand the essential meaning, four constituents are described: the unpredictable body, longing for comprehension, playing a game, and longing to share one's vulnerability. Conclusions: Young women with existential concerns are vulnerable, as they are profoundly influenced by these concerns. They have to navigate through daily life while trying to fit in and to make their situation comprehensible. These young women have a longing to share their existential concerns with a trustworthy person, while at the same time they fear revealing their existential concerns and risking being rejected by others. A lifeworld-led, caring science approach, intertwined with the results of the present study, has the potential to direct caring practice.
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Affiliation(s)
- Maria Lundvall
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås , Borås , Sweden
| | - Elisabeth Lindberg
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås , Borås , Sweden
| | - Ulrica Hörberg
- Department of Health and Caring Sciences, Linnaeus University , Växjö , Sweden
| | - Gunilla Carlsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås , Borås , Sweden
| | - Lina Palmér
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås , Borås , Sweden
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Abstract
Objective Experiencing pain not only affects patients' biopsychosocial functioning but also the existential domain. Attention to the existential, in addition to the biopsychosocial domains, might thus be important in chronic pain care. Therefore, we investigated: (a) how satisfied patients were with the attention of their practitioners to the impact of pain on biological, psychological, social, and existential life domains, and (b) how satisfaction with each domain was related to patient functioning. Method Pain patients ( N = 163) were questioned on their satisfaction with the attention of their practitioners to biological, psychological, social, and existential life domains, and on pain intensity, pain disability, life satisfaction, and depressive symptoms. Results Patients reported low satisfaction with the attention of their practitioners to the social and existential domains. Satisfaction with each domain was negatively related with pain intensity, pain disability, and depressive symptoms and positively related with life satisfaction. Only satisfaction with the existential domain was able to predict all functional outcomes above and beyond all other satisfaction variables modeled simultaneously. Conclusions Patients reported not feeling satisfied with the attention to the social and existential life domains. Furthermore, practitioners' attention to the existential domain seems highly important for patient functioning. Openness to existential concerns of pain patients might thus be an important aspect of chronic pain care.
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Affiliation(s)
- Jessie Dezutter
- 1 Faculty of Psychology and Educational Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Martin Offenbaecher
- 2 Institute of General Medicine, Ludwig-Maximilians University of Munich, Munich, Germany
| | | | - Siebrecht Vanhooren
- 1 Faculty of Psychology and Educational Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Evalyne Thauvoye
- 1 Faculty of Psychology and Educational Sciences, KU Leuven - University of Leuven, Leuven, Belgium
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Schrøder K, Jørgensen JS, Lamont RF, Hvidt NC. Blame and guilt - a mixed methods study of obstetricians' and midwives' experiences and existential considerations after involvement in traumatic childbirth. Acta Obstet Gynecol Scand 2016; 95:735-45. [PMID: 27072600 DOI: 10.1111/aogs.12897] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 03/06/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION When complications arise in the delivery room, midwives and obstetricians operate at the interface of life and death, and in rare cases the infant or the mother suffers severe and possibly fatal injuries related to the birth. This descriptive study investigated the numbers and proportions of obstetricians and midwives involved in such traumatic childbirth and explored their experiences with guilt, blame, shame and existential concerns. MATERIAL AND METHODS A mixed methods study comprising a national survey of Danish obstetricians and midwives and a qualitative interview study with selected survey participants. RESULTS The response rate was 59% (1237/2098), of which 85% stated that they had been involved in a traumatic childbirth. We formed five categories during the comparative mixed methods analysis: the patient, clinical peers, official complaints, guilt, and existential considerations. Although blame from patients, peers or official authorities was feared (and sometimes experienced), the inner struggles with guilt and existential considerations were dominant. Feelings of guilt were reported by 36-49%, and 50% agreed that the traumatic childbirth had made them think more about the meaning of life. Sixty-five percent felt that they had become a better midwife or doctor due to the traumatic incident. CONCLUSIONS The results of this large, exploratory study suggest that obstetricians and midwives struggle with issues of blame, guilt and existential concerns in the aftermath of a traumatic childbirth.
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Affiliation(s)
- Katja Schrøder
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Jan S Jørgensen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Ronald F Lamont
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark.,Division of Surgery, University College London, Northwick Park Institute for Medical Research Campus, London, UK
| | - Niels C Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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