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professional resilience, coping, palliative care, emotional intelligence, patient loss
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Shanbhag N, Bin Sumaida A, Gurashi Ibrahim H et al. Heart of Care: Embracing Grief and Growth in Oncology and Palliative Medicine [version 1; peer review: awaiting peer review]. F1000Research 2024, 13:1068 (https://doi.org/10.12688/f1000research.153724.1)
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Research Article
Heart of Care: Embracing Grief and Growth in Oncology and Palliative Medicine
[version 1; peer review: awaiting peer review]
PUBLISHED 18 Sep 2024
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This article is included in the Oncology gateway.
Abstract
Corresponding author:
Nandan Shanbhag
Competing interests:
The authors declare that the research was conducted without any commercial or financial relationships that could potentially create a conflict of interest.
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The author(s) declared that no grants were involved in supporting this work.
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© 2024 Shanbhag N et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Shanbhag N, Bin Sumaida A, Gurashi Ibrahim H et al. Heart of Care: Embracing Grief and Growth in Oncology and Palliative Medicine [version 1; peer review: awaiting peer review]. F1000Research 2024, 13:1068 (https://doi.org/10.12688/f1000research.153724.1)
First published: 18 Sep 2024, 13:1068 (https://doi.org/10.12688/f1000research.153724.1)
Latest published: 18 Sep 2024, 13:1068 (https://doi.org/10.12688/f1000research.153724.1)
1. Introduction
Healthcare professionals frequently encounter profound emotional reactions following the loss of a patient. Coping with patient death stands as one of the most daunting challenges in clinical practice, necessitating both intrinsic and extrinsic resources for effective management.1 Utilising effective coping strategies becomes paramount in assisting healthcare professionals in dealing with patient loss. Research has underscored the efficacy of restoration-focused interventions in mitigating complicated grief, with self-efficacy and personal growth identified as pivotal mediating factors.2 Additionally, early implementation of coping strategies has been linked to the prediction of long-term psychological outcomes after traumatic events, thereby underscoring their significance in clinical rehabilitation.3
Encounters with patient loss can also catalyse personal growth and professional development. Studies investigating this phenomenon among bereaved parents have pinpointed resilience and dyadic coping as crucial factors associated with posttraumatic growth.4 The coping mechanisms and experiences following patient loss manifest diversely across various specialities and geographical locations, accentuating the importance of acknowledging these discrepancies for a comprehensive understanding and support of healthcare professionals.5 In nursing, coping strategies surrounding patient death necessitate a multidimensional approach, emphasising the essential requirement of both intrinsic and extrinsic resources for effective management. Moreover, the experiences and coping mechanisms of medical specialists in intensive care, surgery, oncology, and palliative care when confronted with death and dying underline the ambivalence inherent in developing emotional connections with patients and their families.6
Exploring healthcare professionals’ experiences with patient loss across different regions reveals a spectrum of coping mechanisms influenced by cultural, regional, and institutional factors. In Asia, the cultural context significantly shapes how healthcare professionals process and cope with patient loss.7 In certain Asian cultures, where collective well-being precedes individual expression, communal or spiritual coping strategies may be favoured. This could involve seeking colleague support or engaging in cultural or religious rituals to find solace and meaning in patient loss. Conversely, in Western countries such as the United States and parts of Europe, there tends to be a greater emphasis on individualistic coping strategies.8 Healthcare professionals in these regions may seek professional counselling or engage in self-care activities like mindfulness, exercise, or hobbies to manage the emotional toll of patient loss. Institutional support, including employee assistance programs and mental health resources, is critical. The approach to patient loss in African countries often intertwines with local traditions and community support systems, with healthcare workers relying on strong community bonds and extended family networks for emotional support and guidance.9
In Latin American nations, the profound familial structures and cultural emphasis on family connections frequently extend into professional environments, offering healthcare professionals comfort and support through their familial networks. Concurrently, these cultures’ widespread religious and spiritual practices serve as additional frameworks for support and coping strategies.10 In the Middle East, where family and religion hold significant importance, healthcare professionals often turn to their faith and close-knit family structures for support in patient loss, finding solace and perspective through religious rituals and prayers.11
Across the globe, the experience of patient loss and the subsequent coping mechanisms are profoundly shaped by cultural, social, and institutional factors. Recognising these diverse coping strategies and providing culturally sensitive support is imperative for healthcare institutions worldwide. Propelled by the poignant inquiry of one of our authors - “How do you cope with death in Oncology and Palliative Care?” - this study delves into the diverse experiences, emotional responses, and coping mechanisms clinicians employ in the face of patient loss. The study aims to explore these aspects, focusing on healthcare professionals’ experiences in oncology and palliative care across various countries, each with diverse years of experience.
2. Methods
2.1 Study design
This cross-sectional study employed a mixed-methods approach, integrating qualitative and quantitative elements to explore the emotional experiences of healthcare professionals in oncology and palliative medicine. This design was chosen to provide a comprehensive understanding of the complex phenomena under investigation, allowing for an exploration of measurable data and rich, descriptive insights. The cross-sectional nature of the study, conducted over seven months from August 2023 to February 2024, enabled a snapshot of healthcare professionals’ experiences and coping strategies, facilitating comparisons and contrasts across various demographics and experiences. The survey was conducted in English, encouraging broad participation across diverse global regions. This choice helped reach a broad audience of healthcare professionals and ensured the survey’s findings were relevant internationally.
2.2 Questionnaire development
The survey instrument was developed rigorously, beginning with an extensive literature review to identify key focus areas and existing validated instruments. A multidisciplinary team of four professionals, including clinicians from oncology and palliative care, psychologists, and researchers in medical sociology, was convened to contribute to the questionnaire’s development. This team employed a Delphi method12,13 over several rounds to reach consensus on the questionnaire items, ensuring comprehensive coverage of the study’s aims and alignment with established grief management theories.12,13 The final questionnaire (Extended data) comprised open-text and structured quantitative questions to elicit detailed information about participants’ experiences with patient loss, coping strategies, and personal and professional growth. Questions 7-16 were meticulously crafted to explore the multi-dimensional aspects of dealing with patient loss, including emotional responses (Q7), coping mechanisms (Q9, Q10), workplace support (Q11, Q12), the influence of personal beliefs (Q13, Q14), and resultant personal growth (Q15, Q16). Each question was designed to elicit introspective and reflective responses, ensuring depth and relevance in healthcare. To ascertain reliability, the survey underwent a pilot test with a focus group of healthcare professionals, facilitating refinements for clarity and emotional sensitivity, thus ensuring consistent interpretations and responses across diverse participants.14
2.3 Sampling procedure
The study targeted healthcare professionals working in oncology and palliative care. Inclusion criteria were set to include only those actively engaged in clinical roles, ensuring relevance and direct experience with the study’s focus areas. The participants responded to all the questions in English. The study was led by the Department of Oncology, Tawam Hospital, Al Ain, United Arab Emirates.
2.4 Participants recruitment procedure
The study employed purposive and snowball sampling techniques to achieve a diverse and representative sample of oncology and palliative care healthcare professionals. This strategic approach was designed to specifically target individuals with relevant experience and insights into the emotional impact of patient loss, ensuring rich and informative data collection.
Initially, participants were selected based on predefined criteria aligned with the study’s objectives and inclusion criteria. This methodological choice allowed for the intentional inclusion of individuals deemed to provide the most pertinent and valuable perspectives on coping with patient loss. The snowball sampling technique expanded the participant pool following the purposive sampling phase. Early participants were asked to refer colleagues or acquaintances who met the study’s inclusion criteria, leveraging their professional networks. This method facilitated access to more participants, enriching the study’s diversity and representativeness.
2.5 Survey distribution
The primary tool for data collection was a Microsoft Forms survey, which was meticulously designed to capture both quantitative and qualitative aspects of the participants’ experiences and coping mechanisms. The link to the survey was disseminated through email to the initial purposively sampled participants, who were then encouraged to share it with their eligible peers, adhering to the principles of snowball sampling. By combining purposive with snowball sampling, the study gathered insights from various healthcare professionals, enhancing the depth and breadth of understanding regarding how different individuals navigate the complexities associated with patient loss. Circulating the survey link via email further facilitated the efficient and effective recruitment of participants, aligning with contemporary communication practices within professional networks.
2.6 Geographical considerations
Initially targeting the United Arab Emirates (UAE), the study’s geographical scope was expanded to include international participants following significant interest observed during the pilot phase. This decision was motivated by the opportunity to enrich the research with a broader array of cultural and institutional perspectives on coping with patient loss in oncology and palliative care. Expanding the study gave a more comprehensive understanding of diverse coping mechanisms, highlighting universal challenges and region-specific strategies. This global approach aimed to generate insights that could inform more effective support systems for healthcare professionals across different settings, leveraging the wide-ranging experiences and practices encountered in various countries.
2.7 Data management and analysis
The quantitative data was subjected to statistical analysis utilising R Studio and Microsoft Excel to identify significant patterns and trends. Descriptive statistical methods facilitated the summarisation of the dataset, offering a foundational comprehension of the prevalent trends and demographic characteristics within the sample. A one-way Analysis of Variance (ANOVA) was utilised to assess the differences in survey completion times and the number of words to answer across groups of healthcare professionals with varying years of experience. A p-value less than 0.05 would indicate statistical significance.
The study employed thematic analysis for the qualitative component to investigate the textual data collected from open-ended survey questions. This analysis was conducted in several stages. First, the researchers immersed themselves in the data, reading and re-reading the responses to gain an in-depth understanding of the content. Then, the responses were coded, and the data was carefully annotated to identify significant phrases, concepts, and recurring patterns. Codes were analysed and grouped into potential themes. These themes represented patterns across the dataset relevant to the research questions. Identified themes were reviewed and refined to ensure they accurately represented the dataset. This involved a recursive revisiting of the coded data and the original responses. Final themes were clearly defined and named, ensuring they provided a coherent narrative about the data. The results were then contextualized and reported, focusing on how these themes answered the research questions.
Word clouds were utilized in this study to visually synthesize and present the qualitative data gathered from open-ended survey responses. This choice was driven by the word clouds’ ability to highlight the most frequently mentioned terms and themes, offering an intuitive grasp of participants’ key concepts and sentiments. By visually emphasizing words based on their prevalence, word clouds efficiently convey the relative importance of healthcare professionals’ experiences with patient loss, coping strategies, and personal growth. This graphical representation not only enhances the accessibility and engagement of the findings but also facilitates a quick overview of complex data, allowing readers to discern patterns and priorities in the responses at a glance. Thus, word clouds were an innovative and effective way to bridge the gap between quantitative and qualitative analyses, making the rich narrative data more digestible and impactful for a diverse audience.
3. Results
A total of 125 participants from 19 different countries provided their responses. The distribution of participants by country is as follows: the United Arab Emirates had the highest representation with 42 respondents (33.60%), followed by Oman with 35 respondents (28.00%), and Kuwait with 29 respondents (23.20%). These three countries combined accounted for most of the survey participants, making up 85% of the total responses. India, Qatar, and Tanzania had two respondents (1.60%) each, with Canada, Saudi Arabia, Switzerland, Slovenia, Saint Kitts and Nevis, Ghana, St. Vincent, Jordan, the USA, Botswana, El Salvador, Sudan, and Antigua and Barbuda, each contributing one respondent (0.80%) to the study (Figure 1).
Figure 1. Healthcare practitioners by country.
N = 125; colour intensity: darker shades representing higher numbers and lighter shades indicating lower numbers; numbers on bars: show the exact count of respondents from each country.
Among the respondents, 55 were physicians (44.0%), 36 were nurses (28.8%), and 34 were allied healthcare professionals (27.2%) (Figure 2).
Figure 2. Distribution of respondents by healthcare speciality.
N = 125.
A majority, 92 (73.6%), reported feeling overwhelmed by losing a patient. Responding to coping mechanisms, 63 participants (50.2%) stated they utilize specific strategies or techniques to manage the emotional impact of patient loss. Workplace support appears to be somewhat divided, with 69 respondents (55.2%) affirming their workplace provides support for dealing with the emotional stress of patient loss, while 56 (44.8%) reported the absence of such support. The influence of personal beliefs in managing patient loss was acknowledged by 96 individuals (76.8%), and 78 (62.4%) noted experiencing personal growth because of these challenging encounters (Table 1).
Table 1. Participants’ responses to the closed-ended questions on experiences and beliefs.
3.1 Thematic analysis
The thematic analysis of this study’s responses revealed profound insights into the emotional landscape of dealing with patient loss, coping mechanisms, and personal and professional growth. The analysis identified six primary themes: Emotional Impact, Coping Mechanisms, Personal Growth, Professional Challenges, Patient Relationships, and Reflections on Death and Dying.
3.1.1 Emotional impact
Most participants (66, representing 52.8% of respondents) opted not to disclose their personal emotional experiences related to patient loss. However, among those who did share their experiences, 22 respondents (17.6%) identified experiencing grief in various forms as a direct consequence of patient loss. A further 15 respondents (12%) reported increased resilience due to confronting these challenging experiences. Additionally, 10 participants (8%) highlighted difficulties distinguishing between their personal and professional boundaries following a patient loss. Similarly, 11 respondents (8.8%) observed a notable impact on the patient-healthcare worker relationship (Table 2).
Table 2. Sub-themes of emotional impact from a patient loss.
3.1.2 Coping mechanisms
In confronting patient loss, healthcare professionals employ diverse coping strategies (Table 3). Notably, 28 participants (22.4%) reported not utilizing specific coping mechanisms; personal care was mentioned by 35 participants (28.0%), including strategies like “going for walks, speaking to a therapist, meditation” for emotional regulation (Participant 5). Reflective practice was cited by 21 respondents (16.8%), with one individual integrating it with “professional counselling and peer support” (Participant 2). Professional support was indicated by 22 healthcare workers (17.6%), where the value of “interdisciplinary team meetings, support groups, and debrief sessions” was highlighted (Participant 3). Spiritual practices were referenced by 16 respondents (12.8%) as pivotal in managing grief, reflected by “prayer and faith in a higher power” (Participant 7). Two respondents (1.6%) mentioned ‘Crying’, and one respondent (0.8%) mentioned ‘Expectation Management’ as their strategy.
Table 3. Coping strategies.
3.1.3 Personal growth
Many participants reported personal growth because of their experiences. One healthcare worker reflected, “Dealing with patient loss… has been a catalyst for significant personal growth… It helped me to be empathetic, resilient, compassionate” (Participant 7).
3.1.4 Professional challenges
The responses shed light on the complexities and challenges faced in their roles, especially regarding end-of-life care. As one professional mentioned, “Helped me understanding difficult questions reg life and death. Understanding medicine as an art, not only as science” (Participant 12), indicating a deeper appreciation and understanding of their role beyond the clinical aspects.
3.1.5 Patient relationships
The development and maintenance of patient relationships were central to their experience. “I accepted most patients’ losses way before it happened” (Participant 1), a statement that underscores the anticipatory grief and deep connections formed.
3.1.6 Reflections on death and dying
Participants also shared profound insights into their perceptions of death and dying. One poignant reflection was, “Understanding that it is ok to allow a family to cry and express… focusing and introducing a different narrative of a different concept of hope” (Participant 18), illustrating the evolving perspectives on death, dying, and hope in the face of loss.
The word cloud analyses visually represented key themes representing five main areas: experiences dealing with patient loss, coping strategies, support, beliefs, and moments signifying personal and professional growth (Figures 3-7).
Figure 3. Emotional impact.
Figure 4. Word cloud from responses about coping strategies.
Figure 5. Word cloud from responses about support.
Figure 6. Beliefs word cloud.
Figure 7. Word cloud for personal and professional growth.
3.1.7 Experience insights
The study also examined the correlation between the number of years in healthcare and the responses to the experiential questions (Table 4). This table offers valuable insights into how the depth and complexity of responses vary with the years of experience in the healthcare field. The conducted analysis of variance (ANOVA) to examine the average response lengths for each question by years of experience (<5 years, 5-10 years, >10 years) obtained an F-statistic of 1.89 with a p-value of 0.189 (statistical significance p < 0.05).
Table 4. Average response lengths in words for questions by years in healthcare.
The study examined the relationship between the time to complete the survey (in minutes) and the number of years healthcare professionals have been in the field (Figure 8). From the plot, these two variables must have a clear or strong relationship. This observation is confirmed by the calculated correlation coefficient, which is approximately -0.014. This value is close to zero, indicating a weak negative correlation between the two variables.
Figure 8. Correlation plot between time to complete the form to years in healthcare.
The grouped analysis of the survey completion times among healthcare professionals indicated distinctive patterns across varying experience levels (Figure 9). Participants with less than five years of experience generally completed the survey more quickly, exhibiting a shorter average completion time and demonstrating lower variability, suggesting a more consistent approach among newer healthcare workers. Conversely, those with 5-10 years of experience took longer on average to complete the survey and showed a greater standard deviation in their completion times, highlighting a broader range of variability within this group. The most seasoned professionals, with over ten years of experience, occupied a middle ground, displaying moderate average completion times and variability. These observations, while intriguing, were not statistically significant, as evidenced by an ANOVA test, which yielded an F-statistic of 0.497 and a p-value of 0.610 (statistical significance p<0.05).
Figure 9. Completion time by years of experience - grouped analysis.
Finally, since the correlation between the time taken to complete the analysis and the years of experience in healthcare was weak, a Bivariate Density Plot, rendered in a ‘cool, warm’ color scheme, provided a compelling visual representation of the relationship between the two (Figure 10).
Figure 10. Bivariate density plot.
4. Discussion
Multiple studies have highlighted the emotional barriers in healthcare communication, especially in life-threatening conditions.16,17 The word cloud generated from responses about healthcare experiences highlights diverse aspects, indicating a broad range of personal and professional encounters. Key terms in response like ‘care’, ‘support’, and ‘patient’ suggest a strong focus on patient-centred care. This diversity reflects the multifaceted nature of healthcare, where practitioners engage with complex scenarios requiring empathy, knowledge, and adaptability. The prominence of these terms highlights the deep emotional connections healthcare professionals form with their patients and the significant impact of these relationships on their professional lives. This is highlighted by several studies, one of which discusses the importance of addressing spiritual and emotional needs in geriatric oncology.18 As reported in another study, the anticipatory grief and deep connections formed with patients underline healthcare professionals’ significant emotional investment in patient relationships.19
The analysis of responses regarding coping strategies produced a word cloud with a diverse range of terms. Notably, words like ‘support’, ‘team’, ‘care’, and ‘self’ were prominent, reflecting a multifaceted approach to coping. This suggests that healthcare professionals rely on a combination of personal, professional, and communal strategies to manage the emotional toll of their work. Words related to ‘spiritual’ practices also indicate the importance of personal beliefs and rituals in their coping mechanisms. The diverse coping strategies identified in this study align with the findings of a study that discusses the use of problem-focused, emotion-focused, and spiritual coping in palliative care. This reflects the multifaceted approach to coping, blending personal, professional, and spiritual strategies.20 Positive coping strategies are associated with reduced stress levels and improved psychological health. Other strategies include acceptance, self-distraction, optimism, and seeking social support, highlighting the importance of professional and personal support systems in managing stress and emotional challenges faced in the healthcare setting.21 The COVID-19 pandemic has highlighted the significance of coping strategies for healthcare workers. A study found that positive attitudes and social support were crucial in managing professional quality of life. Conversely, avoidance strategies worsened the quality of life, emphasising the need for constructive and functional coping mechanisms during health emergencies like the COVID-19 pandemic.22
The word cloud derived from insights into personal growth shows terms like ‘appreciate’, ‘understanding’, and ‘growth’, indicating ongoing professional and personal development. It suggests that healthcare practitioners view their careers as a continuous learning journey shaped by experiences and reflective practices. This concept encompasses empathy, resilience, and compassion, crucial for healthcare professionals dealing with life and death.23
The responses to beliefs in healthcare practice questions reveal a blend of personal and professional values, with prominent terms like ‘life’, ‘death’, ‘religion’ and ‘belief’. This reflects the personal nature of healthcare, where individual beliefs and values play a significant role in shaping practitioners’ approaches to care and decision-making. Reflecting on death and dying from the perspective of healthcare professionals is a multidimensional issue that involves balancing personal emotions with professional responsibilities.24 Healthcare workers often face pressure to balance their feelings and the need to maintain a professional demeanor in the face of patient mortality. This delicate balance is crucial in providing quality care while managing their emotional well-being.25 The culture of concealing death in society often influences how healthcare professionals approach end-of-life care, affecting both their personal and professional attitudes towards death and the importance of acknowledging death as part of life and thinking about it as a social coping strategy that healthcare professionals must navigate.26,27
Additionally, healthcare workers often undergo a process of personal transformation through their experiences with patients at the end of life, learning to see beyond the illness to the humanity of their patients.28 However, this comes with its challenges, as the emotional impact of patient death can lead to feelings of grief and loss, which healthcare professionals must learn to manage effectively.29
Survey responses reveal a dichotomy in the emotional support and training for healthcare professionals facing patient loss: 56.25% reported access to support and training, while 43.75% experienced a void, suggesting that education and training are pivotal in equipping staff for these challenges. Notably, the absence of formal education on emotional coping is evident in responses requesting “group discussions” and a “separate room” for contemplation, highlighting the unmet need for structured emotional support. Respondents with access to “debriefing sessions” and “learning skills to cope” acknowledge these as essential tools gained through training. The education and training of healthcare professionals play a critical role in preparing them to deal with these challenges.30 Studies suggest the need for enhanced training focused on palliative care and reflections on the theme of death.31 This training could help build resilience and provide healthcare workers the tools to engage empathetically and compassionately with patients and their families during the end-of-life phase.32
The observed correlation between professional experience and the length of responses in this study indicates differential levels of reflection or articulation among healthcare professionals at various stages of their careers. Individuals with 5-10 years of experience provide more extended responses, particularly when discussing their experiences and personal growth moments. This may reflect a certain level of maturity and reflection achieved after several years in the field. Individuals with less than five years of experience tend to have shorter responses, which might be due to lesser exposure or confidence in sharing their experiences and insights. Those with more than ten years of experience provide relatively detailed responses, indicating a wealth of experiences and insights they draw from. With increasing experience, professionals may develop more perspectives or greater depth in their reflections, leading to more extended, detailed responses.
Conversely, the lack of a significant correlation between the time taken to complete the survey and the years of professional experience implies that factors other than the duration of experience influence the engagement of healthcare professionals in research activities. The intense red regions in the plot are not merely illustrative but emphasize where the bulk of the data lies quantitatively. Specifically, they indicate the most frequent survey completion times across different levels of healthcare professional experience. The presence of these zones within time brackets suggests patterns that may correlate with various factors, such as familiarity with survey content or time management skills and comfort with the use of technology, which can vary with professional tenure and skill. Moreover, the moderate and lower density areas, depicted in orange and white, respectively, provide insights into the broader context of the dataset. These areas can signify instances where respondents took significantly longer or shorter to complete the survey than their peers. Such deviations can indicate outliers or unique individual differences in response behaviour, which are worth noting when considering the design and implementation of similar surveys in the future. This aspect represents a potential area for future investigation to understand the diverse elements that motivate or impact the participation of healthcare professionals in research. Factors such as the perceived relevance of the research topic, the format of the survey, institutional culture, and individual differences in engagement styles could be among the variables influencing this engagement. Understanding these factors is crucial for designing more effective and engaging research methodologies in the medical field.
Limitations
While the study provided several insights, some limitations need to be considered. Firstly, the reliance on self-reported data through surveys raises concerns about recall bias and personal interpretation. The subjective nature of self-reporting can affect the accuracy and reliability of the data, as participants’ responses might be influenced by their current mood, personal beliefs, or even a misunderstanding of the questions, leading to skewed or incomplete findings. Secondly, there’s a significant geographic concentration, with most respondents hailing from the Middle East, particularly the United Arab Emirates, Kuwait, and Oman. This regional focus limits the generalizability of the findings to other parts of the world, where cultural, educational, and healthcare systems differ markedly. The sample size of 125 participants, mainly physicians and nurses from the Middle East, introduces a notable limitation in the study’s demographic representation.
5. Conclusions
In conclusion, this study offers crucial insights into healthcare professionals’ emotional and professional experiences in oncology and palliative care, emphasizing the significant impact of patient loss. Key findings highlight the prevalence of emotional challenges, the importance of diverse coping mechanisms, and the supportive role of personal beliefs and workplace environments. The study also reveals the correlation between healthcare experience and response patterns, highlighting the journey of personal and professional growth amidst these challenges. Overall, it emphasizes the resilience of healthcare workers and the critical need for supportive systems in managing the complex emotional landscape of patient care. This research is crucial for healthcare professionals’ well-being and maintaining the quality of care provided to patients at the end of life.
Author contributions
All authors have reviewed the final version to be published and agreed to be accountable for all aspects of the work.
Concept and design: Nandan M. Shanbhag, Abdulrahman Bin Sumaida, Khalid Balaraj, Muhammad Z. Javed, Mehad Araki, Huzaifa G. Ibrahim, Tala Al Dabbous, Amna Al Harrasi
Acquisition, analysis, or interpretation of data: Nandan M. Shanbhag, Abdulrahman Bin Sumaida, Khalid Balaraj
Drafting of the manuscript: Nandan M. Shanbhag, Abdulrahman Bin Sumaida, Khalid Balaraj, Muhammad Z. Javed, Mehad Araki, Tala Al Dabbous, Amna Al Harrasi
Critical review of the manuscript for important intellectual content: Nandan M. Shanbhag, Abdulrahman Bin Sumaida, Khalid Balaraj, Huzaifa G. Ibrahim
Supervision: Nandan M. Shanbhag, Abdulrahman Bin Sumaida, Khalid Balaraj, Tala Al Dabbous, Amna Al Harrasi
Ethical approval
Ethical approval for the study was obtained from the Tawam Human Research Ethics Committee (T-HREC), approval number MF2058-2023-985 (dated 12 October 2023). Informed consent was obtained from every participant, and the forms explicitly mentioned that participation in the survey meant consent, this was mentioned very clearly at the beginning of the questionnaire and those who continued or participated understood that they consented and it is voluntary participation. Participants’ responses were anonymous, and confidentiality was maintained throughout the research. There were no incentives to participate in the study, which was completely voluntary.
Consent statement
All participants in this study obtained consent. The Tawam Human Research Ethics Committee issued approval MF2058-2023-985. Note that the study did not involve collecting patient-related data.
All the participants had the following statements visible:
Voluntary participation
Your participation in this survey is completely voluntary. You may choose to stop participating at any time without any consequences.
Confidentiality
All information collected in this survey will be kept confidential and used solely for research purposes. Your responses will be anonymised; no personally identifiable information will be shared or published.
Data protection
The data collected will be stored securely and only accessible to the research team. It will be de-identified according to the Safe Harbor method to ensure your privacy when used for research purposes or shared for the same purpose.
Data availability
The datasets generated and analyzed during the current study are available in the Figshare repository, under the CC BY 4.0 license.15
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how to cite this article
Shanbhag N, Bin Sumaida A, Gurashi Ibrahim H et al. Heart of Care: Embracing Grief and Growth in Oncology and Palliative Medicine [version 1; peer review: awaiting peer review]. F1000Research 2024, 13:1068 (https://doi.org/10.12688/f1000research.153724.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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