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.

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).

Among the respondents, 55 were physicians (44.0%), 36 were nurses (28.8%), and 34 were allied healthcare professionals (27.2%) ( Figure 2).

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).

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.

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.

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 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.

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:

Your participation in this survey is completely voluntary. You may choose to stop participating at any time without any consequences.

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.

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.

The datasets generated and analyzed during the current study are available in the Figshare repository, under the CC BY 4.0 license. ¹⁵

Ethical approval for the study was obtained from the Tawam Human Research Ethics Committee (T-HREC), approval number MF2058-2023-985 in October 2023.