Being conditions, psychosocial issues and existential provocation. The first

Being a pediatric oncologist involves facing medical challenges, life-threatening conditions, psychosocial
issues and existential provocation. The first nationwide study of 90 Swedish pediatric oncologists focuses
on the psychological aspects for physicians meeting children with cancer, as well as physician-related
factors promoting health and well-being. The experiences of the study population cover a period of more
than 40 years.
The thesis aims to study the everyday life of pediatric oncologists, i.e. their motivating factors, stressresilience
capacity, life satisfaction and work-related difficulties, in relation to relevant background
characteristics, length of experience (more/less than 10 years) and type of medical center (academic/nonacademic).

The study design was cross-sectional and used both quantitative and qualitative methods. Paper I presents
the development of a study-specific questionnaire. Papers II and III present the background characteristics
for 89/90 physicians, working at academic medical centers with 25-90 new cancer patients every year and
non-academic centers with 3-20 new patients. The response rate was 88/89% in the target group. The
study-specific questionnaire and five psychometric instruments measuring coping resources, sense of
coherence, life satisfaction, emotional distress and personality were used. Optimal pediatric oncology
included several colleagues and a multi-professional healthcare team and the work was regarded as very
stimulating for personal development. Time pressure was a reality for every participant, as were a wide
range of coping resources, high sense of coherence, average overall life satisfaction and low levels of
emotional distress. More experienced pediatricians reported a higher impact by motivating factors, past
overall life satisfaction and a lower degree of somatization. Future overall life satisfaction was higher
among physicians who met more pediatric oncology patients. Their personality traits showed low levels of
negative affectivity and high levels of positive affectivity (Hedonic Capacity). Male pediatricians were
more satisfied with their present lives and physicians working at academic medical centers were more
confident about the future. One in ten needed professional help to deal with work-related psychological
problems. Personality traits (Hedonic Capacity) and low levels of depression contributed to every aspect of
overall life satisfaction. Work-related aspects influenced present and future life satisfaction. Paper IV, a
grounded theory analysis of in-depth interviews with 10 experienced physicians, focused on their main
concern, the demanding role of breaking bad news. Strategies for handling the challenges were related to
seeking knowledge and support, building a close relationship with the patients and families, having
reflected on central life issues but avoiding identification. Practical implications and physician-related
recommendations are presented.
The overall picture of this study group reveals an optimistic attitude and stable emotional status, pointing to
a high level of satisfaction. The impediments are particularly related to time pressure, risk of emotional
distress, having less experience and the need for colleagues, plus a multi-professional team. The role of
messenger requires strategies to handle the challenges. Knowledge acquired from the present study is
expected to be useful in improving the physician-patient relationship, thereby helping to retain experienced
physicians and recruit new specialists in pediatric oncology.

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