"You can only take so much, and it took everything out of me": coping strategies used by parents of children with cancer.

OBJECTIVE: This study qualitatively assesses the coping strategies of parents who care for a child with cancer. METHOD: Semi-structured interviews were conducted with 28 French and English families who had had a child diagnosed with cancer in the last ten years in two Eastern Canadian provinces. Interviews were transcribed verbatim and coded with a focus on parental coping strategies. RESULTS: Using coping behaviors as described and categorized in the Family Adjustment and Adaptation Response (FAAR) model as a foundation, we found that families used a variety of appraisal-, emotion-, and problem-focused coping. Appraisal-focused coping strategies involved trying to stay "positive" and "making positive comparisons." Problem-focused coping involved behaviors such as being an advocate for the child and seeking information. The majority of parents, however, described using emotion-focused coping behaviors such as trying to avoid "feeling too much" by hiding difficult emotions and "escaping" from problems. Others used more positive emotion-focused coping behaviors such as humor, seeking support (informal or formal), or writing diaries. A small group of parents used ineffective coping strategies (alcohol abuse, misdirected anger) that added to family stress. These ineffective strategies have led to a modification of the FAAR model indicating that not all coping behaviors are beneficial to family adjustment in crisis. Overall, many parents felt that their coping strategies were effective; however, a few described having a complete "coping breakdown". SIGNIFICANCE OF RESULTS: Parents used a range of coping strategies of which emotion-focused coping was the most prominent. We have enhanced the FAAR model by including additional coping behaviors as well as a description of how some coping behaviors add to the daily stressors for parents dealing with a child's illness. Professional health care providers need to understand the variability of the coping behaviors in order to appropriately assist parents to avoid coping breakdowns.

The challenges and rewards of rural family practice in New Brunswick, Canada: lessons for retention.

INTRODUCTION: This study examined the work environment of rural family physicians in New Brunswick, a province in eastern Canada. The purpose of the research was to explore the job satisfaction of rural family physicians based on gender, age, years in practice, and language and location of practice. METHODS: We used a qualitative, collective case study approach (24 cases of two individuals each: 48 interviews). Cases were selected based on gender, location (urban/rural), language (French/English) and number of years since medical school graduation (<10 years, 10-20 years, >20 years). The data reported is based on 21 interviews with rural physicians. Participants were recruited using the College of Physicians and Surgeons of New Brunswick website information. The research team traveled to physicians' offices throughout the province of New Brunswick to conduct interviews in the language of preference of the physician (French or English). Male researchers interviewed male participants and female researchers interviewed female participants. Interviews were transcribed verbatim and analyzed for themes related to the benefits and challenges of rural practice. Consensus on themes was reached among the entire research team. RESULTS: Many rural practitioners face a host of challenges ranging from professional isolation, complex patient profiles and maintaining professional boundaries. In this study, the most important challenge rural family physicians faced was the non-clinical issue of boundary maintenance. When rural family physicians had difficulties maintaining boundaries they were more likely to consider leaving their rural practice. Overall, few differences, based on gender, age, years in practice and language of practice were found. A few rural family physicians felt that the benefits of rural practice outweighed the challenges. CONCLUSIONS: This study demonstrates that rural family physicians in the province of New Brunswick, Canada face numerous challenges while practicing in rural areas. The most important challenges are not medical or technical in nature, but the 'soft' issue of maintaining professional and private boundaries. Rural physicians, when off duty, want privacy. Rural family physicians have to become more assertive about their needs, while at the same time, patients have to realize that off-duty physicians are private citizens.

Disrespect, harassment, and abuse: all in a day's work for family physicians.

OBJECTIVE: To examine harassment and abusive encounters between family physicians and their patients or colleagues in the workplace. DESIGN: Qualitative case study using semistructured interviews. SETTING: Province of New Brunswick. PARTICIPANTS: Forty-eight family physicians from across the province. METHODS: A collective case-study approach was developed, with 24 cases of 2 individuals per case. Cases were selected based on sex, location (urban or rural), language (French or English), and number of years since medical school graduation (< 10 years, 10 to 20 years, or > 20 years). Physicians were interviewed in either French or English. Participants were recruited using the College of Physicians and Surgeons of New Brunswick's physician directory. Based on the rates of response and participation, some cases were overrepresented, while others were not completed. All interviews were audiotaped, transcribed verbatim, and analyzed thematically using a categorical aggregation approach. A coding scheme for the thematic analysis was developed by the research team before the interviews were transcribed. MAIN FINDINGS: Although the original intent of this study was to examine the work environment of family physicians in light of the increasing number of women entering the profession, harassment and abusive encounters in the workplace emerged as a main theme. These encounters ranged from minor to severe. Minor abusive encounters included disrespectful behaviour and verbal threats by patients, their families, and occasionally colleagues. More severe forms of harassment involved physical threats, physical encounters, and stalking. Demanding patients, such as heavy drug users, were often seen as threatening. Location of practice, years in practice, and sex of the physician seemed to affect abusive encounters--young, female, rural physicians appeared to experience such encounters most often. CONCLUSION: Abusive encounters in the workplace are concerning. It is essential to address these issues of workplace harassment and abuse in order to protect physician safety and avoid workplace dissatisfaction. Abusive encounters might push family physicians to leave clinical practice prematurely or refuse to work in higher-risk environments, such as emergency departments or rural areas.

Crossing boundaries: family physicians' struggles to protect their private lives.

OBJECTIVE: To explore the tensions between professional and personal boundaries and how they affect the work and private lives of family physicians. DESIGN: Qualitative case study using semistructured interviews. SETTING: Province of New Brunswick. PARTICIPANTS: Forty-eight family physicians from across the province. METHODS: A collective case-study approach was developed, with 24 cases of 2 individuals per case. Cases were selected based on sex, location (urban or rural), language (French or English), and number of years since medical school graduation (< 10 years, 10 to 20 years, or > 20 years). Physicians were interviewed in either French or English. Participants were recruited using the College of Physicians and Surgeons of New Brunswick's physician directory. Based on the rates of response and participation, some cases were overrepresented, while others were not completed. All interviews were audiotaped, transcribed verbatim, and analyzed thematically using a categorical aggregation approach. A coding scheme for the thematic analysis was developed by the research team before the interviews were transcribed. MAIN FINDINGS: Almost all of the family physicians interviewed discussed how their profession negatively affected their personal lives. Many struggled with issues such as heavy workloads, the adverse effects of their profession on their family lives, and the trespassing of patients onto their personal lives in small towns and rural communities. Some physicians had developed strategies to balance their personal lives with their professional demands; however, this often meant reducing work hours or terminating certain shifts, such as those in the emergency department or after-hours clinics. CONCLUSION: Family physicians struggle to keep their profession from intruding too much into their private lives. These struggles are important to acknowledge and address in order to avoid physician burnout and premature retirement from clinical practice.