From will to live to will to die: oncologists, nurses, and social workers identification of suicidality in cancer patients.

PURPOSE: The purpose of this research was to examine how oncologists, nurses, and social workers identify suicidality in cancer patients. METHODS: Sixty-one healthcare professionals (23 oncologists, 18 social workers, and 20 nurses) at two academic cancer centers were interviewed using an in-depth interview guide. This was a qualitative study based on grounded theory methodology. Analysis involved line-by-line coding, with categories and themes emerging from participants' narratives. RESULTS: Suicidality in cancer patients exists on a wide spectrum that ranges from an active will to live to an active will to die. Four phases were identified that included: (A) a strong will to live expressed in themes of active treatments, seeking second opinions, overtreatment, and alternative treatments; (B) a decreasing will to live indicated in themes of mental health distress and physical pain and suffering; (C) a readiness to die expressed in themes of mental health distress, previous mental health diagnoses, physical pain, avoiding more suffering, preserving quality of life in old age, nearing end of life, lack of social support, and maintaining a sense of control; and (D) a will to die indicated in themes of euthanasia and active suicidality. CONCLUSIONS: Suicidality in cancer patients exists on a continuum. Cancer patients fluctuate on this spectrum depending on circumstances such as degree of suffering, their personalities and life circumstances, and whether they are nearing the end of life. Results of the study emphasize the need to collect more context specific data on suicidality among cancer patients and the importance of early integration of psychosocial and palliative care in the cancer treatment trajectory.

Early exposure to a clinical oncology course during the preclinical second year of medical school.

PROBLEM: Although only some medical students pursue a career in oncology, all should have a basic understanding of the issues surrounding cancer and its treatment. The authors designed and implemented a one-week introductory clinical oncology course for second-year medical students at Ben Gurion University of the Negev. The course presents a holistic approach to caring for patients with cancer that goes beyond the biological aspects of the disease. APPROACH: In 2013, the authors interviewed four former students and surveyed all current students before and after they completed the course to evaluate its reception and effectiveness. OUTCOMES: Of the 86 students in the course, 77 (90%) completed both the pre- and postcourse surveys. After taking the course, more students reported being concerned about ethical issues, being emotionally stirred by the course, being comfortable speaking with a cancer patient about death and dying, and being comfortable with the fact that the course dealt with issues of death and loss and with "how to live with cancer." In addition, more students reported a fear of causing a cancer patient suffering because of a treatment yet viewed cancer optimistically. Finally, more students considered specializing in oncology. NEXT STEPS: That students reported increased empathy toward cancer patients despite increased trepidation about causing them suffering is promising. Such courses may be one way to counteract the decrease in empathy among students as they progress through medical school. As such, medical schools might consider including this type of curriculum in their preclinical oncology studies.