More than “hematology”: A qualitative study on the experience of hematologists treating people with blood cancer in Greece

More than “hematology”: A qualitative study on the experience of hematologists treating people with blood cancer in Greece | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article More than “hematology”: A qualitative study on the experience of hematologists treating people with blood cancer in Greece Nikolaos Vrontaras, George Koulierakis, Dimitrios Kyrou, Anargyros Kapetanakis, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4761324/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Mar, 2025 Read the published version in Supportive Care in Cancer → Version 1 posted 8 You are reading this latest preprint version Abstract Purpose : The present study aims to investigate the experiences of hematologists providing care to patients with hematological malignancies, whose care is pertinent to oncology. Methods : Semi-structured interviews with 30 hematologists across Greece were conducted. The interviews took place over the course of six months at 2020. Reflexive thematic analysis was employed for data analysis. Results : Three key themes (personal impact, organizational framework, and relating to patients) and eight subthemes were generated: 1. Hematologists were greatly affected on a personal level, as they had poor life-work balance and impacted social relationships. They experienced a great emotional toll, sometimes questioning the meaning of their work. They frequently struggled with loss, by witnessing people’s passing. Nevertheless, they reported coping better over time. 2. On an organizational level, hematologists supported each other emotionally, but only rarely had formal support in managerial or administrative recourses. They were also hindered by structural restraints, both in terms of limited psychosocial training and supportive services. 3. Hematologists’ relationship with their patients increased their job satisfaction. However, they strived to keep boundaries while balancing how close they got to their patients. Conclusion : High job demands and organizational aspects pose hematologists with the risk of developing compassion fatigue or burnout. Working under difficult conditions, they needed to go above and beyond to provide appropriate care to their patients. At the same time, individual resources, teamwork, or other structural opportunities emerged as crucial coping elements. Support should be offered both personally and professionally to improve their lives and prevent potential turnover. hematological neoplasm neoplasm delivery of health care qualitative research Figures Figure 1 Introduction Hematological malignancies are a heterogeneous group of cancer currently on the rise in the Western world [ 1 ]. Globally, the overall age-standardized incidence rate of hematological malignancies increased from 1990 to 2017, while the age-standardized disability-adjusted life-years and death rates for the same group decreased during the same period [ 2 ]. This implies that the quality of care is getting better for people with hematological malignancies, although, they still face many challenges [ 3 ]. Managing the challenges of providing care for people with life-threatening hematological diseases renders the hematologist’s role quite complex. It involves assessing patients [ 4 ], selecting treatment options [ 5 ], and ensuring high medication adherence [ 6 ]. Hematologists are also required to maintain patients’ and sometimes the caregivers’ quality of life [ 7 , 8 ] and manage and facilitate palliative care [ 9 – 11 ]. To meet the demands of their role, hematologists are expected to have various skills, such as mastery over patient communication, emotional support, information, and decision-making preferences [ 12 – 15 ]. They have to collaborate with patients [ 16 ] as well as with other specialists within the health care team [ 17 ]. Hematologists, similarly to any other health care providers, are also required to perceive their role clearly [ 18 ] and own a great sense of clinical adequacy [ 19 ], but at the same time also be self-aware [ 20 ]. Furthermore, they need to be addressing the intricate ethical issues that might arise, in a variety of circumstances [ 21 ]. The treatment of people with hematological malignancies within a health care setting and the multi-level complexity of their role leave hematologists dealing with many of the aforementioned challenges. This often results in increased stress, burnout, and exhaustion [ 22 – 24 ] and impacts their well-being [ 25 ]. Despite the high demands put on hematologists and the challenges they face, there is a scarcity of in-depth studies investigating their experiences from treating people with hematological malignancies. Those that do exist focus on specific populations, like hematologists treating pediatric patients [ 24 ], specific stages of care, like palliative care [ 9 ], or specific aspects of care, such as communication between hematologists and patients [ 14 ]. These studies, however, do not explore the overall impact of working with patients with hematological malignancies. This is in contrast to the number of equivalent studies available relating to general oncology like that of Hlubocky and colleagues [ 26 ], which are constantly updated. The present study aims to investigate the impact of working as a hematologist with patients requiring care pertaining to that of oncological patients, i.e., patients with hematological malignances. This study was conducted by the European Research Initiative on CLL (ERIC) within the context of its CLL patient empowerment program [ 14 ]. Methods Design A qualitative approach was adopted to allow the in-depth exploration of the individual experiences and perceptions of participants [ 27 ]. Qualitative data were gathered through semi-structured interviews with hematologists treating people with hematological malignancies in Greece, which took place over the course of six months at 2020. The Consolidated Criteria for Reporting Qualitative Research (COREQ) [ 28 ] were used (see Supplement A). Participants Thirty (n = 30) hematologists (18 females) working in hematology departments of hospitals and/or private practice across Athens, Thessaloniki, Heraklion, Larisa, Serres, Alexandroupoli, Mytilini participated in the study. Participants’ clinical experience ranged from 2 to 32 years (m = 14.5); four were in hematology residency training and one had retired the year before. Purposive sampling was applied [ 29 ], to identify hematologists who were specialized or involved in the treatment of people with hematological malignancies. Data Collection The interview guide was developed after an extensive literature review and used for all the interviews (see Appendix A). A list of possible questions to assess the impact on hematologists was identified and compiled (e.g., “ Could you describe your overall experience as a hematologist? ”). Taking into account recent controversies on data saturation in reflexive thematic analysis (33) , data collection was considered complete when the analysis of the interview data yielded a conceptual structure which was considered adequate in depth, complexity, and richness for addressing the research goals and questions. Procedure The interviews were conducted by one of the researchers (CK, Health Psychologist, Ph.D., female), in a place and time chosen by the participants. The majority of the interviews took place at the Institute of Applied Biosciences, in Thessaloniki, while in the cases of participants’ remote places of residence, interviews were conducted over the phone (n = 4). Face-to-face interviews took place in a private room, but privacy was ensured for all interviews. They were all audio-recorded. Interview duration ranged from 20 to 60 minutes, with an average of 33 minutes. None of the participants refused to participate or withdrew after they had given consent. Reflexivity The interviewer had already read about hematological malignancies before the interviews took place, and had also interviewed patients with hematological malignancies, so she was quite familiar with the issues that patients face. However, she had not any preunderstanding regarding the perceptions and experiences of healthcare professionals treating them. Ethical considerations Upon recruitment, participants were informed about the study details (e.g., purpose, the hosting organization, procedural issues). Their rights (e.g., anonymity, confidentiality, getting informed about the findings, withdrawing from the study) were particularly stressed. All participants gave their informed consent for participation and the interview’s audio recording. The interviewer had no prior relationship with the participants. Ethical approval for this study was obtained by the Research Ethics Committee of the Institute of Applied Biosciences at CERTH (Ref. ETH.COM-20) and each participating hospital. The interview audio recordings were stored according to the EU General Data Protection Regulation [ 30 ]. Any information that could identify the participants was anonymized at the time of transcription (e.g., participants were assigned different names). To support the participants through any arising distress, an informal debriefing and information on supportive services were offered when requested. Analysis The research material was analyzed using reflexive thematic analysis [ 27 , 31 ] under a critical realist approach [ 32 ]. No formal transcription method was used, as it is not necessary for thematic analysis [ 27 ]. The transcription was undertaken by CK and the analysis by NV (Health Psychologist, M.Sc., male). The analysis was performed according to the approach and guidelines of Braun & Clark [ 27 ]. After the interviews were thoroughly read, inductive coding was performed to develop initial concepts from the data. Next, the developed codes were grouped into higher-level groups, i.e., subthemes, that encapsulated repeated patterns across the data. Then, subthemes were clustered in overarching groups that formed the “themes”, which reflected the basic organizing concepts of the data. The external heterogeneity and internal homogeneity of the developed subthemes and themes were reviewed in a multidisciplinary research team. Then, the most indicative transcribed interview quotes for each theme and subtheme were selected to facilitate the presentation of themes and subthemes. The selected quotes were translated from Greek to English by NV and were checked for comprehensibility by CK. Discrepancies in coding, and in the translation of quotes, were resolved by discussion until consensus was reached. All data during the coding process were managed with Microsoft Word. Results Exploring the impact of treating people with hematological malignancies on hematologists resulted in three key themes and eight subthemes, which are outlined in detail below, alongside indicative quotes. Themes represent the major personal impact, the organizational framework hematologists work in, and how they are relating to their patients (see Fig. 1 ). Personal Impact Hematologists described the impact on their everyday life and on their emotions, sometimes due to coming in contact with death, and how this experience changed over time. Impinging on personal life All participants described their personal life being affected by their profession. This was demonstrated by routinely returning home and continuing to work. A few described poor “ work-life balance ” as an inability to “ turn your mind off ” and because of their work’s intense nature, it was “hard to leave it behind” . A few reported that their sleep quality was impacted (e.g., nightmares). Many mentioned strained or more distant relationships with family or friends, as they did not have the energy, time, or willingness to engage in “trivial conversations” . I wake up in fear. ... The cases are adding up, many of them aren’t doing well, do you know what I mean? … The complications are adding up, the deaths are adding up. Frequently I am tormented by [thoughts of] patients on the weekends, 'did I do this well?', 'let nothing happen to them.’ —Female, 7 years or experience Leaving an emotional mark Hematologists were impacted on an emotional level by their job, resulting in a variety of negative and long-lasting effects. Some reported having developed a more fragile and sensitive mental state, making them consider accessing psychological support. Managing patients’ anxiety and fears was difficult for many, as it could gravely affect their own emotions. You are left feeling like you are suffocating, that you can’t manage… I have been drained out… — Female, 10 years of experience Many participants also had existential questions about finding meaning in their work and the everyday lives of their friends and family. Because you see so many people suffer, I feel you grow indifferent to your own difficulties. … you end up more “damaged” as a person… … there is no turning back to the way things were. — Male, 4 years of experience Some struggled with thoughts around ‘ what if it had happened to me or my family ’ and how they would cope with it. Others thought their work was futile, suggesting that since they could not preserve patients’ life, there was no other way for them to help. Many hematologists singled out a few very challenging situations in the profession that took a great emotional toll on them. One was the delivery of bad news (e.g., reporting toxicity levels, the effectiveness of the treatment, relapses, a terminal diagnosis, the unavailability of other treatments). Treating younger people was extremely stressful for many, since “ they have their whole life ahead of them ”. The emotional load is great. … Especially, if you are dealing with younger people, and you also have their family to deal with. It's not easy. … Relapse is where things get really difficult. —Female, 31 years of experience One participant showed the universal nature of this by saying, “ everyone has shed tears over losing young people to a malignant disease ”. Lastly, the withholding of information was creating internal conflicts in hematologists, making them feel uncertain or dishonest on the one hand (“ like you are lying to them, … to give them hope ”), but leaving room for patients’ hopes on the other. Participants reported struggling in front of such ethical dilemmas, which could also have legal repercussions. Dealing with death Hematologists shared their experience around people’s passing and how they coped with it. Many found it particularly difficult and tried to avoid being physically present at a patient’s death, especially when they had developed a relationship with them. Over the years, a new death would bring back memories of previous accumulated losses, leading to emotional exhaustion. Instances they knew someone would soon pass (e.g., terminal diagnosis) were also challenging. Some struggled to understand the reasoning for offering an intense treatment that would reduce a patient’s quality of life without significantly prolonging it. “For approximately the first nine months, I used to say that I am virtually only seeing people die. It even became my motto ‘everybody dies’. Then I asked myself, “what is it that we are even doing here?” If someone is meant to die, should I offer them three more months to live? … as one of the great philosophers put it ‘life is a series of small deaths’.” —Female, Residency In such cases, they would also emotionally distance themselves from patients to protect themselves from the expected passing. Getting better with time Many participants talked about things getting better over time, either because they were changing, growing, and healing. This belief seemed to be widely adopted and frequently discussed among hematologists. Participants would realize and accept their boundaries while growing more confident and not questioning their decisions as much. Indicating the development of resilience, a few hematologists said that they are no longer bothered by minor, trivial things. “Listen, you start off young and since in an end-stage disease losing young patients or especially likeable older ones gets to you. It is only with time that you develop a philosophy of life and you understand what death is and how it should be dealt with and how it could… … You find a balance there. — Male, 18 years of experience Organizational Framework The healthcare system was frequently perceived as a barrier to their practice and would cause challenges, yet, working with others in a team was very supportive. Being part of a whole Hematologists praised the benefits of working with other professionals, considering it supportive and helpful. Not only would they rely on the team in decision-making, but also, they would informally engage in peer-support. There are usually two or three [treatment] options, each with its pros and cons. While in a clinic, the team will help you a lot with this. … We were a great team, we had the benefit of greatly appreciating and trusting each other, not being competitive with one another. … I remember this team with much affection. … I miss them even after all these years. —Female, 32 years of experience Nearly every participant talked about residency during which the team protected them against professional challenges (e.g., sharing responsibility for decisions). Since as a resident you always have the backup of a specialist, you don't have the responsibility. … Now that I am a specialist, I clearly handle situations differently. –Female, 3 years of experience Hematologists recognized that working within large organizations offers resources and options, mostly related to their scientific development, sometimes in the form of managerial and administrative support, which allowed them to dedicate more time to patients (e.g., longer appointment slots) or research activities. Moreover, when hematologists reported major impact from their work, senior management facilitated the situation by rotating them into a different department (e.g., laboratory work). Initially, I struggled ... I then changed departments … I calmed down; my family and my colleagues here helped me through it— Female, Residency Overcoming structural restraints Hematologists also faced many structural limitations. “It’s a given that Greek reality is making everything difficult for me. I feel it is basically an opponent, sitting on the opposite side and placing obstacles your way, either through the technical infrastructure or through the practice of one’s specialty…” —Male, 8 years of experience Poor working conditions and lack of formal training in psychosocial skills (e.g., communicating with patients) were mentioned. In addition, a few also said that they had to learn through trial and error and through observing senior hematologists. Additionally, participants highlighted the scarcity of psychological services in Greek hospitals. As a consequence, they alone shouldered the psychological support of their patients. Even when such services were available, sometimes patients refused a referral preferring to be supported by their hematologists, which indicates a closer relationship with them. It goes without saying that they would want to talk to you… not to the specialist [psychiatrist] as they are uncomfortable, they wouldn’t want to take up their time… So, you are the one listening to everything” —Female, Residency Relating to Patients Hematologists tried to not get too close to patients as this could possibly have an emotional impact on them. Nonetheless, they enjoyed the connection they had with their patients. Drawing the line To manage the physician-patient relationship, participants were setting boundaries for themselves and their patients. “I want to maintain the face and standing of the physician, meaning that professionally I would not get too emotionally involved, maintain a middle ground and my professionalism. Demonstrate that I care without reaching their depth of sorrow because if I do, I will take this sorrow with me back home.” — Female, Residency Hematologists talked about not sharing their own emotions with their patients, or interacting with them outside the hospital and avoided sharing their personal mobile number, preferring to communicate with one representative of the family. In some remote or isolated areas, this could become an issue, as they might meet in the community and the residence of the physician would be known to their patients. Balancing the emotional bond A few hematologists mentioned that getting close to patients could lead to a painful experience, in case there was a negative unexpected outcome. “I think in this line of work, we all have lost a favorite case. Four years is a long time for you to say ‘it never happened to me’ or that ‘I may have lost people but it hasn’t affected me much’.” — Female, Residency Nevertheless, they also mentioned the rewards of building close relationships with patients, saying “ generally it is a very rewarding profession, you get back as much as you give, more than that usually”. Many enjoyed positive outcomes which brought expressions of gratitude from patients (e.g., wedding invitation, showing pictures of a new baby). “I mean I take back plenty from these people, little things you notice as you receive their love and I consider this as a positive overview. This is what at the end of the day justifies all you do.” —Female, 19 years of experience A few explained that they felt connected on a personal level with young people, especially when they themselves were parents. Notably, few participants emphatically spoke about putting in the effort to develop strong relationships even with people who were initially challenging to approach as worthwhile. Overall, the participants spoke warmly about enjoying practicing hematology very much. “I mean I take back plenty from these people, little things you notice as you receive their love and I consider this as a positive overview. This is what at the end of the day justifies all you do.” —Female, 19 years of experience Discussion This qualitative study explored the impact of treating people with hematological malignancies on hematologists, in Greece. To the best of our knowledge, this is the first study to offer insights into the perceptions, challenges, and coping strategies that hematologists adopt to deal with the impact of their work. Findings indicated that treating people with hematological malignancies has a significant impact on hematologists at a personal level. Participants experienced strong emotions due to their daily exposure to loss, death, and their patients’ physical and psychological pain. When not managed successfully, these strong emotions can lead to burnout [ 33 ]. Working with people who experience traumatic events is making hematologists susceptible to secondary traumatization which is accompanied by hyperarousal, sleep difficulties, intrusive thoughts, loss of purpose, and detachment from significant others [ 34 ]. Identifying and addressing burnout and secondary traumatization in healthcare professionals is important and can be very impactful. These are both associated with lower well-being, lower job satisfaction, increased turnover, increased physical and emotional disturbances [ 35 , 36 ], suboptimal patient care, and lower patient satisfaction [ 37 ]. Hematologists are experiencing healthcare caregiver burden which in turn, puts a strain on the health care system in general. Concerning how hematologists relate to their patients, many of their responses indicate compassion fatigue [ 35 , 38 ] characterized by reduced compassion towards others. Interventions targeting compassion fatigue like that described by Figley [ 34 ] should be offered to hematologists to increase their job satisfaction and further improve their relationship with patients. Nevertheless, hematologists also described their relationship with their patients as supportive; they enjoyed their work and found it meaningful, which relates to compassion satisfaction [ 35 ]. Notably, participants reported that the balance between compassion fatigue and compassion satisfaction shifted at different times in their careers. The organizational setting in Greek hospitals was perceived as having both strengths and weaknesses. Greece has the highest ratio of physicians among EU countries (625 vs 350 per 100 000 population), and the lowest ratio of practicing nurses (344 vs 864 per 100 000 population) [ 39 ], yet Greek public hospitals and certain services are often heavily understaffed [ 40 ]. This partly explains hematologists’ impact. At the same time, the effectiveness of the Greek health care system lags considerably behind other EU countries in addressing treatable cancer types (e.g. breast, cervical, prostate) [ 39 ]. An organization overhaul of oncological care providers seems to be urgent [ 41 ]. This is supported by the hematologists’ reports; action should be taken to improve the work conditions and the healthcare system in Greece. Hematologists are sometimes left without formal training or adequate support while having to draw only from their own experiences, intuition, and mentors [ 14 ]. As the healthcare system’s performance is reciprocally linked with medical education, specific reforms to healthcare personnel’s education have been suggested [ 42 ]. These include an emphasis on primary health care education and the provision of continuous medical education by a structured framework. The above should help prepare and upskill hematologists in managing the challenges of their everyday work. Interest in compassionate care has risen [ 43 ]; it could be inculcated through health education by considering the interrelation between individual motivation and social structure [ 44 ]. In Greece, the inclusion of compassion in healthcare provision from healthcare professionals seems to be more than a necessity [ 45 ]. Towards this direction, an elective course on compassion in clinical care has been introduced in the curriculum of the Medical School of the University of Crete [ 46 ]. Such initiatives pivot the way for hematologists to form compassionate relationships with their patients, increase their confidence and potentially increase their job satisfaction. Clinical Implications To manage the aforementioned challenges in clinical practice, specific educational initiatives [ 47 ], models [ 48 ], and occupational strategies like rotation [ 49 ] have been developed and implemented with varying degrees of success. Materials and training developed for oncologists could be studied for their appropriateness, adapted, and offered to hematologists treating patients with hematological malignancies by experts in psychology and healthcare communication. Support, including administrative assistance, psychosocial skills training, and access to specialized psychological services, should also be offered to manage the clinical and the emotional load mediate the impact, and reduce staff turnover. Conclusions The present study drew from hematologists’ experiences across their professional development (residency to retirement). In conclusion, it appears that working with patients with hematological malignancies in the Greek health system posed many challenges to hematologists and put them at risk for burnout or compassion fatigue. Hematologists managed to cope through the utilization of personal resources and collaborative efforts. They usually had to go beyond their formal role to provide their patients the proper care. Assistance ought to be provided on a personal and professional level to enhance their well-being, prevent turnover and support them to continue providing high-quality care to their patients. Strengths, Limitations and Future Research The experiences of hematologists treating adults with hematological malignancies constitute an understudied area as most research focuses on the impact of oncology practice [ 26 ] and pediatric hematology [ 24 ]. Consequently, although many initiatives exist, they focus on different specialties rather than focusing on the challenges faced by hematologists in malignant hematology. Regarding the study’s limitations, as all participants were working in Greece, the findings of the present study are context-specific in several aspects. In addition, another limitation was the heterogeneity of the study’s sample as manifested in the wide range of their years of experience. Future studies could focus on the exploration of the experiences of more specific groups of hematologists, like those of residents, and investigate specific unmet training needs. Even though initial findings on coping strategies were presented, coping could be investigated further. Overall, future research should focus on further examining the areas highlighted (e.g., personal impact, organizational framework, and relating to patients) and explore, hematologists’ work satisfaction, coping with stress, and burnout levels. Declarations Funding This work was conducted on behalf of ERIC, the European Research Initiative on CLL, and supported in part by unrestricted grant support by Janssen Europe, the Middle East and Africa, Janssen-Cilag Hellas Société Anonyme, and Gilead Sciences Hellas. The funders had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript. Competing Interests The authors have no relevant financial or non-financial interests to disclose. Author contributions All authors contributed to the study conception and design. Material preparation and data collection was performed by Christina Karamanidou. The analysis was performed by Nikolaos Vrontaras. The first draft of the manuscript was written by Nikolas Vrontaras, George Koulierakis and Dimitrios Kyrou. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Ethics Approval This study was performed in line with the principles of the Declaration of Helsinki. Ethical approval for this study was obtained by the Research Ethics Committee of the Institute of Applied Biosciences at CERTH (Ref. ETH.COM-20) and each participating hospital. Consent to Participate Informed consent was obtained from all individual participants included in the study. Acknowledgments The authors thank all the people who gave their time and contributed to this study. Data availability statement The datasets generated and analyzed during the current study are not publicly available due to the fact that the interview transcripts are in participants’ native language, i.e., Greek, and therefore not suitable for deposit in a public repository. They can be available to anyone interested upon request to the authors of the study. References Loda M, Mucci LA, Mittelstadt ML, et al (eds) (2017) Pathology and Epidemiology of Cancer. Springer International Publishing, Cham Keykhaei M, Masinaei M, Mohammadi E, et al (2021) A global, regional, and national survey on burden and Quality of Care Index (QCI) of hematologic malignancies; global burden of disease systematic analysis 1990–2017. Exp Hematol Oncol 10:11. https://doi.org/10.1186/s40164-021-00198-2 Tsatsou I, Konstantinidis T, Kalemikerakis I, et al (2020) Unmet Supportive Care Needs of Patients with Hematological Malignancies: A Systematic Review. 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Qual Res Psychol 3:77–101. https://doi.org/10.1191/1478088706qp063oa Tong A, Sainsbury P, Craig J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 19:349–357. https://doi.org/10.1093/intqhc/mzm042 Robinson RS (2014) Purposive Sampling. In: Michalos AC (ed) Encyclopedia of Quality of Life and Well-Being Research. Springer Netherlands, Dordrecht, pp 5243–5245 Voigt P, Bussche A (2017) The EU General Data Protection Regulation (GDPR): A Practical Guide. Springer International Publishing, Cham. https://doi.org/10.1007/978-3-319-57959-7 Liamputtong P (2019) Handbook of Research Methods in Health Social Sciences. Springer, Singapore Maxwell JA (2012) A Realist Approach for Qualitative Research. SAGE Maslach C, Jackson SE, Leiter MP (1997) Maslach Burnout Inventory: Third edition. In: Evaluating stress: A book of resources. Scarecrow Education, Lanham, MD, US, pp 191–218 Figley C (2002) Treating Compassion Fatigue. Routledge, New York Sorenson C, Bolick B, Wright K, Hamilton R (2016) Understanding Compassion Fatigue in Healthcare Providers: A Review of Current Literature. J Nurs Scholarsh 48:456–465. https://doi.org/10.1111/jnu.12229 Yates M, Samuel V (2019) Burnout in oncologists and associated factors: A systematic literature review and meta-analysis. Eur J Cancer Care (Engl) 28:e13094. https://doi.org/10.1111/ecc.13094 Murali K, Banerjee S (2018) Burnout in oncologists is a serious issue: What can we do about it? Cancer Treat Rev 68:55–61. https://doi.org/10.1016/j.ctrv.2018.05.009 Berger RS, Wright RJ, Faith MA, Stapleton S (2022) Compassion fatigue in pediatric hematology, oncology, and bone marrow transplant healthcare providers: An integrative review. Palliat Support Care 20:867–877. https://doi.org/10.1017/S147895152100184X Economou C, Kaitelidou D, Karanikolos M, Maresso A (2017) Greece: Health System Review. Health Syst Transit 19:1–166 Ifanti AA, Argyriou AA, Kalofonou FH, Kalofonos HP (2014) Physicians’ brain drain in Greece: a perspective on the reasons why and how to address it. Health Policy Amst Neth 117:210–215. https://doi.org/10.1016/j.healthpol.2014.03.014 Emmanouilides C (2015) Reorganisation of Oncologic Care in Greece: A Proposal. Forum Clin Oncol 6:28–34. https://doi.org/10.1515/fco-2015-0018 Cinoku II, Zampeli E, Moutsopoulos HM (2021) Medical education in Greece: Necessary reforms need to be re-considered. Med Teach 43:287–292. https://doi.org/10.1080/0142159X.2020.1832651 Shea S, Lionis C (2010) Restoring humanity in health care through the art of compassion: an issue for the teaching and research agenda in rural health care. Rural Remote Health 10:1679 Fotaki M (2015) Why and how is compassion necessary to provide good quality healthcare? Int J Health Policy Manag 4:199–201. https://doi.org/10.15171/ijhpm.2015.66 Lionis C (2015) Why and How Is Compassion Necessary to Provide Good Healthcare? Comments From an Academic Physician. Int J Health Policy Manag 4:771–772. https://doi.org/10.15171/ijhpm.2015.132 Lionis C, Shea S, Markaki A (2011) Introducing and implementing a compassionate care elective for medical students in Crete. J Holist Healthc 8:38–41 Richardson DR, Tan X, Winzelberg G, et al (2020) Development of an Art of Oncology Curriculum to Mitigate Burnout and Foster Solidarity Among Hematology/Oncology Fellows. JCO Oncol Pract 16:e384–e394. https://doi.org/10.1200/JOP.19.00529 Sinclair S, Bouchal SR, Schulte F, et al (2021) Compassion in pediatric oncology: A patient, parent and healthcare provider empirical model. Psychooncology 30:1728–1738. https://doi.org/10.1002/pon.5737 McFarland DC, Holland J, Holcombe RF (2015) Inpatient Hematology-Oncology Rotation Is Associated With a Decreased Interest in Pursuing an Oncology Career Among Internal Medicine Residents. J Oncol Pract 11:289–295. https://doi.org/10.1200/JOP.2015.003798 Additional Declarations No competing interests reported. Supplementary Files APPENDIXA.docx Cite Share Download PDF Status: Published Journal Publication published 20 Mar, 2025 Read the published version in Supportive Care in Cancer → Version 1 posted Editorial decision: Revision requested 30 Oct, 2024 Reviews received at journal 19 Sep, 2024 Reviewers agreed at journal 08 Sep, 2024 Reviewers agreed at journal 05 Sep, 2024 Reviewers invited by journal 03 Sep, 2024 Editor assigned by journal 03 Sep, 2024 Submission checks completed at journal 21 Jul, 2024 First submitted to journal 18 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4761324","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":329845086,"identity":"dc1dc787-7987-49a2-99b0-6649657e18a9","order_by":0,"name":"Nikolaos Vrontaras","email":"","orcid":"","institution":"Centre for Research and Technology Hellas","correspondingAuthor":false,"prefix":"","firstName":"Nikolaos","middleName":"","lastName":"Vrontaras","suffix":""},{"id":329845087,"identity":"56a3f29a-96ab-47a0-94f3-b17e77d7fc69","order_by":1,"name":"George Koulierakis","email":"","orcid":"","institution":"University of West Attica","correspondingAuthor":false,"prefix":"","firstName":"George","middleName":"","lastName":"Koulierakis","suffix":""},{"id":329845088,"identity":"b441cbb1-75dd-4615-bc04-dbfa4e21a298","order_by":2,"name":"Dimitrios Kyrou","email":"","orcid":"","institution":"Centre for Research and Technology Hellas","correspondingAuthor":false,"prefix":"","firstName":"Dimitrios","middleName":"","lastName":"Kyrou","suffix":""},{"id":329845089,"identity":"48acef32-6a4d-4a22-9545-0eec5074c903","order_by":3,"name":"Anargyros Kapetanakis","email":"","orcid":"","institution":"Centre for Research and Technology Hellas","correspondingAuthor":false,"prefix":"","firstName":"Anargyros","middleName":"","lastName":"Kapetanakis","suffix":""},{"id":329845092,"identity":"4792d148-ba0a-4565-8bb2-abbfe3c1e533","order_by":4,"name":"Aliki Xochelli","email":"","orcid":"","institution":"Ippokrateio General Hospital of Thessaloniki","correspondingAuthor":false,"prefix":"","firstName":"Aliki","middleName":"","lastName":"Xochelli","suffix":""},{"id":329845094,"identity":"094d9e96-20bf-458e-a1d2-7069b86c70a2","order_by":5,"name":"Paolo Ghia","email":"","orcid":"","institution":"IRCCS Ospedale San Raffaele","correspondingAuthor":false,"prefix":"","firstName":"Paolo","middleName":"","lastName":"Ghia","suffix":""},{"id":329845095,"identity":"e0462c5c-f2fb-4c23-9c68-24a2b65e838c","order_by":6,"name":"Kostas Stamatopoulos","email":"","orcid":"","institution":"Centre for Research and Technology Hellas","correspondingAuthor":false,"prefix":"","firstName":"Kostas","middleName":"","lastName":"Stamatopoulos","suffix":""},{"id":329845098,"identity":"d162897e-77cd-490b-85b2-b0b2304f9eb0","order_by":7,"name":"Christina Karamanidou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYDACHijNxpDAwPABxJIgRQvjDJAA0VoYgFqYeYjRwt9z+NmHnzl2eXzsycekbWps8u2lG5hfV+DRInG2zXhm77bkYjaeZ2nSOcfSLHtkDrBZnsGjxYCfwZiBdxtzYptEjpl0bsNhAx6JBDbDBrxa2D8z/t1WD9Fi2fCfCC28PcbMvNsOQ7QwNhwAaWF+iE+LxJkzxcyy244ntvE8S7bsOZZswHMjsY0Rnxb+nvTNjG+3VSfOb08+eONHjZ0B+4zkwx/xacEGGNsIxiYGYP5AspZRMApGwSgYzgAAlLtF8gYIBwgAAAAASUVORK5CYII=","orcid":"","institution":"Centre for Research and Technology Hellas","correspondingAuthor":true,"prefix":"","firstName":"Christina","middleName":"","lastName":"Karamanidou","suffix":""}],"badges":[],"createdAt":"2024-07-18 09:11:59","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4761324/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4761324/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00520-025-09320-0","type":"published","date":"2025-03-20T15:57:46+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":62733800,"identity":"d2056e34-291e-46de-ac6a-29279c397beb","added_by":"auto","created_at":"2024-08-19 00:00:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":69736,"visible":true,"origin":"","legend":"\u003cp\u003eThemes and Subthemes\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote. Red lines highlight challenges, while green lines depict facilitating factors\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4761324/v1/299b62ac529675907537daff.png"},{"id":79121023,"identity":"61644adc-b066-4f3b-b762-2ddb73678959","added_by":"auto","created_at":"2025-03-24 16:11:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":781092,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4761324/v1/3193de76-fdf4-469b-921d-c25a3e67a65f.pdf"},{"id":62733799,"identity":"09fd439c-0414-4084-aa08-baab7756ac20","added_by":"auto","created_at":"2024-08-19 00:00:58","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15108,"visible":true,"origin":"","legend":"","description":"","filename":"APPENDIXA.docx","url":"https://assets-eu.researchsquare.com/files/rs-4761324/v1/602af0bf492793f621097efd.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"More than “hematology”: A qualitative study on the experience of hematologists treating people with blood cancer in Greece","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHematological malignancies are a heterogeneous group of cancer currently on the rise in the Western world [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Globally, the overall age-standardized incidence rate of hematological malignancies increased from 1990 to 2017, while the age-standardized disability-adjusted life-years and death rates for the same group decreased during the same period [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This implies that the quality of care is getting better for people with hematological malignancies, although, they still face many challenges [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eManaging the challenges of providing care for people with life-threatening hematological diseases renders the hematologist\u0026rsquo;s role quite complex. It involves assessing patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], selecting treatment options [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and ensuring high medication adherence [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Hematologists are also required to maintain patients\u0026rsquo; and sometimes the caregivers\u0026rsquo; quality of life [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and manage and facilitate palliative care [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo meet the demands of their role, hematologists are expected to have various skills, such as mastery over patient communication, emotional support, information, and decision-making preferences [\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. They have to collaborate with patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] as well as with other specialists within the health care team [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Hematologists, similarly to any other health care providers, are also required to perceive their role clearly [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and own a great sense of clinical adequacy [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], but at the same time also be self-aware [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Furthermore, they need to be addressing the intricate ethical issues that might arise, in a variety of circumstances [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe treatment of people with hematological malignancies within a health care setting and the multi-level complexity of their role leave hematologists dealing with many of the aforementioned challenges. This often results in increased stress, burnout, and exhaustion [\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and impacts their well-being [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the high demands put on hematologists and the challenges they face, there is a scarcity of in-depth studies investigating their experiences from treating people with hematological malignancies. Those that do exist focus on specific populations, like hematologists treating pediatric patients [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], specific stages of care, like palliative care [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], or specific aspects of care, such as communication between hematologists and patients [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These studies, however, do not explore the overall impact of working with patients with hematological malignancies. This is in contrast to the number of equivalent studies available relating to general oncology like that of Hlubocky and colleagues [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], which are constantly updated.\u003c/p\u003e \u003cp\u003eThe present study aims to investigate the impact of working as a hematologist with patients requiring care pertaining to that of oncological patients, i.e., patients with hematological malignances. This study was conducted by the European Research Initiative on CLL (ERIC) within the context of its CLL patient empowerment program [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eA qualitative approach was adopted to allow the in-depth exploration of the individual experiences and perceptions of participants [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Qualitative data were gathered through semi-structured interviews with hematologists treating people with hematological malignancies in Greece, which took place over the course of six months at 2020. The Consolidated Criteria for Reporting Qualitative Research (COREQ) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] were used (see Supplement A).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003e Thirty (n\u0026thinsp;=\u0026thinsp;30) hematologists (18 females) working in hematology departments of hospitals and/or private practice across Athens, Thessaloniki, Heraklion, Larisa, Serres, Alexandroupoli, Mytilini participated in the study. Participants\u0026rsquo; clinical experience ranged from 2 to 32 years (m\u0026thinsp;=\u0026thinsp;14.5); four were in hematology residency training and one had retired the year before. Purposive sampling was applied [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], to identify hematologists who were specialized or involved in the treatment of people with hematological malignancies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eThe interview guide was developed after an extensive literature review and used for all the interviews (see Appendix A). A list of possible questions to assess the impact on hematologists was identified and compiled (e.g., \u0026ldquo;\u003cem\u003eCould you describe your overall experience as a hematologist?\u003c/em\u003e\u0026rdquo;).\u003c/p\u003e \u003cp\u003eTaking into account recent controversies on data saturation in reflexive thematic analysis\u003csup\u003e(33)\u003c/sup\u003e, data collection was considered complete when the analysis of the interview data yielded a conceptual structure which was considered adequate in depth, complexity, and richness for addressing the research goals and questions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eProcedure\u003c/h2\u003e \u003cp\u003eThe interviews were conducted by one of the researchers (CK, Health Psychologist, Ph.D., female), in a place and time chosen by the participants. The majority of the interviews took place at the Institute of Applied Biosciences, in Thessaloniki, while in the cases of participants\u0026rsquo; remote places of residence, interviews were conducted over the phone (n\u0026thinsp;=\u0026thinsp;4). Face-to-face interviews took place in a private room, but privacy was ensured for all interviews. They were all audio-recorded. Interview duration ranged from 20 to 60 minutes, with an average of 33 minutes. None of the participants refused to participate or withdrew after they had given consent.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eReflexivity\u003c/h2\u003e \u003cp\u003eThe interviewer had already read about hematological malignancies before the interviews took place, and had also interviewed patients with hematological malignancies, so she was quite familiar with the issues that patients face. However, she had not any preunderstanding regarding the perceptions and experiences of healthcare professionals treating them.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003eUpon recruitment, participants were informed about the study details (e.g., purpose, the hosting organization, procedural issues). Their rights (e.g., anonymity, confidentiality, getting informed about the findings, withdrawing from the study) were particularly stressed. All participants gave their informed consent for participation and the interview\u0026rsquo;s audio recording. The interviewer had no prior relationship with the participants. Ethical approval for this study was obtained by the Research Ethics Committee of the Institute of Applied Biosciences at CERTH (Ref. ETH.COM-20) and each participating hospital.\u003c/p\u003e \u003cp\u003eThe interview audio recordings were stored according to the EU General Data Protection Regulation [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Any information that could identify the participants was anonymized at the time of transcription (e.g., participants were assigned different names). To support the participants through any arising distress, an informal debriefing and information on supportive services were offered when requested.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis\u003c/h2\u003e \u003cp\u003eThe research material was analyzed using reflexive thematic analysis [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] under a critical realist approach [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNo formal transcription method was used, as it is not necessary for thematic analysis [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The transcription was undertaken by CK and the analysis by NV (Health Psychologist, M.Sc., male). The analysis was performed according to the approach and guidelines of Braun \u0026amp; Clark [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. After the interviews were thoroughly read, inductive coding was performed to develop initial concepts from the data. Next, the developed codes were grouped into higher-level groups, i.e., subthemes, that encapsulated repeated patterns across the data. Then, subthemes were clustered in overarching groups that formed the \u0026ldquo;themes\u0026rdquo;, which reflected the basic organizing concepts of the data. The external heterogeneity and internal homogeneity of the developed subthemes and themes were reviewed in a multidisciplinary research team.\u003c/p\u003e \u003cp\u003eThen, the most indicative transcribed interview quotes for each theme and subtheme were selected to facilitate the presentation of themes and subthemes. The selected quotes were translated from Greek to English by NV and were checked for comprehensibility by CK. Discrepancies in coding, and in the translation of quotes, were resolved by discussion until consensus was reached.\u003c/p\u003e \u003cp\u003eAll data during the coding process were managed with Microsoft Word.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eExploring the impact of treating people with hematological malignancies on hematologists resulted in three key themes and eight subthemes, which are outlined in detail below, alongside indicative quotes. Themes represent the major personal impact, the organizational framework hematologists work in, and how they are relating to their patients (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003ePersonal Impact\u003c/h2\u003e \u003cp\u003eHematologists described the impact on their everyday life and on their emotions, sometimes due to coming in contact with death, and how this experience changed over time.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eImpinging on personal life\u003c/h2\u003e \u003cp\u003eAll participants described their personal life being affected by their profession. This was demonstrated by routinely returning home and continuing to work. A few described poor \u0026ldquo;\u003cem\u003ework-life balance\u003c/em\u003e\u0026rdquo; as an inability to \u0026ldquo;\u003cem\u003eturn your mind off\u003c/em\u003e\u0026rdquo; and because of their work\u0026rsquo;s intense nature, it was \u003cem\u003e\u0026ldquo;hard to leave it behind\u0026rdquo;\u003c/em\u003e. A few reported that their sleep quality was impacted (e.g., nightmares). Many mentioned strained or more distant relationships with family or friends, as they did not have the energy, time, or willingness to engage in \u003cem\u003e\u0026ldquo;trivial conversations\u0026rdquo;\u003c/em\u003e.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI wake up in fear. ... The cases are adding up, many of them aren\u0026rsquo;t doing well, do you know what I mean? \u0026hellip; The complications are adding up, the deaths are adding up. Frequently I am tormented by [thoughts of] patients on the weekends, 'did I do this well?', 'let nothing happen to them.\u0026rsquo; \u0026mdash;Female, 7 years or experience\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLeaving an emotional mark\u003c/h2\u003e \u003cp\u003eHematologists were impacted on an emotional level by their job, resulting in a variety of negative and long-lasting effects. Some reported having developed a more fragile and sensitive mental state, making them consider accessing psychological support. Managing patients\u0026rsquo; anxiety and fears was difficult for many, as it could gravely affect their own emotions.\u003c/p\u003e \u003cp\u003e \u003cem\u003eYou are left feeling like you are suffocating, that you can\u0026rsquo;t manage\u0026hellip; I have been drained out\u0026hellip; \u0026mdash; Female, 10 years of experience\u003c/em\u003e \u003c/p\u003e \u003cp\u003eMany participants also had existential questions about finding meaning in their work and the everyday lives of their friends and family.\u003c/p\u003e \u003cp\u003e \u003cem\u003eBecause you see so many people suffer, I feel you grow indifferent to your own difficulties. \u0026hellip; you end up more \u0026ldquo;damaged\u0026rdquo; as a person\u0026hellip; \u0026hellip; there is no turning back to the way things were. \u0026mdash; Male, 4 years of experience\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSome struggled with thoughts around \u0026lsquo;\u003cem\u003ewhat if it had happened to me or my family\u003c/em\u003e\u0026rsquo; and how they would cope with it. Others thought their work was futile, suggesting that since they could not preserve patients\u0026rsquo; life, there was no other way for them to help.\u003c/p\u003e \u003cp\u003eMany hematologists singled out a few very challenging situations in the profession that took a great emotional toll on them. One was the delivery of bad news (e.g., reporting toxicity levels, the effectiveness of the treatment, relapses, a terminal diagnosis, the unavailability of other treatments). Treating younger people was extremely stressful for many, since \u0026ldquo;\u003cem\u003ethey have their whole life ahead of them\u003c/em\u003e\u0026rdquo;.\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe emotional load is great. \u0026hellip; Especially, if you are dealing with younger people, and you also have their family to deal with. It's not easy. \u0026hellip; Relapse is where things get really difficult. \u0026mdash;Female, 31 years of experience\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOne participant showed the universal nature of this by saying, \u0026ldquo;\u003cem\u003eeveryone has shed tears over losing young people to a malignant disease\u003c/em\u003e\u0026rdquo;.\u003c/p\u003e \u003cp\u003eLastly, the withholding of information was creating internal conflicts in hematologists, making them feel uncertain or dishonest on the one hand (\u0026ldquo;\u003cem\u003elike you are lying to them, \u0026hellip; to give them hope\u003c/em\u003e\u0026rdquo;), but leaving room for patients\u0026rsquo; hopes on the other. Participants reported struggling in front of such ethical dilemmas, which could also have legal repercussions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eDealing with death\u003c/h2\u003e \u003cp\u003eHematologists shared their experience around people\u0026rsquo;s passing and how they coped with it. Many found it particularly difficult and tried to avoid being physically present at a patient\u0026rsquo;s death, especially when they had developed a relationship with them. Over the years, a new death would bring back memories of previous accumulated losses, leading to emotional exhaustion.\u003c/p\u003e \u003cp\u003eInstances they knew someone would soon pass (e.g., terminal diagnosis) were also challenging. Some struggled to understand the reasoning for offering an intense treatment that would reduce a patient\u0026rsquo;s quality of life without significantly prolonging it.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;For approximately the first nine months, I used to say that I am virtually only seeing people die. It even became my motto \u0026lsquo;everybody dies\u0026rsquo;. Then I asked myself, \u0026ldquo;what is it that we are even doing here?\u0026rdquo; If someone is meant to die, should I offer them three more months to live? \u0026hellip; as one of the great philosophers put it \u0026lsquo;life is a series of small deaths\u0026rsquo;.\u0026rdquo; \u0026mdash;Female, Residency\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIn such cases, they would also emotionally distance themselves from patients to protect themselves from the expected passing.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eGetting better with time\u003c/h2\u003e \u003cp\u003eMany participants talked about things getting better over time, either because they were changing, growing, and healing. This belief seemed to be widely adopted and frequently discussed among hematologists. Participants would realize and accept their boundaries while growing more confident and not questioning their decisions as much. Indicating the development of resilience, a few hematologists said that they are no longer bothered by minor, trivial things.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Listen, you start off young and since in an end-stage disease losing young patients or especially likeable older ones gets to you. It is only with time that you develop a philosophy of life and you understand what death is and how it should be dealt with and how it could\u0026hellip; \u0026hellip; You find a balance there. \u0026mdash; Male, 18 years of experience\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eOrganizational Framework\u003c/h2\u003e \u003cp\u003eThe healthcare system was frequently perceived as a barrier to their practice and would cause challenges, yet, working with others in a team was very supportive.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eBeing part of a whole\u003c/h2\u003e \u003cp\u003eHematologists praised the benefits of working with other professionals, considering it supportive and helpful. Not only would they rely on the team in decision-making, but also, they would informally engage in peer-support.\u003c/p\u003e \u003cp\u003e \u003cem\u003eThere are usually two or three [treatment] options, each with its pros and cons. While in a clinic, the team will help you a lot with this. \u0026hellip; We were a great team, we had the benefit of greatly appreciating and trusting each other, not being competitive with one another. \u0026hellip; I remember this team with much affection. \u0026hellip; I miss them even after all these years. \u0026mdash;Female, 32 years of experience\u003c/em\u003e \u003c/p\u003e \u003cp\u003e Nearly every participant talked about residency during which the team protected them against professional challenges (e.g., sharing responsibility for decisions).\u003c/p\u003e \u003cp\u003e \u003cem\u003eSince as a resident you always have the backup of a specialist, you don't have the responsibility. \u0026hellip; Now that I am a specialist, I clearly handle situations differently. \u0026ndash;Female, 3 years of experience\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHematologists recognized that working within large organizations offers resources and options, mostly related to their scientific development, sometimes in the form of managerial and administrative support, which allowed them to dedicate more time to patients (e.g., longer appointment slots) or research activities. Moreover, when hematologists reported major impact from their work, senior management facilitated the situation by rotating them into a different department (e.g., laboratory work).\u003c/p\u003e \u003cp\u003e \u003cem\u003eInitially, I struggled ... I then changed departments \u0026hellip; I calmed down; my family and my colleagues here helped me through it\u0026mdash; Female, Residency\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eOvercoming structural restraints\u003c/h2\u003e \u003cp\u003eHematologists also faced many structural limitations.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It\u0026rsquo;s a given that Greek reality is making everything difficult for me. I feel it is basically an opponent, sitting on the opposite side and placing obstacles your way, either through the technical infrastructure or through the practice of one\u0026rsquo;s specialty\u0026hellip;\u0026rdquo; \u0026mdash;Male, 8 years of experience\u003c/em\u003e \u003c/p\u003e \u003cp\u003ePoor working conditions and lack of formal training in psychosocial skills (e.g., communicating with patients) were mentioned. In addition, a few also said that they had to learn through trial and error and through observing senior hematologists.\u003c/p\u003e \u003cp\u003eAdditionally, participants highlighted the scarcity of psychological services in Greek hospitals. As a consequence, they alone shouldered the psychological support of their patients. Even when such services were available, sometimes patients refused a referral preferring to be supported by their hematologists, which indicates a closer relationship with them.\u003c/p\u003e \u003cp\u003e \u003cem\u003eIt goes without saying that they would want to talk to you\u0026hellip; not to the specialist [psychiatrist] as they are uncomfortable, they wouldn\u0026rsquo;t want to take up their time\u0026hellip; So, you are the one listening to everything\u0026rdquo; \u0026mdash;Female, Residency\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eRelating to Patients\u003c/h2\u003e \u003cp\u003eHematologists tried to not get too close to patients as this could possibly have an emotional impact on them. Nonetheless, they enjoyed the connection they had with their patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eDrawing the line\u003c/h2\u003e \u003cp\u003e To manage the physician-patient relationship, participants were setting boundaries for themselves and their patients.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I want to maintain the face and standing of the physician, meaning that professionally I would not get too emotionally involved, maintain a middle ground and my professionalism. Demonstrate that I care without reaching their depth of sorrow because if I do, I will take this sorrow with me back home.\u0026rdquo; \u0026mdash; Female, Residency\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHematologists talked about not sharing their own emotions with their patients, or interacting with them outside the hospital and avoided sharing their personal mobile number, preferring to communicate with one representative of the family. In some remote or isolated areas, this could become an issue, as they might meet in the community and the residence of the physician would be known to their patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eBalancing the emotional bond\u003c/h2\u003e \u003cp\u003eA few hematologists mentioned that getting close to patients could lead to a painful experience, in case there was a negative unexpected outcome.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think in this line of work, we all have lost a favorite case. Four years is a long time for you to say \u0026lsquo;it never happened to me\u0026rsquo; or that \u0026lsquo;I may have lost people but it hasn\u0026rsquo;t affected me much\u0026rsquo;.\u0026rdquo; \u0026mdash; Female, Residency\u003c/em\u003e \u003c/p\u003e \u003cp\u003eNevertheless, they also mentioned the rewards of building close relationships with patients, saying \u0026ldquo;\u003cem\u003egenerally it is a very rewarding profession, you get back as much as you give, more than that usually\u0026rdquo;.\u003c/em\u003e Many enjoyed positive outcomes which brought expressions of gratitude from patients (e.g., wedding invitation, showing pictures of a new baby).\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I mean I take back plenty from these people, little things you notice as you receive their love and I consider this as a positive overview. This is what at the end of the day justifies all you do.\u0026rdquo; \u0026mdash;Female, 19 years of experience\u003c/em\u003e \u003c/p\u003e \u003cp\u003e A few explained that they felt connected on a personal level with young people, especially when they themselves were parents. Notably, few participants emphatically spoke about putting in the effort to develop strong relationships even with people who were initially challenging to approach as worthwhile. Overall, the participants spoke warmly about enjoying practicing hematology very much.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I mean I take back plenty from these people, little things you notice as you receive their love and I consider this as a positive overview. This is what at the end of the day justifies all you do.\u0026rdquo; \u0026mdash;Female, 19 years of experience\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis qualitative study explored the impact of treating people with hematological malignancies on hematologists, in Greece. To the best of our knowledge, this is the first study to offer insights into the perceptions, challenges, and coping strategies that hematologists adopt to deal with the impact of their work.\u003c/p\u003e \u003cp\u003eFindings indicated that treating people with hematological malignancies has a significant impact on hematologists at a personal level. Participants experienced strong emotions due to their daily exposure to loss, death, and their patients\u0026rsquo; physical and psychological pain. When not managed successfully, these strong emotions can lead to burnout [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Working with people who experience traumatic events is making hematologists susceptible to secondary traumatization which is accompanied by hyperarousal, sleep difficulties, intrusive thoughts, loss of purpose, and detachment from significant others [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIdentifying and addressing burnout and secondary traumatization in healthcare professionals is important and can be very impactful. These are both associated with lower well-being, lower job satisfaction, increased turnover, increased physical and emotional disturbances [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], suboptimal patient care, and lower patient satisfaction [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Hematologists are experiencing healthcare caregiver burden which in turn, puts a strain on the health care system in general.\u003c/p\u003e \u003cp\u003eConcerning how hematologists relate to their patients, many of their responses indicate compassion fatigue [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] characterized by reduced compassion towards others. Interventions targeting compassion fatigue like that described by Figley [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] should be offered to hematologists to increase their job satisfaction and further improve their relationship with patients. Nevertheless, hematologists also described their relationship with their patients as supportive; they enjoyed their work and found it meaningful, which relates to compassion satisfaction [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Notably, participants reported that the balance between compassion fatigue and compassion satisfaction shifted at different times in their careers.\u003c/p\u003e \u003cp\u003eThe organizational setting in Greek hospitals was perceived as having both strengths and weaknesses. Greece has the highest ratio of physicians among EU countries (625 vs 350 per 100 000 population), and the lowest ratio of practicing nurses (344 vs 864 per 100 000 population) [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], yet Greek public hospitals and certain services are often heavily understaffed [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. This partly explains hematologists\u0026rsquo; impact. At the same time, the effectiveness of the Greek health care system lags considerably behind other EU countries in addressing treatable cancer types (e.g. breast, cervical, prostate) [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. An organization overhaul of oncological care providers seems to be urgent [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. This is supported by the hematologists\u0026rsquo; reports; action should be taken to improve the work conditions and the healthcare system in Greece.\u003c/p\u003e \u003cp\u003eHematologists are sometimes left without formal training or adequate support while having to draw only from their own experiences, intuition, and mentors [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. As the healthcare system\u0026rsquo;s performance is reciprocally linked with medical education, specific reforms to healthcare personnel\u0026rsquo;s education have been suggested [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. These include an emphasis on primary health care education and the provision of continuous medical education by a structured framework. The above should help prepare and upskill hematologists in managing the challenges of their everyday work.\u003c/p\u003e \u003cp\u003eInterest in compassionate care has risen [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]; it could be inculcated through health education by considering the interrelation between individual motivation and social structure [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. In Greece, the inclusion of compassion in healthcare provision from healthcare professionals seems to be more than a necessity [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Towards this direction, an elective course on compassion in clinical care has been introduced in the curriculum of the Medical School of the University of Crete [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Such initiatives pivot the way for hematologists to form compassionate relationships with their patients, increase their confidence and potentially increase their job satisfaction.\u003c/p\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eClinical Implications\u003c/h2\u003e \u003cp\u003eTo manage the aforementioned challenges in clinical practice, specific educational initiatives [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], models [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], and occupational strategies like rotation [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e] have been developed and implemented with varying degrees of success. Materials and training developed for oncologists could be studied for their appropriateness, adapted, and offered to hematologists treating patients with hematological malignancies by experts in psychology and healthcare communication. Support, including administrative assistance, psychosocial skills training, and access to specialized psychological services, should also be offered to manage the clinical and the emotional load mediate the impact, and reduce staff turnover.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe present study drew from hematologists\u0026rsquo; experiences across their professional development (residency to retirement). In conclusion, it appears that working with patients with hematological malignancies in the Greek health system posed many challenges to hematologists and put them at risk for burnout or compassion fatigue. Hematologists managed to cope through the utilization of personal resources and collaborative efforts. They usually had to go beyond their formal role to provide their patients the proper care. Assistance ought to be provided on a personal and professional level to enhance their well-being, prevent turnover and support them to continue providing high-quality care to their patients.\u003c/p\u003e "},{"header":"Strengths, Limitations and Future Research","content":"\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003cp\u003eThe experiences of hematologists treating adults with hematological malignancies constitute an understudied area as most research focuses on the impact of oncology practice [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and pediatric hematology [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Consequently, although many initiatives exist, they focus on different specialties rather than focusing on the challenges faced by hematologists in malignant hematology.\u003c/p\u003e \u003cp\u003eRegarding the study\u0026rsquo;s limitations, as all participants were working in Greece, the findings of the present study are context-specific in several aspects. In addition, another limitation was the heterogeneity of the study\u0026rsquo;s sample as manifested in the wide range of their years of experience.\u003c/p\u003e \u003cp\u003eFuture studies could focus on the exploration of the experiences of more specific groups of hematologists, like those of residents, and investigate specific unmet training needs. Even though initial findings on coping strategies were presented, coping could be investigated further. Overall, future research should focus on further examining the areas highlighted (e.g., personal impact, organizational framework, and relating to patients) and explore, hematologists\u0026rsquo; work satisfaction, coping with stress, and burnout levels.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was conducted on behalf of ERIC, the European Research Initiative on CLL, and supported in part by unrestricted grant support by Janssen Europe, the Middle East and Africa, Janssen-Cilag Hellas Société Anonyme, and Gilead Sciences Hellas. The funders had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation and data collection was performed by Christina Karamanidou. The analysis was performed by Nikolaos Vrontaras. The first draft of the manuscript was written by Nikolas Vrontaras, George Koulierakis and Dimitrios Kyrou. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Ethical approval for this study was obtained by the Research Ethics Committee of the Institute of Applied Biosciences at CERTH (Ref. ETH.COM-20) and each participating hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank all the people who gave their time and contributed to this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003estatement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to the fact that the interview transcripts are in participants’ native language, i.e., Greek, and therefore not suitable for deposit in a public repository. They can be available to anyone interested upon request to the authors of the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLoda M, Mucci LA, Mittelstadt ML, et al (eds) (2017) Pathology and Epidemiology of Cancer. Springer International Publishing, Cham\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeykhaei M, Masinaei M, Mohammadi E, et al (2021) A global, regional, and national survey on burden and Quality of Care Index (QCI) of hematologic malignancies; global burden of disease systematic analysis 1990\u0026ndash;2017. 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J Holist Healthc 8:38\u0026ndash;41\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichardson DR, Tan X, Winzelberg G, et al (2020) Development of an Art of Oncology Curriculum to Mitigate Burnout and Foster Solidarity Among Hematology/Oncology Fellows. JCO Oncol Pract 16:e384\u0026ndash;e394. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1200/JOP.19.00529\u003c/span\u003e\u003cspan address=\"10.1200/JOP.19.00529\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSinclair S, Bouchal SR, Schulte F, et al (2021) Compassion in pediatric oncology: A patient, parent and healthcare provider empirical model. 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J Oncol Pract 11:289\u0026ndash;295. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1200/JOP.2015.003798\u003c/span\u003e\u003cspan address=\"10.1200/JOP.2015.003798\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"hematological neoplasm, neoplasm, delivery of health care, qualitative research","lastPublishedDoi":"10.21203/rs.3.rs-4761324/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4761324/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: The present study aims to investigate the experiences of hematologists providing care to patients with hematological malignancies, whose care is pertinent to oncology.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Semi-structured interviews with 30 hematologists across Greece were conducted. The interviews took place over the course of six months at 2020. Reflexive thematic analysis was employed for data analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Three key themes (personal impact, organizational framework, and relating to patients) and eight subthemes were generated: 1. Hematologists were greatly affected on a personal level, as they had poor life-work balance and impacted social relationships. They experienced a great emotional toll, sometimes questioning the meaning of their work. They frequently struggled with loss, by witnessing people’s passing. Nevertheless, they reported coping better over time. 2. On an organizational level, hematologists supported each other emotionally, but only rarely had formal support in managerial or administrative recourses. They were also hindered by structural restraints, both in terms of limited psychosocial training and supportive services. 3. Hematologists’ relationship with their patients increased their job satisfaction. However, they strived to keep boundaries while balancing how close they got to their patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: High job demands and organizational aspects pose hematologists with the risk of developing compassion fatigue or burnout. Working under difficult conditions, they needed to go above and beyond to provide appropriate care to their patients. At the same time, individual resources, teamwork, or other structural opportunities emerged as crucial coping elements. Support should be offered both personally and professionally to improve their lives and prevent potential turnover.\u003c/p\u003e","manuscriptTitle":"More than “hematology”: A qualitative study on the experience of hematologists treating people with blood cancer in Greece","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-19 00:00:52","doi":"10.21203/rs.3.rs-4761324/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-31T00:07:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-19T17:45:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158768410957668758104471541748631207984","date":"2024-09-08T19:44:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4520646262610385801352170045526480527","date":"2024-09-05T15:37:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-03T14:44:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-03T14:39:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-21T23:21:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2024-07-18T09:10:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"c5dac40e-76d9-40ec-aff0-15281a6d59c5","owner":[],"postedDate":"August 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-24T16:08:40+00:00","versionOfRecord":{"articleIdentity":"rs-4761324","link":"https://doi.org/10.1007/s00520-025-09320-0","journal":{"identity":"supportive-care-in-cancer","isVorOnly":false,"title":"Supportive Care in Cancer"},"publishedOn":"2025-03-20 15:57:46","publishedOnDateReadable":"March 20th, 2025"},"versionCreatedAt":"2024-08-19 00:00:52","video":"","vorDoi":"10.1007/s00520-025-09320-0","vorDoiUrl":"https://doi.org/10.1007/s00520-025-09320-0","workflowStages":[]},"version":"v1","identity":"rs-4761324","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4761324","identity":"rs-4761324","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}