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RESEARCH ARTICLE

Understanding the User's Point of View: When the Doctor Gets Sick with
Cancer and Seeks Help
Elena Massa1,*, Eleonora Lai1, Clelia Donisi1, Mario Scartozzi1, Laura Orgiano1, Olga Mulas2, Andrea Pretta1, Giovanni
Caocci2 and Mauro Giovanni Carta1
1
Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
2
Ematology Hematology and e CTMOHSCT Center, Businco Hospital, ARNAS “G. Brotzu”, Cagliari, Italy

Abstract:
Background:
When physicians confront a serious personal illness, they may discover that the transition to the “sick” role is challenging and not easy. We
conducted a qualitative study in which a group of doctors with cancer (DP) was compared with a group of patients with cancer, not doctors (NDP)
but with a degree of education, qualifications, and a professional role comparable to that of a doctor.

Objectives:
The main objective was to evaluate the effect of the diagnosis and the treatment of cancer on both the patient’s personal and professional life. It
was also designed to understand the effect that the experience of cancer may have on the subsequent clinical practice of DP.

Methods:
The eligibility criteria included diagnosis of tumors of different sites and at any stage of disease treated with local (surgery, radiotherapy) or
systemic (chemotherapy, hormonal, target) therapies or a combination of both; patients actively working. A semi-structured interview was used to
collect information about the patient’s cancer experiences. In both groups, six main themes and ten subthemes were identified.

Results:
From July to November 2021, 59 patients were enrolled in the study. Among them, 29 were DP and 30 were NDP. The median age and gender
were 55.9 years ± 9.3 SD (range 38-82 y), M/F ratio 12/17 for DP, and 56.3 years ± 8.9 SD (range 40-83 y), M/F ratio 11/19 for NDP, respectively.
The main themes were: theme 1, practical aspects related to diagnosis: most of the DP did not encounter difficulties in performing the tests
necessary to confirm the diagnosis of cancer, unlike what was observed in NDP. Theme 2, cancer diagnosis experience: Many DP and NDP felt
prepared for their own cancer experience. Two-thirds of DP already knew their cancer prognosis from their previous background knowledge and
one-third of NDP did not want to discuss the prognosis in depth with their referring oncologists for the fear of learning that their cancer had a poor
prognosis. Theme 3, treatment experience: for many DP, having a professional background contributed to more active participation in care and also
in the management of side effects of treatments. Most NDP were satisfied with the treatment received in the hospital and the relationship with the
health professionals. Theme 4, changes in work: None of the patients from both the groups stopped working permanently or lost their job because
of the disease. A higher number of DP and NDP reported a loss of interest in their job. Theme 5, changes in personal/family life and friendships:
more than half of the patients in both groups developed a new perspective on their private lives. Theme 6, comfort from faith: most of the patients
in both groups who followed a faith, found comfort in that faith. For DP only, we explored the theme of the change in the doctor/patient
relationship. Important findings from our study included positive changes in the doctor’s clinical practice including having a more empathic
relationship with patients, greater consideration of the psychological impact of cancer, and greater attention to certain symptoms of cancer reported
by patients.

Conclusion:
This study suggests the need to know the special needs of professional patients, in particular, related to the emotional difficulties, maintenance of
privacy, and the need for support on their return to work. These results can help to foster improvements in current cancer care practices.

Keywords: Cancer, Cancer treatment, Doctors, Cancer/patient relationship, Empathy, Family.

Article History Received: January 31, 2023 Revised: July 21, 2023 Accepted: August 01, 2023

DOI: 10.2174/0117450179241325231011070735, 2023, 19, e17450179241325

2 Clinical Practice & Epidemiology in Mental Health, 2023, Volume 19 Massa et al.

1. INTRODUCTION cancer with at least one of the following therapies: surgery +/-
radiotherapy +/- chemotherapy +/- hormonal therapy +/-
The risk of work-related stress in the medical field,
biological (or target) therapy. Written informed consent was
psychological disorders, and mental health of doctors globally,
obtained from all subjects after a full study description. For
are extensively discussed topics in many published scientific
NDP, other eligibility criteria were: education level (the
articles, while there is little evidence on the barriers that
minimum required qualification was a bachelor's degree), job
doctors face when they get sick with serious illnesses such as
qualification, and roles (chief consultant, CEO, employee). The
cancer. Thus, their experiences are poorly understood [1 - 5].
Exclusion Criteria were: patients who did not give informed
When physicians confront a serious personal illness, they may
consent to the interview; patients who had retired or had
discover that the transition to the “sick” role is challenging and
become unemployed when diagnosed with cancer. After being
not easy. The doctors’ attitude to their own disease is affected
informed of the objectives and procedures of the study, patients
by different factors: during training, doctors fall into the habit
who matched the eligibility criteria signed a written informed
of associating the illness with patients and not themselves;
consent. All procedures were carried out under the 1964
during their activities, the professional status of the physician
Helsinki Declaration and its later amendments. The study was
and the medical knowledge have the potential to complicate
approved on March 31, 2021, by the Ethical Committee of
their ability to cope with difficult or terminal diagnoses [6 -
AOU Cagliari, Sardinia, Italy, and registered with the number
10]. Paradoxically, knowledge about a condition may fuel
PG/2021/5468. A semistructured interview was used to collect
anxiety instead of alleviating the fear associated with the
information about the patient’s cancer experiences. The
unknown. Interestingly, personal illness experiences can lead
interviewer was a female researcher with a clinical background
to novel insights about patienthood, bringing about positive
(medical oncologist) and with experience in cancer and
changes in professional-patient subsequent clinical practice as
healthcare research. The interviews lasted between 35 minutes
a result of newfound empathy [5, 10, 11]. As reported by
on average (range: 20-55 min) and occurred in the Oncology
Kitzman [10], the overlapping experiences of being a
Department, in a dedicated room, respecting everyone’s
healthcare worker and a patient can help create or develop
privacy and in compliance with the security regulations
strategies for improved patient care. We conducted a
imposed by the COVID-19 pandemic. The interviews were not
qualitative study in which a group of doctors with cancer were
recorded, but the interviewer was authorized by the patients to
compared with a group of cancer patients, who were not
write notes about their answers. The semi-structured interview
doctors, but with a comparable degree of education,
was used to lead an individual informal conversation. A
qualifications, and professional role. The objectives of the
prolonged engagement approach was used in order to generate
study were to evaluate how much and in which way the
depth and richness in the participant’s responses. However, the
diagnosis of cancer and the treatment’s path affects personal
patients did not have to give clear-cut answers (e.g.: yes/ no).
and working life, with particular attention to the interest in
The topics of the semistructured interview focused on
work and planning both personal and professional life. Our
psychological and personal life aspects, the working sphere,
study was also designed to understand the effect that the
and the ability to plan. The same aspects were explored for
experience of cancer may have on subsequent clinical practice.
both groups of patients except for the change in the
A qualitative design was chosen to offer an in-depth
doctor/patient relationship topic which specifically referred to
understanding of the experience of an illness while locating it
being a doctor. At the end of the interview, and to close it, the
in its broader social context.
patient was asked if he or she could describe the feelings they
had experienced during the interview and to share any further
2. MATERIALS AND METHODS
stories. The open interview is reproduced below.
2.1. Study Design
3.2. Data Analysis
We conducted a qualitative observational study in which a
group of doctors with cancer (doctor-patients-DP) was Thematic analysis following Braun and Clarke's five‐
stage method was used [11 - 14]. A research team, composed
compared with a group of patients with cancer who were not
of the PI (EM) and two research assistants (EL and CD)
doctors (non-doctor patients - NDP).
transcribed into a written form (reported in a file) with the
3. METHODS information provided by each patient. The first phase of data
analysis was to familiarize with the data by reading the file of
3.1. Instrument each patient repeatedly and assessing factors that shaped the
subjects' experiences. In the second phase, a preliminary
3.1.1. Eligibility Criteria
coding framework was developed by two researchers (EM and
The participants were recruited from the Medical CD) using a subset of transcripts, and the remaining transcripts
Oncology Unit of the University Hospital of Cagliari, Italy. were independently coded by EM. In the third phase, the
The eligibility criteria for both groups were: age ≥ 18 years; themes and codes were checked for consistency. Discrepancies
histologically confirmed diagnosis of tumors of different sites were resolved through discussion until a 100% agreement was
and at any stage of disease; patients actively working at the reached. In the fourth phase, a revision of the themes was
time of diagnosis and during therapy; patients treated for carried out, during this phase some themes collapsed into each
* Address correspondence to this author at the Department of Medical Sciences
other, and others themes were divided into separate ones. In the
and Public Health, University of Cagliari, Cagliari, Italy; last phase, themes were defined and named and the data within
Tel: 0039 3495398501; E-mail: dinetto13112012@gmail.com them were analyzed (Fig. 1).
Understanding the User's Point of View Clinical Practice & Epidemiology in Mental Health, 2023, Volume 19 3

Questions for Doctors Patients (DP) and No-Doctor Patients (NDP)

1. How long did it take to perform the tests necessary to reach a diagnosis? And how long after did
the first treatment start?

2. What was your reaction to the diagnosis?

3. How did you choose the oncologic team?

4. Had you looked into the staging, the prognosis, and the therapies of your cancer? What tools did
you use to investigate these aspects? (Stage, prognosis and cancer therapy)

5. Were you concerned about the loss of your privacy (at work, with family, with friends)

6. Did you involve, inform, and share with your family, friends and colleagues the news of the cancer
diagnosis and the treatment plan? Did you receive support from your family, friends, and colleagues?

7. Did you have to take time off from work after being diagnosed with cancer? temporarily?
definitely?

8. Were you a victim of discrimination as a patient?

9. Had you lost interest in your job? Did you realize that you're not able to do the same job as before?
How did you react? Has your professional role changed? Had you been demoted? Were you forced to do it?

10. Did the consideration of your private life change?

11. Did your work planning change?

12. Do you follow a faith? If so, did your religious beliefs influence the way you dealt with the disease
and the path of diagnosis and treatment?

Questions for Doctor Cancer Patients (DCP) only.

13. Did you become more attentive to any incorrect attitudes of health professionals towards patients?
Did you become more sympathetic with your patients?

Fig. (1). Open interview.

4 Clinical Practice & Epidemiology in Mental Health, 2023, Volume 19 Massa et al.

4. RESULTS AND DISCUSSION job position, faith (religion or personal), stage, site of tumor
and anticancer therapies are mostly overlapping. The only
4.1. Sociodemographic and Clinical Characteristics of difference was related to the educational background; both
Patients groups of patients had university degrees, but all doctors also
From July to November 2021, 59 patients were enrolled in had specialties in addition to the degrees in medicine and
the study. Among them, 29 were doctors and 30 were non- surgery. The medical specialties of the doctors were the
doctors. Mean age and gender were 55.9 years ± 9.3 SD (range following: anesthesia, physical therapist, orthopedics,
38-82 y), M/F ratio 12/17 for DP, and 56.3 years ± 8.9 SD gastroenterology, endocrinology, geriatrics, oncology, general
(range 40-83 y), M/F ratio 11/19 for NDP, respectively. As medicine, radiology, hygiene, otolaryngology, cardiology,
reported in Tables 1 and 2, the socio-demographic and clinical pediatric, internal medicine, surgery, urology, gynecology. The
characteristics of the two patient groups including sex, marital average number of working years was 20.7 and 18.6 for DP
status, number and age of children, educational background, and NDP, respectively.

Table 1. Sociodemographic characteristics of Dps and NDP.

Dps NDP
- -
(Doctor Patients) (No Doctor Patients)
Total - N % N %
- - 29 100 30 100
Age (Years) Mean ±SD (range) 55.9±9.3 (38-82) 56.3 ±8.9(40-83)
Gender Male 12 41.4 11 37
Female 17 58.6 19 63
Marital Status Married 24 82,8 25 83.3
single/divorced/widow 5 17.2 5 16.7
Educational Background Graduate 29 100 30 100
Belief Catholic 20 68,9 17 57
Atheist 5 17.3 5 17
-
Agnostic 4 13.8 8 26
Job/work position Medical Manager / Employee 6 20.7 18 60
Chief consultant / CEO 2 6.9 8 27
Consultant / Private Business 21 72.4 4 13
Actively Working at the Diagnosis yes 29 100 30 100
no 0 - 0 -
Retired (at the moment of the open interview) - 2 6.9 3 10

Table 2. Clinical characteristics of Dps and NDP.

Dps NDP
- -
(Doctor Patients) (No-doctor Patients)
- - N % N %
Total - 29 100 30 100
Breast 10 34.5 9 30
Lung 4 13.8 5 17
Prostate 3 10.4 3 10
Melanoma 2 10.4 4 13
Colon 3 10.4 0 0
Ovarian 2 6.9 2 6
Site of Tumor Thyroid 1 3.4 0 0
Kidney 1 3,4 1 4
Stomach 1 3,4 0 0
Pancreas 1 3,4 0 0
Testicular 0 0 1 4
Uterus 0 0 3 10
Cervical 0 0 1 4
Understanding the User's Point of View Clinical Practice & Epidemiology in Mental Health, 2023, Volume 19 5

(Table 2) contd.....

Dps NDP
- -
(Doctor Patients) (No-doctor Patients)
I 3 10.4 3 10
II 9 31 6 20
Stage
III 10 34.5 9 30
IV 7 24.1 12 40
Chemotherapy + hormonotherapy 13 44.8 11 36
Chemotherapy 3 10.3 7 23
Systemic Therapies Immunotherapy 2 6.9 6 21
Ormonotherapy 1 3.4 5 17
Target Therapy 1 3.4 1 3
Surgery + Radiotherapy 18 62.2 11 37
Surgery 9 31 13 43
Local Therapies Local-regional therapy (TARF) 1 3.4 0 0
Surgery + Local-regional Therapy (TARF) 1 3.4 2 7
Radiotherapy 0 0 4 13

Table 3. Themes and sub-themes.

COD Themes COD Subthemes

1.0 -
- Practical aspects related to diagnosis 1.1 Difficulties in performing diagnostic tests
- 1.2 Choice of the oncologic team
2.0 - -
- 2.1 Emotional/psychological reaction to the cancer diagnosis
Cancer diagnosis experience
- 2.2 Request for information on prognosis
- 2.3 Support from family, friends and colleagues
3.0 - -
- 3.1 Involvement in the therapeutic decision-making process
Treatments experience
- 3.2 Relationship with the hospital and health professionals
- 3.3 Treatment tolerability
4.0 - -
- 4.1 Temporary and permanent interruptions from work
Changes in work
- 4.2 Loss of interest in work
- 4.3 Changes in professional/work planning.
5.0 Changes in personal/family life and friendships. - .
6.0 Comfort from faith
Themes identified only for the group of physicians with cancer
1.0 Change in the doctor/patient relationship

4.2. Overview of Themes and Subthemes patients (1 DP and 3 NDP) postponed diagnostic tests by
In both groups, six main themes and ten subthemes were choice even though clinical symptoms of cancer were present
identified relating to a cancer patient’s experience. The main and the suspicion of cancer was strong. Most DPS who wanted
themes were: 1) practical aspects related to diagnosis, 2) to have diagnostic tests done as quickly as possible admitted
diagnosis experience, 3) treatment experience, 4) changes in that being a doctor shortened the time to book and perform the
work, 5) changes in personal/family life and friendships, 6) tests needed to confirm their cancer diagnosis, while several
comfort in faith. The changes in subsequent clinical practice NDPS who wanted to have tests right away, found it difficult to
and doctor-patient relationships were identified exclusively for book an appointment and be seen within a short period. The
the study group of doctors/patients. only DP who deliberately postponed diagnostic tests reported
The themes and subthemes explored are reported in Table that although it was clear to him that he needed to seek help,
3. the busyness of his schedule and the weight of the workload
acted as a barrier to seeking treatment. For a few of the NDPS,
5. PRACTICAL ASPECTS RELATED TO DIAGNOSIS
the reasons for postponing diagnostic tests were: the belief that
5.1. Difficulties in Performing Diagnostic Tests the suspicion of a neoplastic disease was unfounded or not so
Most patients from both study groups immediately carried strong as to have to perform the tests quickly, the fear of
out the necessary tests to confirm the diagnosis. Only a few having the diagnosis of cancer confirmed, and the need to
6 Clinical Practice & Epidemiology in Mental Health, 2023, Volume 19 Massa et al.

provide care for other sick family members as well as from the referring physician but also sought information
themselves. independently via the Internet or from friends and family.

5.2. Choice of the Oncological Team 6.3. Support from Family, Friends, and Colleagues
A significant difference was observed between the two More than half of the patients in both groups (18/29 Dps
study groups in the number of specialists consulted during the and 19/30 NDP) reported that they weren't worried about their
diagnosis and treatment. Most of the DPS consulted only one, privacy. They shared the diagnosis of cancer with family,
or at most two, specialists for the diagnosis and treatment. friends, and colleagues. A subset of doctors shared the
Many of them decided to be treated at their place of work. diagnosis with their family but only disclosed some
Having connections within the industry led to receiving a information related to the disease, avoiding talking about
subjectively higher quality of care and facilitated the choice of certain topics such as stage, prognosis, survival, or mortality
the oncological team to rely on. The number of physicians rate to protect loved ones from excessive worries about their
consulted by NDP was much higher, with up to three health. As doctors, they knew they were the ones on whom
specialists during the diagnostic phase and the same number in others relied for their well-being and, at times, comfort and
the treatment phase. The main reason for this behavior was the consolation, and they found it very difficult to admit that they
confusion derived from the different suggestions received from had to cross over and become a patient. About a third of NDPS
relatives, friends, and/or colleagues regarding the specialists to and a few doctors with cancer decided not to share their cancer
be consulted. diagnosis with colleagues in the workplace. The fear of
demotion or the loss of authority in one's role was one of the
6. CANCER DIAGNOSIS EXPERIENCE main reasons for this decision. Most patients in both groups
received support from family, friends, and colleagues. Only a
6.1. Emotional/psychological Reaction to the Cancer few patients from both groups, 2 DPS, and 3 NDP, reported
Diagnosis with disappointment that they did not receive the support,
Emotional/psychological reactions to the cancer diagnosis empathy, and understanding expected from some colleagues
were very similar in the two groups, although the reasons with whom they had shared the diagnosis.
behind the specific reactions were very different. Most of the
DP and NDP reacted to the cancer diagnosis with an attitude of 7. TREATMENTS EXPERIENCE
acceptance and determination to face the diagnostic therapeutic
7.1. Involvement in the Therapeutic Decision-making
path as quickly as possible. Many doctors felt prepared for
Process
their own cancer experience, primarily due to knowing the
various steps of the patient's path and understanding their likely For many DPS, having a professional background
prognosis. Professional patients' knowledge enabled them to contributed to more active participation in care. Medical
recognize their diagnosis was not a death sentence. A few knowledge has enabled them to self-manage side effects and
described a complete absence of fear. Many NDP who had adverse events related to treatment both in the hospital and at
already experienced cancer within their family, or through home. Most of the doctors, despite having the possibility and
friends or colleagues, reported that they never thought they knowledge to make choices about their treatment, decided to
were immune to cancer. They had an idea of what they would rely totally on the team of specialists chosen. Some doctors
have to face in the event of being diagnosed with cancer. Some (5/29) with limited knowledge (for example, doctors whose
character aspects, such as optimism and having a positive cancer was outside of their specialty) preferred to be treated as
outlook on life helped these patients to face their diagnosis normal patients and to receive standard information. A very
with determination. A small number of patients from both small number of NDPS found that providers were reluctant to
groups (1DP and 3 NDP) reacted to the cancer diagnosis with a discuss the decision-making process in detail, especially
severe state of anxiety that for some of them resulted in real regarding the use of different therapies other than the one
despair. For one doctor who had cared for terminal patients, proposed or complementary and alternative therapies.
having background knowledge was not helpful; on the
contrary, it led to imagine catastrophic scenarios of metastatic 7.2. Relationship with the Hospital and Health
disease and death. For some NDP, anxiety, and desperation Professionals
were due to the fear of not being able to deal with the treatment Many DPS chose to be treated at their place of work
and its side effects and the fear of suffering and death. considering an advantage, in their knowledge, and
understanding of the said place. They felt it gave them the
6.2. Request for Information on Prognosis
ability to move within the healthcare system that is already
Two-thirds (20/29) of DP and only one-third (10/30) of familiar to them. Familiarity with the context helped in the
NDP did not want to discuss the prognosis in depth with their procurement of information and resources and helped to create
referring oncologists. Many DPS said they already know their an overwhelming environment in the hospital. During the
cancer prognosis thanks to their background knowledge, while diagnostic and therapeutic path, some DPS benefited from
for some NDP the main reason for not asking detailed modification to the usual hospital practice, with some patients
questions about the prognosis was the fear of learning that their receiving treatment in separate rooms or in a less crowded time
cancer had a poor prognosis. Most of the NDP asked for slot than other patients. Most of the NDPs were satisfied with
information about the stage of the disease and its prognosis the treatment they received in the hospital and the relationship
Understanding the User's Point of View Clinical Practice & Epidemiology in Mental Health, 2023, Volume 19 7

with the health professionals (doctors, nurses, technicians). (mainly fatigue), but also because the new position required an
Few NDP (3/30) and only one DP felt discriminated against excessive mental effort, required more time away from their
because of their illness, reporting that they felt discriminated family, friends, hobbies, or because the new professional role
against mainly by health professionals such as nurses or health also required moving to another city. A few NDP had to
assistants rather than by doctors. Rudeness, unkind responses, change some job roles due to cancer, but none of them had
and long waits for therapies are among the behaviors displayed been demoted.
by the healthcare personnel that have mainly contributed to
making patients of both groups feel discriminated against. 9. CHANGES IN PERSONAL / FAMILY LIFE AND
FRIENDSHIPS
7.3. Treatment Tolerability More than half of the patients of both groups developed a
Before starting the treatment, many NDPS were afraid of new perspective on their private lives. Most of the DPS after
the possibility of side effects, but most of them found that the the cancer diagnosis decided to spend more time with their
treatment phase was less overwhelming than expected. Many family (children and especially grandchildren) and friends and
DPS, thanks to their background knowledge, felt prepared to dedicated more time to their hobbies (music, painting, and
face the side effects of the treatments. For many patients theatre). They realized that before being diagnosed with cancer,
(mainly women, but not only) of both groups, hair loss due to they spent most of their time at work and that even when they
chemotherapy was one of the most difficult side effects to were at home they often continued to work. Furthermore, some
accept. Some patients of both groups suffered psychological (3/29) DPS refused to spend money on a new car or a second
discomfort from cancer and its treatment, including anxiety, house, whereas some NDP (3/30) decided not to spend money
depression, and concern for the suffering of others as a result of on trivial things. Due to the neoplasia, three female NDPs
their disease. One of the late and longer-lasting side effects abandoned the idea of having children.
reported by patients in both groups was mild but persistent
cognitive dysfunction, including a lack of mental stamina and 10. COMFORT IN FAITH
problems with concentration and short-term memory. Most of the patients in both groups who followed a faith,
whether it be personal or religious, found comfort in faith and
8. CHANGES IN WORK spirituality at different periods of the disease.

8.1. Temporary and Permanent Interruptions from Work 10.1. Themes Identified only for the Group of Doctors with
All patients of both groups had temporarily stopped their Cancer
work for some months during the diagnostic and treatment
10.1.1. Changes in the Doctor/Patient Relationship
phase. No patient had to permanently stop working or lose their
job because of the disease, but two DPS and one NDP Although most DPs described themselves as empathetic
anticipated their retirement from work by a few years towards their patients before they were diagnosed with cancer,
compared to the expected date. Significant emotional half of them changed their approach to interacting with
difficulties accompanied the return to work for more than a patients, especially cancer patients. Some of the DPs have
third of doctors, especially those who worked with cancer become more careful in detecting cancer symptoms or side
patients. effects of treatments reported by patients. Asthenia, dysgeusia,
sarcophobia, and mild and moderate constipation, were
8.2. Loss of Interest in Work considered to be of minor importance because they did not
endanger the patient's life. After experiencing cancer, they
A higher number of patients in both groups reported a loss
realized that these symptoms, although mild, have a significant
of interest in their jobs. For the DPS, the main reasons for the
impact on the patient’s quality of life. They, therefore, began to
loss of interest in the job were the need to take care of
give importance to these symptoms, adopting early
themselves associated with feelings of disempowerment and
prophylactic and therapeutic measures to identify and counter
loss of professional identity. A handful (5/29) of DPS
them. Moreover, DP sometimes underestimated the symptom
described finding it difficult to separate the identity of a
“pain” reported by patients, both acute pain and chronic pain.
physician from that of a patient. Some of the DPS
Some of them introduced the use of tools suitable for pain
acknowledged that they were no longer confident in carrying
measurement (such as pain measurement scales) in their daily
out their work and were afraid of making mistakes. Very few
clinical practice and started to have less hesitation in
DPS (2/29) felt unmotivated to continue in their work. Despite
prescribing drugs for moderate-severe pain, such as opioids. A
everything, DP, after having stopped working for a few
subset of physicians reported to pay more attention to the
months, did not encounter any difficulties in starting to work
patient’s psychological support, investigating any symptoms of
again. depression/anxiety, and offering advice and support, including
pharmacological ones. A non-oncologist doctor with a long
8.3. Changes in Professional/Work Planning
personal history of cancer (25 years) from about 8 years with
After the diagnosis of cancer, about a quarter of the DP and metastatic disease, described himself as an empathetic doctor
very few NDP changed their previous beliefs regarding their with his patients prone to empathizing with them, even before
professional lives. Some DPS renounced any career becoming a cancer patient himself. With disappointment, he
advancement for various reasons such as physical difficulties described situations in which other doctors showed no
8 Clinical Practice & Epidemiology in Mental Health, 2023, Volume 19 Massa et al.

sensitivity and attention (not towards himself but towards other confident in carrying out their work and were afraid of making
patients). Observing the behavior from the patient’s standpoint mistakes. Regarding the changes in personal/family life,
of another doctor towards patients enabled him to become friendship, and future planning, we observed a change in the
more critical and objective in evaluating the fairness and ethics doctor's approach to life after the diagnosis of cancer compared
of other physicians. A young DP reported having difficulty to NDP. On average, doctors work 53.3 hours per week, of
managing patients who had received the same cancer-type which 38% report working> 60 hours per week [18 - 20]. We
diagnosis, especially if they were young females with children. have to consider that as busy professionals with equally time-
She further stated that if she could, she would further avoid consuming family commitments, doctors tend to live like
having to deal with these patients. The discomfort was not due everyone else, from one activity to another, without really
to the fear of being unable to do her job well, but rather having stopping to consider the meaning of their daily lives. Having
to relive emotions, feelings, and situations that she would like cancer was a reason to analyze what they were doing every
to forget. One DP reported that she developed a greater ability day, to prioritize and dedicate time to those aspects of their life
to identify patients who suffered truly from those who only that are essential. Some things that seemed important before
appeared to be suffering but were not suffering or had suffered cancer seemed trivial after a cancer diagnosis. Important
to a lesser extent. Finally, DP found that as a patient, the findings from our study include positive changes in clinical
perception of the time that doctors devote to patients in medical practice, particularly in the management of cancer patients,
care was very different. The same amount of time dedicated to including having more empathetic relationships with patients,
a patient during their activity, before they became cancer greater consideration of the psychological impact of cancer,
patients, was perceived differently. The time devoted to him by and greater attention to certain symptoms reported by patients
the doctor was perceived as shorter. such as asthenia, dysgeusia, sarcophobia, mild and moderate
constipation. Although participants considered themselves
CONCLUSION empathic prior to their diagnosis, there was a frequently
reported deepening of understanding following their diagnosis.
As cancer is one of the most common chronic diseases
The acquisition of self-experiential empathy has resulted in
diagnosed worldwide, it is inevitable that many working cancer
more authentic communication and more active involvement in
health professionals will be diagnosed with cancer in their the care of patients. Evidently, these subjective improvements
lifetime [5]. Multiple issues complicate the process of a in practice arose from the insights gained from having suffered
physician assuming a new role as a patient. The present study from an illness that was directly related to their healthcare
shows that professional patients who develop a serious illness, profession. Empathy is considered a prerequisite to having a
experience unique needs, benefits and challenges which non- successful physician-patient relationship, an integral part of
health-professional patients and general professional patients high-quality patient-centered healthcare [21 - 23]. Empathetic
are unlikely to encounter. In adopting the patient role, being a engagement in patient care seems to exert positive influences
doctor is an advantage in some aspects and a disadvantage in on both patients and physicians. It has been linked with a
others [5, 11, 15]. The scientific knowledge of physicians, the decrease in patient symptoms like pain [24, 25] and anxiety
personal and working relationships with other specialists, and [26], increased patient satisfaction [27 - 35], increased
the knowledge of the health system's organization allow them adherence to treatment [18, 23], and improved clinical
to solve problems related to practical aspects and to participate outcomes [27, 35 - 42]. In addition, empathetic physicians
more actively in the management of their disease. In our study, demonstrate a higher level of well-being [43 - 45], achieve
the DP consulted a lower number of specialists, both during the higher ratings of clinical skills [46], suffer from lower levels of
diagnosis and treatment phase, compared to the NDP. We can burnout [45], and are at decreased risk of medical malpractice
hypothesize that this difference reflects the better self- [47 - 49]. In our study, the DP had the opportunity to
management skills of healthcare professionals compared to the objectively observe the behavior of their colleagues not only
NDP. Conversely, having background knowledge made the towards themselves but also toward the other patients.
experience of cancer fear-inducing for some DPs. Fear Although returning to work can be difficult for some cancer
concerning the worst‐case scenarios of metastatic disease and survivors, for many, it represents a return to normality and aids
death (particularly for those who had previously cared for in rebuilding personal identity [50]. Hence, DPs who bear the
terminally ill patients) and distress when later treating similar loss of their previous professional abilities may face further
patients [16, 17]. Physicians who become ill face distinct challenges in the form of a potentially complicated
privacy-related challenges. In our study, only a few DPs survivorship journey. Accordingly, these difficulties should be
decided not to share their cancer diagnosis with colleagues in addressed within supportive care for DPs who are required to
the workplace. The main reasons for this decision were due to modify their clinical practice, or through return‐to‐work
the fear of demotion or the loss of authority in one's role. The programs for those who resume their original duties. The
main differences observed between the two groups of patients limitations of the study concern both the methodology and the
were the loss of interest in work and changes in characteristics of the sample. The sample consisted of patients
personal/family life and friendships. One of the reasons why (both DP -e-NDP) with different stages of the disease; an early
most of the doctors (vs a few NDPS) reported a temporary loss or advanced stage of cancer can affect how patients cope with
of interest in their work derives only in part from physical any aspect of the disease. Another methodological limitation is
difficulties but more from psycho-emotional issues in dealing the lack of interview recording reports. This study provides
with clinical situations that they have experienced themselves. commendations from DP regarding general cancer care,
About a third of DPs acknowledged that they were no longer healthcare professional training, and DP care. Compared to
Understanding the User's Point of View Clinical Practice & Epidemiology in Mental Health, 2023, Volume 19 9

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