DISSERTATION

DISSERTATION PROGRESS
PROGRESS PRESENTATION

Researcher Guide
Ms. Anshu Makol Ms. Anshuma Dubey
M.Phil Clinical Psychology Trainee Assistant Professor

Department of Clinical Psychology, AIBAS

Amity University Lucknow Campus
Disenfranchised Grief, Compassion Fatigue & Emotional
Processing among Health Care Workers associated with
Cancer Care
 AIM
METHOD To study Disenfranchised Grief,
Compassion Fatigue and Emotional
Processing among Health Care
Workers associated with Cancer Care
 Objectives Hypotheses
H₀1: There will be no significant
To assess and compare D.G among
difference in D.G among
Oncologists, Nurses and Health
Oncologists, Nurses and Health Care
Care Assistants.
Assistants.
To assess and compare C.F among H₀2: There will be no significant
Oncologists, Nurses and Health difference in C.F among Oncologists,
Care Assistants. Nurses and Health Care Assistants.

To assess and compare E.P among H₀3: There will be no significant

Oncologists, Nurses and Health difference in E.P among Oncologists,
Care Assistants. Nurses and Health Care Assistants.
 Objectives Hypotheses

To explore relationship btw H₀4: There will be no significant

D.G, C.F & E.P among relationship btw D.G,C.F & E.P
Oncologists, Nurses and among Oncologists, Nurses and
Health Care Assistants. Health Care Assistants.
SELECTION CRITERIA
 Inclusion Criteria Group 1 (Oncologists )
Doctors who have completed their M.D / D.M /MCh and are registered under Medical Council of
India

Both Male and Female Oncologists attending Oncology hospitals/departments and treating diverse
range of Cancer patients for at least 6 months.

Individuals up to 60 years of age

Individuals who have provided informed consent

Exclusion Criteria
Individuals who have not experienced a patient’s death in past 6 months.
Individuals solely practising as private practitioners,

Individuals who have reported experiencing death in the immediate family, diagnosis of a
major illness in the family , divorce or any other significant loss in the past 6 months.
 Inclusion Criteria Group 2 ( Nurses)

Individuals who have completed B.SC Nursing/ General Nursing and Midwifery( GNM)
from institutions recognized by the Indian Nursing Council

Both male and female nurses attending Oncology Hospitals/ departments and caring for
diverse range of cancer patients for at least 6 months

Individuals up to 60 years of age and those who have provided informed consent

Exclusion Criteria

Individuals who have not experienced a patient’s death in past 6 months.

Individuals who have reported experiencing death in the immediate family,
diagnosis of a major illness in the family, divorce or any other significant loss in
the past 6 months.
 Inclusion Criteria Group 3 ( Health Care Assistants)
Individuals who can read & write in Hindi
Both Male and Female Assistants attending Oncology hospitals/departments and
treating diverse range of Cancer patients for at least 6 months.
Individuals up to 60 years of age & who have provided informed consent
Exclusion Criteria

Individuals who have not experienced a patient’s death in past 6 months.

Individuals who have reported experiencing death in the immediate family, diagnosis
of a major illness in the family, divorce or any other significant loss in the past 6
months.
 TOOLS
Table 1 shows tools used

Measure Tool Description

Disenfranchised Grief The Grief Support  in  • Keith A. Anderson (2010)

Healthcare Scale • Three components of D.G theory
• 15 -item questionnaire, 5 point likert scale 1=
S.D and 5=S.A
• Reliability of .89, .86, and .78, respectively. 

Compassion Fatigue Compassion fatigue— • Beth Hundall Stamm (2009)

Professional Quality of  Life • Two independent  subscales: Secondary
Questionnaire—(Pro QOL) Traumatic Stress and Burnout
• Reliability 0.64 for burnout and 0.81 for STS.

Emotional Processing Emotional Processing Scale – 25 •  Baker et al., (2009)

( EPS-25) • 25- item questionnaire, five subscales
Reliability of   0 .74 and a validity of 0.92
 PROCEDURE
STROBE FLOW CHART
 STATISTICAL ANALYSIS
STATISTIC TEST USED PURPOSE

Descriptive Statistics Frequency(n), Percentage(%), Summarize Socio-demographic

Mean (M) & Standard details
Deviation (S.D)
Inferential Statistics Kruskal -Wallis Test To compare the difference
between three groups on study
variables
Spearmen’s rank Correlation To explore the relationship
between D.G,C.F & E.P among
three groups

Note. D.G = Disenfranchised Grief, C.F= Compassion Fatigue & E.P = Emotional Processing
RESULTS
*significant at a level of p<0.05
*significant at a level of p<0.05
Unpro.=Unprocessed, Con.=Controllability, Exp.=Experience
D.G =Disenfranchised Grief, C. F =Compassion Fatigue ,E.P = Emotional Processing
*Correlation is significant at a level of p < 0.05(2-tailed)
**Correlation is significant at a level of p < 0.01 (2-tailed)
D.G (1)=Relationship with the patient, D.G (2) =Acknowledgment of loss, D.G (3)=Inclusion as Griever
E.P=Emotional Processing, Sup.= Suppression, Unpr.= Unprocessed, Con.=Controllability, Avoid.=Avoidance, Ex.=Experience.
*Correlation is significant at a level of p < 0.05(2-tailed)
 **Correlation is significant at a level of p < 0.01 (2-tailed)
E.P (1)= Suppression, E.P(2)= Unprocessed, E.P(3) =Controllability, E.P (4)= Avoidance, E.P=Experience
DISCUSSION
 Hypothesis Results Previous Findings

H01:There will be no significant No. Significant difference in D.G among three (Papadatou, 2009)
difference in D.G among three groups groups
H01=Accepted  (Bram & Katz, 2007)

H02:There will be no significant
difference in C.F (STS & BO) among
three groups
H03:There will be no significant
difference in E.P among three groups
H04: There will be no significant
relationship btw D.G, C.F (STS &
BO)& E.P among the three groups
Significant difference in levels of Burnout among (Kohli & Padmakumari,
three groups 2019).
H02:Rejected
Significant difference on Experience Sub-scale of ( Helsel,2008)
E.P among three groups
H03:Rejected (Pei et al .,2021)
D.G & C.F
• Negative correlation between BO and the (Brown & Wood, 2009)
second & third sub-domain of D.G among three
groups (Gross et al., 2019)
• A positive correlation between BO & STS
• Negative correlation between STS & third sub- (Whippen and
domain of D.G among three groups Canellos,1991)
H04:Rejected
 Hypothesis Results Findings

D.G & E.P

• Negative correlation between the (Baker et al., 2009)
third subdomain of D.G &
Controllability Subscale of E.P,
D.G (total) & Controllability
Subscale of E.P among three
H04: There will be no significant groups
relationship btw D.G, C.F (STS &
BO)& E.P among the three groups
C.F & E.P

• Positive correlation between BO (Joseph and Newman, 2010; 

& Controllability, between BO & Dijk et al., 2017)
Unprocessed Subscale of E.P
among three groups
• Positive correlation between BO (Gross, 1998; Thwaites, 2017)
&Experience Subscale of E.P
• Positive correlation between STS
& Controllability, between STS
& Unprocessed Subscale of E.P
 CONCLUSION

● Disenfranchised grief is a unique and common phenomenon in healthcare, where loss is a daily occurrence for
both patients and carers.
● Role of stressful environment of hospital-based oncology units, caring for terminally ill patients in the
perception of support received for grieving the loss. 
● Emotional beliefs & rules guide the expression as well as experience of any emotion, leading to heightened
controllability & unprocessed emotions especially if the expression is seen as inadequate or reflects ineptitude
on part of HCWs
● The lack of HCWs' spontaneous manifestation of emotions, at the workplace, has personal implications such as:
Feelings of frustration, inability to deal with work-related stressors (BO), repetitive intrusive thoughts (STS) & an
inability to label one’s emotions, misconstruing them as physical symptoms(Experience)
 LIMITATIONS

● Unequal sample distribution among three groups

● Limited to only one geographical area.
● The sample was recruited only from private hospitals
● Included only those Oncology HCWs who are trained to provide medical care but not
emotional needs.
● The majority of the participants belong to one hospital (generalizability and group
conformity)
● Institutional factors (fear of losing job, social stigma)
● Non-Death related losses at work could not be explored
 FUTURE DIRECTIONS

● Equal sample distribution, large sample size

● HCWs working in both private & govt. oncology set-ups. across India
● Mixed method research design (qualitative – experiential encounters, in-depth
understanding of non–death related losses at the workplace)
● Comparison with other HCWs such as Psychologists associated with Cancer Care –
who are trained to deal with the emotional & psychological needs of dying patients.
● Comparison with professionals from other domains or professionals dealing with
other chronic life-threatening illness
● Comparison with Informal Home Care Caregivers
 IMPLICATIONS

● The study provides evidence related to emotional difficulties among those who are

seen as absorbers of the illness experiences of the dying patient.

● Highlights the need for holistic psychological intervention to address the professional

as well as personal implications of loss & traumatic experiences at the workplace

 REFERENCES
Asai, M., Matsumoto, Y., Miura, T., Hasuo, H., Maeda, I., Ogawa, A., Morita, T., Uchitomi, Y., &
Kinoshita, H. (2022, August 27). Psychological distress among caregivers for patients who die of
cancer: A preliminary study in Japan. Journal of Nippon Medical School. Retrieved October 14, 2022,
from https://doi.org/10.1272/jnms.JNMS.2022_89-410

Grief over patients, compassion fatigue, and the role of social ... (n.d.). Retrieved October 14, 2022,
from https://onlinelibrary.wiley.com/doi/10.1002/pon.5286

Kaur-Aujla, H., Lillie, K., & Wagstaff, C. (1AD, January 1). Prognosticating covid therapeutic
responses: Ambiguous loss and disenfranchised grief. Frontiers. Retrieved October 14, 2022, from
https://doi.org/10.3389/fpubh.2022.799593

Lathrop, D. (2017, July 1). Disenfranchised grief and physician burnout. Annals of Family Medicine.
Retrieved October 14, 2022, from https://doi.org/10.1370/afm.2074

A nonheroic cancer narrative: Body deterioration, grief ... (n.d.). Retrieved October 14, 2022, from
https://journals.sagepub.com/doi/10.1177/0030222819852836
THANK YOU !
 INTRODUCTION

Disenfranchised Compassion Fatigue Emotional Processing

Grief A state of emotional distress Multiple Mechanisms

A loss that is not or and exhaustion experienced allows one to move from

cannot be openly by healthcare providers or emotional disturbance to

acknowledged, socially caregivers (Stamm,2010) resolution in face of

validated, or publicly conflict

mourned (Doka,1989) (Baker et al.,2015)

 INTRODUCTION (Contd.)

Acc. to National Classification of Occupations, Ministry of Labour & Employment,

Govt. of India (2015), HCWs have been distinguished into three categories

Oncologists Nursing Professionals Health Care Assistants

 REVIEW OF LITERATURE
Total Number of Literature Reviewed 59

International 49

Indian 10

D.G, Health Care Workers & Cancer Care Nurses: 05, Home Care Workers: 02, Oncologists:03

C.F, Health Care Workers & Cancer Care Nurses : 10, Home Care Workers: 01, Oncologists: 11

Social Acknowlegment of Grief , C.F , Health Nurses: 03, Oncologists :05, Psycho-oncologists : 01,
Care Workers & Cancer Care Psychologists: 01

E.P, Health Care Workers & Cancer Care 06

D.G ,E.P, Health Care Workers & Cancer Care Oncologists:02 , Nurses : 05

E.P, C.F, Helath Care Workers & Cancer Care Oncology Professionals: 06
 RATIONALE

01 Cancer - a life threatening disease, strikes fear into the hardiest of souls.

02 In countries with less advanced healthcare facilities, such as India, the mortality-to-incidence
ratio is high, which can be overwhelming for Healthcare Workers (NCR,2020)

The expected role is to provide medical care as well as to meet the complex emotional
03and
psychological needs of cancer patients.

04labour Despite experiencing patients' death every day, not recognized for their emotional labor &
right to grieve, may suppress self-awareness of grief which impedes recovery & motivation to
care
 RATIONALE (Contd.)
.
So far Indian research in the field of oncology has majorly focused on cancer patients
05 in isolation; little attention on the treating team ; Health care aides as invisible HCWs
;;

06 The dearth of literature quantitatively exploring the relationship btw three variables,
including both Health Care Professionals & Health Care Aides.