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Table 3 Categories and subcategories of analysis and quotes

From: Experience of oncology residents with death: a qualitative study in Mexico

CategoriesExample quotations by subcategories
1 Concept of death1.1 General concept of death
“[…] There is a chance that the spirit will go on, that is something very clear and very precise and that has been clear to me all my life […] a life ends and you do not know what there is beyond, right? […] “. (Dr.1)
“[…] I obtained my concept at home: it’s based on my religion […]” . (Dr. 6)
1.2 Personal concept of death
“[...] At this moment, it would be something terrible [...] a person like me who has just graduated, just trained, I would say: ‘Death right now, ‘What horror’ [...] but in 30 years [...] it would be something that would not scare me […]” . (Dr. 3)
“[…] I have lived so close to death that it’s not a stranger to me […] I’m not really afraid about my own death; what scares me is not knowing what would happen with my family […]” (Dr. 5)
1.3 Personal experiences and reactions associated with death
“[…] I had a tumor in the nasopharynx [...] I am very much blocking the tragic events in my life; I’ve always done so […] I remember that I was in the ICU [...] my parents crying everyday [...] it is not something that I reflect upon […].” (Dr. 2)
“[…] I should have intervened, the symptoms were evident […] I still think about how the diagnosis was delayed [niece with leukemia] and I am very frustrated because it was something that could have had a different outcome […]” . (Dr. 6)
“[...] and everyone is all over you: ‘Did you go see him?’ [...] And you think: ‘What should I say, what should I do, how do I get through this?’ I am not his doctor, so I cannot give a medical report […] I am his relative […]” . (Dr. 4)
1.4 Concept of death in medical practice
“[…] I don’t like to think that a patient doesn’t have a chance [...] I always offer something else that could be done […]” . (Dr. 3)
“[…] I don’t like to say ‘there is nothing we can do’ […] it is a term that I avoid because you can almost always do something […] even if you can’t do something to eradicate the patient’s disease […] there is something that you can offer to alleviate the patient’s suffering and give him a better quality of life […]” . (Dr. 4)
2.Actions and reactions toward death2.1 Recognition of imminent death in a patient
“[…] There is a body of knowledge in the medical literature, then you can know how advanced the disease is and how likely it is for the patient to be cured [...] “. (Dr. 2)
“[…] Over the years you realize that it is not only about medical aspects […] it is about how much the patient wants to live […] those who want to fight […] those who have family support […]” . (Dr. 5)
2.2 Communication of imminent death to patients and families
“[...] Something I always tell those patients that ask me ‘Am I going to die?’ is ‘Look, I would love to be the creator, to have a crystal ball so I could say Yes, the answer is yes, but I am human, I don’t know […] I can’t give you that answer’ […]” . (Dr. 7)
“[…] You can’t ignore the relatives who are asking you not to do it [deliver bad news], but it seems to me that the patient has the right to know […] it makes me very angry that they are not told […]” . (Dr. 3)
“[…] Well, we do not tell anyone as such that he is going to die. That is the advantage! […]” . (Dr. 6)
2.3 Reacting as a medical professional to death
“[…] I get really frustrated with those patients, then I get mad and say ‘Why don’t they want to try it if there is still something that can be done?’ […]” . (Dr. 1)
“[…] I’ve done everything humanly possible for him […] I don’t feel frustrated because since one first begins to treat patients like these, one is aware that treatments have limitations […]” . (Dr. 5).
2.4 Ways of coping with death.
“[...] I do not want to relate too much with the patient [...] I frame a distance [...] is like my defense mechanism […]” . (Dr. 5)
“[...] With my peers sometimes we joke about things related to diseases [...] so everything you live daily doesn’t be so overwhelming […]” . (Dr. 6)
“[...] a very easy way out is to calmly establish limits and treat everyone as if they have a simple flu [...] I have not been able to do that [...] I’ve committed myself to the specialty […]” . (Dr. 1)
2.5 Support to deal daily with death
“[…] I talk to my wife; she is a physician; we talk about medical issues […]” . (Dr. 4)
“[…] Buy things, read something, record music […] to diverge the tension […] it helps you to keep doing things better […]” . (Dr. 2)
3.Training aspects to learn how to face death3.1 The social representation of the physician’s figure
“[…] You study medicine to cure people […] your obligation is to help them as much as they want […]” . (Dr. 5)
“[…] As a doctor, I put my thoughts and my energy into seeing what I can offer, in reasoning about suffering, not in living it […]” . (Dr. 1)
3.2 Specific training to face death as a physician
“[…] You see how they approach them [patients] and how the patient reacts [...] there was no one to sit and tell you how to do so, so you approach [to the teaching physicians] and you watch […]” . (Dr. 3)
“[…] it’s something that is not learned, it is not something that is studied, it is something that is learned as you go […]” . (Dr. 2)
3.3 Models and anti-models
”[…] He always said that they [patients] should be treated with respect and like we would want to be treated […]” . (Dr. 6)
“[…] And he said: ‘look, of course you are bleeding, you have a lymphoma, do you know what that is? No, right? To stop the bleeding, I would have to get you to the operating room and I’m not going to do that now, so you will have to handle it’ […] that’s not the way! […]” . (Dr. 4)
3.4Teaching others to face death
“[…] I tried to teach them how to get close to the relatives […] I always try to show them how to do things […]” . (Dr. 3)
3.5 Self-perceived ability to cope with death
“[…] They never teach us how to deliver bad news […] I have no idea if my method is good, if it is bad or if it is worse, but it is the one that has worked for me […]” . (Dr. 1)
“[…] Here, I see that the physicians in charge of the patient are not going to give the bad news; we, the residents, are the ones who generally have to do it […] the treating physician is not going to come here at 2 or 3 in the morning […]” . (Dr. 6)
“[...] it is complicated if they aren’t my patients as it happens in a guard […] or when you receive a case in the emergency room and you have to inform the relatives that the patient is going to die; it is difficult because you don’t know them, you don’t know how they will react […]” . (Dr. 4)
3.6 Perceived needs to cope with death
“[…] Thinking about courses or groups or things like that, we don’t even have time, we are overworked, tired […] we live entire seasons in the hospital […] if you get one more class, what you think is ‘good, I’m going to sleep’[…]” . (Dr. 2)
“… we say it jokingly, but we say that everyone in oncology has something wrong … I don’t know if it would be better if I had it [psychotherapy], or if I should look for it …” . (Dr. 7)