Our study illustrates the diverse effects of patient death on oncologists. While not all patient deaths were perceived as distressing, several factors shaped individual responses, including patient and physician characteristics, death circumstances, and the depth of the physician-patient relationship. Emotional responses ranged from grief and sadness, helplessness and guilt to relief and satisfaction. Long-term personal and professional consequences included calmness in facing death, changes of life perspective and clinical approach, but also difficulty maintaining professional boundaries and emotional numbing. Informal peer support and intrapersonal strategies, commonly involving medical reflection and emotional distancing emerged as central coping forms. Institutional resources, despite expressed interest, were rarely used – possibly due to reported barriers such as time pressure and taboos around death. While many oncologists reported no current support needs, educational gaps and a lack of accessible support formats emerged in some interviews.

In line with earlier non-European studies, participants experienced typical aspects of grief such as sadness, but also distinct HCP-specific aspects including professional self-doubt, guilt and fear of legal consequences following patient death^6,16,22. The impact on oncologists appeared to be shaped by individual factors, rather than by the sheer number of patient deaths encountered, consistent with prior research³. While some oncologists found routine through exposure with death beneficial, others reported emotional numbing and reduced empathy, possibly indicating compassion fatigue among oncologists, a state of emotional exhaustion and reduced empathy resulting from prolonged exposure to others’ suffering²³, in line with findings from other healthcare systems^3,13. Several participants described focusing on medical aspects during case reflection and quickly returning to work tasks as a coping strategy. This has been discussed as a form of emotional compartmentalization which – while potentially necessary for short-term professional functioning – may compromise physician wellbeing in the long term⁸.

Although many participants felt adequately supported in coping with patient death, our results highlight specific gaps in educational and institutional support, as well as systemic barriers to participation. Reported unmet needs underline the importance of systemically integrating practice-oriented curricular contents on patient death during medical education and clinical training, which – consistent with medical education research – should be adapted to learners’ experience level and supported by pre-and debriefing to ensure psychological safety²⁴. Some adverse impacts, notably feelings of helplessness and difficulty maintaining professional boundaries, appeared particularly common among resident physicians. Consistent with prior research¹⁴, early-career oncologists may be especially vulnerable to emotional overwhelm following patient death and may require specifically tailored support interventions to prevent adverse outcomes or maladaptive coping in the long term. Although interest in hospital-based coping support was widely expressed, low uptake of such offers was reported. This apparent discrepancy may stem from coping barriers described by participants, including time constraints, perceived taboos around death, blame culture, and reluctance to display vulnerability around colleagues and superiors. Interventions targeting communication culture around death and error could improve both coping and acceptance of available offers. Moreover, institutions may consider the possibility of establishing low-threshold, timely individual counselling formats such as open consultation hours or hotlines. Informal peer support and emotional expression emerged as key coping resources, though availability varied, with some oncologists describing social interactions as unhelpful. Moderated or regular peer group formats may enhance consistency and reduce reliance on incidental support.