{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:49:44Z","timestamp":1785890984103,"version":"3.56.0"},"reference-count":45,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The aim of this study was to develop a conceptual framework for understanding surgeon grief in pediatric neurosurgery, examine its intersection with moral distress and professional burnout, and review evidence for institutional interventions supporting physician well-being after patient death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The author conducted a narrative review of English-language literature on physician grief, moral distress, and burnout in surgical specialties, with attention to pediatric practice. PubMed, PsycINFO, and CINAHL were searched for publications from January 2000 to December 2024. The initial search yielded 847 articles; after screening, 67 met inclusion criteria for narrative synthesis. An illustrative case of a neonate with an unresectable brain tumor contextualizes the framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Five dimensions of surgeon grief specific to therapeutic futility were identified: grief of unexpressed mastery (inability to deploy technical expertise), grief of identity disruption (challenge to action-oriented surgical identity), grief of anticipatory knowledge (burden of prognostic awareness), grief of perceived failure (internalization of patient death as personal defeat), and disenfranchised grief (grief not socially recognized within surgical culture). These dimensions interact bidirectionally with moral distress to produce cumulative emotional burden contributing to burnout and career attrition. Evidence supports institutional interventions that include structured debriefing, peer support programs, Schwartz Rounds, and early palliative care integration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Surgeon grief represents a significant but understudied occupational hazard in pediatric neurosurgery. The proposed 5-dimension framework provides a conceptual foundation for research, instrument development, and targeted interventions. Recognizing that providing a good death is a form of surgical success and that surgeon grief reflects preserved humanity is essential for workforce sustainability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.5.focus26127","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:01:14Z","timestamp":1785283274000},"page":"E15","source":"Crossref","is-referenced-by-count":0,"title":["When newborns die: walking the extra mile. Surgeon grief in pediatric neurosurgery: qualitative synthesis and framework development"],"prefix":"10.3171","volume":"61","author":[{"given":"Suhas","family":"Udayakumaran","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Center, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Acad Med","first-page":"403","article-title":"Beyond curriculum reform: confronting medicine\u2019s hidden curriculum","volume":"73","author":"Hafferty FW","year":"1998","unstructured":"Hafferty FW. Beyond curriculum reform: confronting medicine\u2019s hidden curriculum. Acad Med. 1998;73(4):403\u2013407. doi:10.1097\/00001888-199804000-00013"},{"issue":"10209","key":"b2","series-title":"Lancet","first-page":"1591","article-title":"Physician burnout: the need to rehumanise health systems","volume":"394","year":"2019","unstructured":"Physician burnout: the need to rehumanise health systems. Lancet. 2019;394(10209):1591."},{"issue":"9","key":"b3","series-title":"Mayo Clin Proc","first-page":"1681","article-title":"Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2017","volume":"94","author":"Shanafelt TD","year":"2019","unstructured":"Shanafelt TD, West CP, Sinsky C,  Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2017. Mayo Clin Proc. 2019;94(9):1681\u20131694. doi:10.1016\/j.mayocp.2018.10.023"},{"issue":"11","key":"b4","series-title":"JAMA","first-page":"1114","article-title":"Association of clinical specialty with symptoms of burnout and career choice regret among US resident physicians","volume":"320","author":"Dyrbye LN","year":"2018","unstructured":"Dyrbye LN, Burke SE, Hardeman RR,  Association of clinical specialty with symptoms of burnout and career choice regret among US resident physicians. JAMA. 2018;320(11):1114\u20131130. doi:10.1001\/jama.2018.12615"},{"issue":"5","key":"b5","series-title":"World Neurosurg","first-page":"e59","article-title":"Career satisfaction and burnout among U.S. neurosurgeons: a feasibility and pilot study","volume":"80","author":"Klimo P Jr","year":"2013","unstructured":"Klimo P Jr, DeCuypere M, Ragel BT, McCartney S, Couldwell WT, Boop FA. Career satisfaction and burnout among U.S. neurosurgeons: a feasibility and pilot study. World Neurosurg. 2013;80(5):e59\u2013e68. doi:10.1016\/j.wneu.2012.09.009"},{"issue":"5","key":"b6","series-title":"J Neurosurg","first-page":"1349","article-title":"Factors associated with burnout among US neurosurgery residents: a nationwide survey","volume":"129","author":"Attenello FJ","year":"2018","unstructured":"Attenello FJ, Buchanan IA, Wen T,  Factors associated with burnout among US neurosurgery residents: a nationwide survey. J Neurosurg. 2018;129(5):1349\u20131363. doi:10.3171\/2017.9.JNS17996"},{"issue":"1","key":"b7","series-title":"J Neurosurg","first-page":"161","article-title":"Factors associated with career satisfaction and burnout among US neurosurgeons: results of a nationwide survey","volume":"123","author":"McAbee JH","year":"2015","unstructured":"McAbee JH, Ragel BT, McCartney S,  Factors associated with career satisfaction and burnout among US neurosurgeons: results of a nationwide survey. J Neurosurg. 2015;123(1):161\u2013173. doi:10.3171\/2014.12.JNS141348"},{"issue":"1","key":"b8","series-title":"Arch Surg","first-page":"54","article-title":"Special report: suicidal ideation among American surgeons","volume":"146","author":"Shanafelt TD","year":"2011","unstructured":"Shanafelt TD, Balch CM, Dyrbye L,  Special report: suicidal ideation among American surgeons. Arch Surg. 2011;146(1):54\u201362. doi:10.1001\/archsurg.2010.292"},{"issue":"7","key":"b9","series-title":"JAMA Netw Open","first-page":"e209385","article-title":"Resilience and burnout among physicians and the general US working population","volume":"3","author":"West CP","year":"2020","unstructured":"West CP, Dyrbye LN, Sinsky C,  Resilience and burnout among physicians and the general US working population. JAMA Netw Open. 2020;3(7):e209385. doi:10.1001\/jamanetworkopen.2020.9385"},{"key":"b10","series-title":"BMJ","first-page":"j3360","article-title":"Burnout among doctors","volume":"358","author":"Lemaire JB","year":"2017","unstructured":"Lemaire JB, Wallace JE. Burnout among doctors. BMJ. 2017;358:j3360. doi:10.1136\/bmj.j3360"},{"issue":"4","key":"b11","series-title":"Arch Surg","first-page":"371","article-title":"Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences","volume":"144","author":"Balch CM","year":"2009","unstructured":"Balch CM, Freischlag JA, Shanafelt TD. Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences. Arch Surg. 2009;144(4):371\u2013376. doi:10.1001\/archsurg.2008.575"},{"issue":"4","key":"b12","series-title":"Pediatr Neurol","first-page":"249","article-title":"Perinatal brain tumors: a review of 250 cases","volume":"27","author":"Isaacs H Jr","year":"2002","unstructured":"Isaacs H Jr. Perinatal brain tumors: a review of 250 cases. Pediatr Neurol. 2002;27(4):249\u2013261. doi:10.1016\/s0887-8994(02)00472-1"},{"key":"b13","series-title":"World Neurosurg","first-page":"e664","article-title":"Congenital brain tumors: surgical outcomes and long-term prognostic factors","volume":"191","author":"Isikay AI","year":"2024","unstructured":"Isikay AI, Gurses ME, Gecici NN,  Congenital brain tumors: surgical outcomes and long-term prognostic factors. World Neurosurg. 2024;191:e664\u2013e673. doi:10.1016\/j.wneu.2024.09.021"},{"issue":"2","key":"b14","series-title":"Childs Nerv Syst","first-page":"86","article-title":"Congenital brain tumors in Japan (ISPN Cooperative Study): specific clinical features in neonates","volume":"6","author":"Oi S","year":"1990","unstructured":"Oi S, Kokunai T, Matsumoto S. Congenital brain tumors in Japan (ISPN Cooperative Study): specific clinical features in neonates. Childs Nerv Syst. 1990;6(2):86\u201391. doi:10.1007\/BF00307927"},{"issue":"12","key":"b15","series-title":"Arch Intern Med","first-page":"964","article-title":"Nature and impact of grief over patient loss on oncologists\u2019 personal and professional lives","volume":"172","author":"Granek L","year":"2012","unstructured":"Granek L, Tozer R, Mazzotta P, Ramjaun A, Krzyzanowska M. Nature and impact of grief over patient loss on oncologists\u2019 personal and professional lives. Arch Intern Med. 2012;172(12):964\u2013966. doi:10.1001\/archinternmed.2012.1426"},{"issue":"23","key":"b16","series-title":"JAMA","first-page":"3007","article-title":"The inner life of physicians and care of the seriously ill","volume":"286","author":"Meier DE","year":"2001","unstructured":"Meier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA. 2001;286(23):3007\u20133014. doi:10.1001\/jama.286.23.3007"},{"issue":"5","key":"b17","series-title":"Oncologist","first-page":"425","article-title":"Burnout: caring for the caregivers","volume":"5","author":"Penson RT","year":"2000","unstructured":"Penson RT, Dignan FL, Canellos GP, Picard CL, Lynch TJ Jr. Burnout: caring for the caregivers. Oncologist. 2000;5(5):425\u2013434. doi:10.1634\/theoncologist.2000-0425"},{"issue":"5","key":"b18","series-title":"N Engl J Med","first-page":"326","article-title":"Symptoms and suffering at the end of life in children with cancer","volume":"342","author":"Wolfe J","year":"2000","unstructured":"Wolfe J, Grier HE, Klar N,  Symptoms and suffering at the end of life in children with cancer. N Engl J Med. 2000;342(5):326\u2013333. doi:10.1056\/NEJM200002033420506"},{"issue":"11","key":"b19","series-title":"PLoS One","first-page":"e0143763","article-title":"Surgeons\u2019 emotional experience of their everyday practice: a qualitative study","volume":"10","author":"Orri M","year":"2015","unstructured":"Orri M, Revah-Levy A, Farges O. Surgeons\u2019 emotional experience of their everyday practice: a qualitative study. PLoS One. 2015;10(11):e0143763. doi:10.1371\/journal.pone.0143763"},{"issue":"6","key":"b20","series-title":"Acad Med","first-page":"718","article-title":"A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators","volume":"90","author":"Cruess RL","year":"2015","unstructured":"Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. Acad Med. 2015;90(6):718\u2013725. doi:10.1097\/ACM.0000000000000700"},{"issue":"7","key":"b21","series-title":"J Pediatr Surg","first-page":"1003","article-title":"Perinatal (fetal and neonatal) germ cell tumors","volume":"39","author":"Isaacs H Jr","year":"2004","unstructured":"Isaacs H Jr. Perinatal (fetal and neonatal) germ cell tumors. J Pediatr Surg. 2004;39(7):1003\u20131013. doi:10.1016\/j.jpedsurg.2004.03.045"},{"issue":"3","key":"b22","series-title":"Death Stud","first-page":"197","article-title":"The dual process model of coping with bereavement: rationale and description","volume":"23","author":"Stroebe M","year":"1999","unstructured":"Stroebe M, Schut H. The dual process model of coping with bereavement: rationale and description. Death Stud. 1999;23(3):197\u2013224. doi:10.1080\/074811899201046"},{"key":"b23","series-title":"Clinical Dimensions of Anticipatory Mourning: Theory and Practice in Working with the Dying, Their Loved Ones, and Their Caregivers","author":"Rando TA","year":"2000","unstructured":"Rando TA. Clinical Dimensions of Anticipatory Mourning: Theory and Practice in Working with the Dying, Their Loved Ones, and Their Caregivers. Research Press; 2000."},{"issue":"1","key":"b24","series-title":"Surg Clin North Am","first-page":"153","article-title":"When bad things happen to good surgeons: reactions to adverse events","volume":"92","author":"Luu S","year":"2012","unstructured":"Luu S, Leung SO, Moulton CA. When bad things happen to good surgeons: reactions to adverse events. Surg Clin North Am. 2012;92(1):153\u2013161. doi:10.1016\/j.suc.2011.12.002"},{"issue":"2","key":"b25","series-title":"J Surg Educ","first-page":"452","article-title":"You remember those days\u2014a qualitative study of resident surgeon responses to complications and deaths","volume":"79","author":"Bamdad MC","year":"2022","unstructured":"Bamdad MC, Vitous CA, Rivard SJ,  You remember those days\u2014a qualitative study of resident surgeon responses to complications and deaths. J Surg Educ. 2022;79(2):452\u2013462. doi:10.1016\/j.jsurg.2021.09.011"},{"key":"b26","series-title":"Disenfranchised Grief: Recognizing Hidden Sorrow","author":"Doka KJ","year":"1989","unstructured":"Doka KJ. Disenfranchised Grief: Recognizing Hidden Sorrow. Lexington Books;1989."},{"issue":"1","key":"b27","series-title":"Br J Anaesth","first-page":"74","article-title":"Grief reactions and coping strategies of trainee doctors working in paediatric intensive care","volume":"123","author":"ffrench-O\u2019Carroll R","year":"2019","unstructured":"ffrench-O\u2019Carroll R, Feeley T, Crowe S, Doherty EM. Grief reactions and coping strategies of trainee doctors working in paediatric intensive care. Br J Anaesth. 2019;123(1):74\u201380. doi:10.1016\/j.bja.2019.01.034"},{"issue":"2","key":"b28","series-title":"J Nurs Scholarsh","first-page":"117","article-title":"Moral distress among healthcare professionals: report of an institution-wide survey","volume":"47","author":"Whitehead PB","year":"2015","unstructured":"Whitehead PB, Herbertson RK, Hamric AB, Epstein EG, Fisher JM. Moral distress among healthcare professionals: report of an institution-wide survey. J Nurs Scholarsh. 2015;47(2):117\u2013125. doi:10.1111\/jnu.12115"},{"issue":"1","key":"b29","series-title":"J Gen Intern Med","first-page":"93","article-title":"Moral distress amongst American physician trainees regarding futile treatments at the end of life: a qualitative study","volume":"31","author":"Dzeng E","year":"2016","unstructured":"Dzeng E, Colaianni A, Roland M,  Moral distress amongst American physician trainees regarding futile treatments at the end of life: a qualitative study. J Gen Intern Med. 2016;31(1):93\u201399. doi:10.1007\/s11606-015-3505-1"},{"issue":"4","key":"b30","series-title":"Semin Fetal Neonatal Med","first-page":"101445","article-title":"Unmasking grief: reflections on the complicated relationship between moral distress and grief","volume":"28","author":"Wocial LD","year":"2023","unstructured":"Wocial LD, Hannan A. Unmasking grief: reflections on the complicated relationship between moral distress and grief. Semin Fetal Neonatal Med. 2023;28(4):101445. doi:10.1016\/j.siny.2023.101445"},{"key":"b31","series-title":"Margin of Error: The Ethics of Mistakes in the Practice of Medicine.","first-page":"217","article-title":"Moral residue","author":"Webster GC","year":"2000","unstructured":"Webster GC, Baylis F. Moral residue. In: Rubin SB, Zoloth L, eds.Margin of Error: The Ethics of Mistakes in the Practice of Medicine.University Publishing Group;2000:217-230."},{"issue":"4","key":"b32","series-title":"Pediatr Nurs","first-page":"185","article-title":"Bereavement debriefing sessions: an intervention to support health care professionals in managing their grief after the death of a patient","volume":"36","author":"Keene EA","year":"2010","unstructured":"Keene EA, Hutton N, Hall B, Rushton C. Bereavement debriefing sessions: an intervention to support health care professionals in managing their grief after the death of a patient. Pediatr Nurs. 2010;36(4):185\u2013190."},{"issue":"2","key":"b33","series-title":"J Pediatr","first-page":"229","article-title":"One method of coping: resident debriefing after the death of a patient","volume":"145","author":"Serwint JR","year":"2004","unstructured":"Serwint JR. One method of coping: resident debriefing after the death of a patient. J Pediatr. 2004;145(2):229\u2013234. doi:10.1016\/j.jpeds.2004.04.055"},{"issue":"6","key":"b34","series-title":"Acad Med","first-page":"1073","article-title":"The Schwartz Center Rounds: evaluation of an interdisciplinary approach to enhancing patient-centered communication, teamwork, and provider support","volume":"85","author":"Lown BA","year":"2010","unstructured":"Lown BA, Manning CF. The Schwartz Center Rounds: evaluation of an interdisciplinary approach to enhancing patient-centered communication, teamwork, and provider support. Acad Med. 2010;85(6):1073\u20131081. doi:10.1097\/ACM.0b013e3181dbf741"},{"issue":"7237","key":"b35","series-title":"BMJ","first-page":"726","article-title":"Medical error: the second victim","volume":"320","author":"Wu AW","year":"2000","unstructured":"Wu AW. Medical error: the second victim. BMJ. 2000;320(7237):726\u2013727. doi:10.1136\/bmj.320.7237.726"},{"issue":"9","key":"b36","series-title":"Acad Med","first-page":"1200","article-title":"Peer support for clinicians: a programmatic approach","volume":"91","author":"Shapiro J","year":"2016","unstructured":"Shapiro J, Galowitz P. Peer support for clinicians: a programmatic approach. Acad Med. 2016;91(9):1200\u20131204. doi:10.1097\/ACM.0000000000001297"},{"issue":"20","key":"b37","series-title":"JAMA","first-page":"2104","article-title":"Association between palliative care and patient and caregiver outcomes: a systematic review and meta-analysis","volume":"316","author":"Kavalieratos D","year":"2016","unstructured":"Kavalieratos D, Corbelli J, Zhang D,  Association between palliative care and patient and caregiver outcomes: a systematic review and meta-analysis. JAMA. 2016;316(20):2104\u20132114. doi:10.1001\/jama.2016.16840"},{"issue":"5","key":"b38","series-title":"Pediatrics","first-page":"1248","article-title":"Hospital staff and family perspectives regarding quality of pediatric palliative care","volume":"114","author":"Contro NA","year":"2004","unstructured":"Contro NA, Larson J, Scofield S, Sourkes B, Cohen HJ. Hospital staff and family perspectives regarding quality of pediatric palliative care. Pediatrics. 2004;114(5):1248\u20131252. doi:10.1542\/peds.2003-0857-L"},{"issue":"11","key":"b39","series-title":"N Engl J Med","first-page":"1051","article-title":"The next GME accreditation system\u2014rationale and benefits","volume":"366","author":"Nasca TJ","year":"2012","unstructured":"Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system\u2014rationale and benefits. N Engl J Med. 2012;366(11):1051\u20131056. doi:10.1056\/NEJMsr1200117"},{"issue":"1","key":"b40","series-title":"BMC Med Educ","first-page":"108","article-title":"That\u2019s not what you expect to do as a doctor, you know, you don\u2019t expect your patients to die. Death as a learning experience for undergraduate medical students","volume":"16","author":"Smith-Han K","year":"2016","unstructured":"Smith-Han K, Martyn H, Barrett A, Nicholson H. That\u2019s not what you expect to do as a doctor, you know, you don\u2019t expect your patients to die. Death as a learning experience for undergraduate medical students. BMC Med Educ. 2016;16(1):108. doi:10.1186\/s12909-016-0631-3"},{"issue":"5","key":"b41","series-title":"Arch Intern Med","first-page":"453","article-title":"Efficacy of communication skills training for giving bad news and discussing transitions to palliative care","volume":"167","author":"Back AL","year":"2007","unstructured":"Back AL, Arnold RM, Baile WF,  Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch Intern Med. 2007;167(5):453\u2013460. doi:10.1001\/archinte.167.5.453"},{"issue":"4","key":"b42","series-title":"Oncologist","first-page":"302","article-title":"SPIKES\u2014a six-step protocol for delivering bad news: application to the patient with cancer","volume":"5","author":"Baile WF","year":"2000","unstructured":"Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES\u2014a six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5(4):302\u2013311. doi:10.1634\/theoncologist.5-4-302"},{"issue":"5","key":"b43","series-title":"Pediatrics","first-page":"e20160791","article-title":"The AAP resilience in the face of grief and loss curriculum","volume":"138","author":"Serwint JR","year":"2016","unstructured":"Serwint JR, Bostwick S, Burke AE,  The AAP resilience in the face of grief and loss curriculum. Pediatrics. 2016;138(5):e20160791. doi:10.1542\/peds.2016-0791"},{"issue":"11","key":"b44","series-title":"JAMA","first-page":"1155","article-title":"Self-care of physicians caring for patients at the end of life","volume":"301","author":"Kearney MK","year":"2009","unstructured":"Kearney MK, Weininger RB, Vachon MLS, Harrison RL, Mount BM. Self-care of physicians caring for patients at the end of life. JAMA. 2009;301(11):1155\u20131164,E1. doi:10.1001\/jama.2009.352"},{"issue":"6","key":"b45","series-title":"Tumori","first-page":"472","article-title":"Pediatric palliative care in patients with brain tumors: timing, activation, and management of acute events","volume":"111","author":"Nigro O","year":"2025","unstructured":"Nigro O, Podda M, Schiavello E,  Pediatric palliative care in patients with brain tumors: timing, activation, and management of acute events. Tumori. 2025;111(6):472\u2013477. doi:10.1177\/03008916251365032"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/61\/2\/article-pE15.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/61\/2\/article-pE15.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/61\/2\/article-pE15.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:01:30Z","timestamp":1785888090000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/61\/2\/article-pE15.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,1]]},"references-count":45,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2026.5.focus26127","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,1]]}}}