Overcoming Burnout and Promoting Wellness in Radiation Oncology: A Report From the ACR Commission on Radiation Oncology

Implementation Mapping to Identify Strategies to Increase Timely Postoperative Radiotherapy Initiation for Head/Neck Cancer

OBJECTIVE

Timely initiation of postoperative radiotherapy (PORT) for head and neck squamous cell carcinoma (HNSCC) is associated with improved survival, but rates of timely PORT initiation are low. To support uptake in a tertiary academic center, we aimed to identify implementation determinants (eg, barriers and facilitators) to timely PORT initiation and to design context-specific implementation strategies.

METHODS

We created an implementation blueprint through a sequential mixed-methods study where we (1) identified determinants by fielding a 15-item survey based on the Theoretical Domains Framework (TDF), (2) prioritized determinants through focus groups with relevant stakeholders, (3) mapped barriers to implementation strategies using the Consolidated Framework for Implementation Research (CFIR)-Expert Recommendations for Implementing Change (ERIC) matching tool, and (4) operationalized strategies using the Action, Actor, Context, Target, Time (AACTT) framework.

RESULTS

Twenty-three participants from three departments (61% Radiation Oncology, 35% Otolaryngology, 4% Medical Oncology) in a variety of roles (35% physicians, 39% nurses or advanced practice providers, 22% radiation therapists or dosimetrists, and 4% research coordinators) completed surveys. Participants identified 10 determinants affecting timely PORT initiation. After strategy selection and operationalization by focus group participants (n = 13), three ERIC strategies were selected for clinical implementation: remind clinicians, conduct educational meetings, and facilitate relay of clinical data to providers.

DISCUSSION

This work developed a menu of implementation strategies for future deployment to support timely PORT initiation. Codesign centered the voice of frontline workers, increasing the likelihood of successful implementation.

IMPLICATIONS FOR PRACTICE

The systematic approaches to development can serve as a model for process improvement in other contexts.

Patient, Caregiver, and Provider Well-Being in Oncology

Addressing various dimensions of well-being can help improve oncology patients' symptoms and their overall quality of life (QOL); similar strategies can be used to support caregivers of oncology patients to improve not only QOL of the caregiver, but the patient. Beyond patient and caregiver support, interventions focusing on dimensions of well-being can improve the culture of wellness, practice efficiency, and enhance personal resilience among oncology providers to mitigate burnout. Herein, the authors discuss multiple evidence-based strategies to improve well-being of oncology patients, caregivers, and providers.

Burnout levels among radiation oncology residents in Spain: a cross-sectional survey

PURPOSE

This study aimed to investigate the prevalence and characteristics of burnout among Radiation Oncology residents in Spain, focusing on its associated risk factors and implications for residency training.

MATERIALS AND METHODS

A cross-sectional online survey was conducted from June to September 2024, using the Maslach Burnout Inventory (MBI) to evaluate emotional exhaustion, depersonalization, and self-fulfillment. Residents from various Spanish regions completed an anonymous questionnaire covering workload and burnout.

RESULTS

Fifty residents, predominantly in their third (38%) and fourth (42%) years of training, participated. High emotional exhaustion was reported by 58%, while 54% exhibited elevated depersonalization. Self-fulfillment scores were low in 32%. Overall, 70% experienced at least one burnout symptom, with 12% meeting criteria for full-burnout syndrome. An inverse correlation between self-fulfillment and emotional exhaustion was observed (p = 0.007). Trends suggested higher burnout risk in senior residents (R3-R4) compared to juniors (R1-R2), though these differences were not statistically significant (OR = 1.682; p = 0.086).

CONCLUSION

The findings reveal a high prevalence of at least one burnout symptom among Radiation Oncology residents in Spain, with emotional exhaustion and depersonalization notably elevated. However, full-burnout syndrome is not prevalent. These findings underscore the need for reforms in residency training programs, emphasizing workload management, well-being initiatives, and support for scientific and professional development.

Characterizing Wellness Initiatives in Academic Radiation Oncology Departments

Purpose

Burnout is prevalent in radiation oncology (RO), and an increased focus on promoting physician wellness and formalizing wellness-directed efforts has transpired in recent years. We aimed to characterize current wellness leadership positions and efforts within academic RO departments.

Methods and Materials

Academic RO department chairs were contacted to inquire whether they had a departmental wellness leader with a request for leader contact information, if applicable. Wellness leaders were invited to complete an anonymous survey in January and February 2023 using Qualtrics. Questions assessed leader demographic characteristics, role structure and resources, current initiatives, and impacts to date. Descriptive statistics and summaries of free-text responses are reported.

Results

A total of 120 chairs were contacted. In total, 71 (59%) responded, with 43 (61%) having departmental wellness leaders, of which 17 (39.5%) responded, to the survey. A total of 70.6% were female, and 76.5% were physician faculty. Most respondents were early-career. The most common previously implemented initiatives included offering programming and education (33.3%) and improved access to mental health services (25%). The most common active initiatives include conducting studies to address root causes of burnout (41.7%), developing specific wellness goals (25%), performing a review of policies that encourage prolonged work hours (25%), and offering programming and education (25%). Challenges included limited bandwidth (66.7%), lack of funding (41.7%), and lack of departmental interest in organizing or attending events (33.3%). Leaders highlight the importance of a dedicated individual to tangibly implement changes and the unique opportunity of someone within RO to understand the specific challenges faced by those in our field.

Conclusions

Wellness leadership roles exist in many RO departments. As evidenced by a limited number of fully implemented initiatives, these roles are new and evolving. A focus on wellness has the potential to bring positive change to departments; however, the impact of newly established wellness roles on culture and balance requires longitudinal followup.

ESMO Resilience Task Force recommendations to manage psychosocial risks, optimise well-being, and reduce burnout in oncology

BACKGROUND

Burnout in health care professionals (HCPs) results from exposure to psychosocial risks at work. Left unaddressed, burnout can lead to chronic health problems, increased staff turnover, reduced work hours, absenteeism, and early retirement from clinical practice, thus impacting patient care. The European Society for Medical Oncology (ESMO) Resilience Task Force (RTF) was established in December 2019 to support the well-being of oncology HCPs globally. This ESMO RTF position paper aims to provide a set of recommendations to optimise well-being and mitigate burnout in oncology, and to help individuals and institutions maintain the delivery of optimal cancer care.

DESIGN

Recommendations were developed by a diverse multinational panel of interprofessional experts based on the key findings from three previously reported ESMO RTF surveys.

RESULTS

Several recurrent work-related psychosocial risks in oncology were identified; in particular, concerns about workload and professional development. The need for flexible work patterns, continued use of virtual resources, well-being resources, and targeted support for at-risk groups were highlighted as key considerations to safeguard HCPs' health and prevent burnout. In total, 11 recommendations relating to three priority themes were developed: (i) information and training; (ii) resources; (iii) activism and advocacy.

CONCLUSION

Optimising the well-being of oncology HCPs is essential for the provision of high-quality, sustainable care for patients globally. The ESMO RTF will continue its mission and is rolling out several initiatives and activities to support the implementation of these recommendations.

Sharing Patient Praises With Radiology Staff: Workflow Automation and Impact on Staff

OBJECTIVE

This study aims to develop and evaluate a semi-automated workflow using natural language processing (NLP) for sharing positive patient feedback with radiology staff, assessing its efficiency and impact on radiology staff morale.

METHODS

The HIPAA-compliant, institutional review board-waived implementation study was conducted from April 2022 to June 2023 and introduced a Patient Praises program to distribute positive patient feedback to radiology staff collected from patient surveys. The study transitioned from an initial manual workflow to a hybrid process using an NLP model trained on 1,034 annotated comments and validated on 260 holdout reports. The times to generate Patient Praises e-mails were compared between manual and hybrid workflows. Impact of Patient Praises on radiology staff was measured using a four-question Likert scale survey and an open text feedback box. Kruskal-Wallis test and post hoc Dunn's test were performed to evaluate differences in time for different workflows.

RESULTS

From April 2022 to June 2023, the radiology department received 10,643 patient surveys. Of those surveys, 95.6% contained positive comments, with 9.6% (n = 978) shared as Patient Praises to staff. After implementation of the hybrid workflow in March 2023, 45.8% of Patient Praises were sent through the hybrid workflow and 54.2% were sent manually. Time efficiency analysis on 30-case subsets revealed that the hybrid workflow without edits was the most efficient, taking a median of 0.7 min per case. A high proportion of staff found the praises made them feel appreciated (94%) and valued (90%) responding with a 5/5 agreement on 5-point Likert scale responses.

CONCLUSION

A hybrid workflow incorporating NLP significantly improves time efficiency for the Patient Praises program while increasing feelings of acknowledgment and value among staff.

The prevalence of burnout in oncology professionals: an overview of systematic reviews with meta-analyses including more than 90 distinct studies

PURPOSE

This overview of reviews aimed to summarize the prevalence of burnout and the dimensions of burnout (emotional exhaustion, depersonalization, and personal accomplishment) in oncology professionals around the world.

METHODS

The CINAHL, Embase, PsycINFO, and PubMed databases were searched from inception to September 13, 2023. AMSTAR 2 was used to assess the quality of reviews. The overlap between reviews was calculated.

RESULTS

Twelve reviews were included. Overall, reviews showed that burnout was prevalent in oncologists and oncology nurses. On the other hand, no reviews meta-analyzed the prevalence of burnout in oncology radiation therapists. In addition, the dimensions of burnout, high emotional exhaustion, high depersonalization, and low personal accomplishment were highly prevalent across reviews in oncologists, oncology nurses, and oncology radiation therapists. In oncologists, the Americas (specifically Canada) showed the highest prevalence rates for high emotional exhaustion, whereas high depersonalization and low personal accomplishment were mainly prevalent in Europe and Asia, respectively. In oncology nurses, high emotional exhaustion and high depersonalization were mainly prevalent in Asia, whereas low personal accomplishment was more prevalent in the Americas (specifically Canada). The prevalence of overall levels of burnout was not meta-analyzed by continents.

CONCLUSION

Some methodological improvements may help to make more robust the findings of this overview (e.g., specific subgroup meta-analyses by oncology specialties), which may help readers reach more precise, direct, and consistent findings.

PROTOCOL REGISTRATION

https://doi.org/10.17605/OSF.IO/QPWG5 .

Achieving the Unachievable: Work-Life Balance in Radiation Oncology

As radiation oncologists, we often participate in discussions on work-life balance, are offered lectures and free meals, and complete hospital-mandated modules, all under the guise of physician wellness. But how often are these measures efficacious? How do we define being well in our demanding and fast-paced careers? What does it actually look like on a day-to-day basis to achieve work-life balance? Furthermore, is it even possible?