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Nindra U, Shivasabesan G, Mellor R, Chua W, Ng W, Karikios D, Richards B, Liu J. Evaluating Systemic Burnout in Medical Oncology Through a National Oncology Mentorship Program. JCO Oncol Pract 2024; 20:549-557. [PMID: 38290086 DOI: 10.1200/op.23.00469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/14/2023] [Accepted: 12/01/2023] [Indexed: 02/01/2024] Open
Abstract
PURPOSE Mentorship has a positive influence on trainee skills and well-being. A 2022 Pilot Mentorship Program in New South Wales involving 40 participants revealed high burnout rates in Medical Oncology trainees. As part of an Australia-wide inaugural National Oncology Mentorship Program in 2023 (NOMP23), a national survey was undertaken to assess the prevalence of burnout, anxiety, depression, professional fulfilment, and drivers of distress in the Australian medical oncology workforce. METHODS NOMP23 is a 1-year prospective cohort study that recruited medical oncology trainees and consultants using e-mail correspondence between February and March 2023. Each participant completed a baseline survey which included the Maslach Burnout Index (MBI), Stanford Professional Fulfilment Index, and Patient Health Questionnaire-4 for anxiety and depression. RESULTS One hundred and twelve participants (56 mentors, 56 mentees) were enrolled in NOMP23, of which 86 (77%) completed the baseline survey. MBI results at baseline demonstrated that 77% of consultants and 82% of trainees experienced burnout in the past 12 months. Professional fulfilment was noted to be <5% in our cohort. Screening rates of anxiety and depression in trainees were 32% and 16%, respectively, compared with 7% and 2% for consultants. When assessing reasons for workplace stress, two thirds stated that heavy patient load contributed to stress, while almost three quarters attributed a heavy administrative load. Lack of supervision was a key stressor for trainees (39%), as was lack of support from the training college (58%). CONCLUSION Trainees and consultant medical oncologists demonstrate high rates of burnout and low professional fulfilment. The NOMP23 program has identified a number of key stress factors driving burnout and demonstrated concerning levels of anxiety and depression. Ongoing mentorship and other well-being initiatives are needed to address these issues.
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Affiliation(s)
- Udit Nindra
- Department of Medical Oncology, Liverpool Hospital, Liverpool, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Gowri Shivasabesan
- Department of Medical Oncology, Liverpool Hospital, Liverpool, Australia
| | - Rhiannon Mellor
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia
- Garvan Institute of Applied Medical Research, Sydney, Australia
- School of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Wei Chua
- Department of Medical Oncology, Liverpool Hospital, Liverpool, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Weng Ng
- Department of Medical Oncology, Liverpool Hospital, Liverpool, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Deme Karikios
- School of Medicine, University of Sydney, Sydney, Australia
- Department of Medical Oncology, Nepean Hospital, Sydney, Australia
| | - Bethan Richards
- Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, Australia
- Institute of Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Jia Liu
- Garvan Institute of Applied Medical Research, Sydney, Australia
- School of Medicine, University of Sydney, Sydney, Australia
- The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney Australia
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Sobczuk P, Gawlik-Urban A, Sigorski D, Kiszka J, Osmola M, Machulska-Ciuraj K, Wilk M, Brodziak A. Prevalence and factors associated with professional burnout in Polish oncologists-results of a nationwide survey. ESMO Open 2024; 9:102230. [PMID: 38266421 PMCID: PMC10937194 DOI: 10.1016/j.esmoop.2023.102230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/03/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND High rates of burnout are observed among health care professionals worldwide, which could have negative consequences on personal and organizational levels. We aimed to evaluate the burnout prevalence and factors associated with burnout among oncologists in Poland. MATERIALS AND METHODS An online survey was conducted using the validated Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and additional work/lifestyle questions. Descriptive statistics, parametric and nonparametric tests, and multivariate logistic regression were used to identify factors associated with burnout. RESULTS A total of 228 physicians participated in the survey, including 168 medical oncologists, 43 radiation oncologists, and 17 from other specialties. Data collected from 211 medical and radiation oncologists were included in the final analyses. Most participants were female (71.6%) and ≤40 years of age (70.1%). A self-reported feeling of burnout was present in 65.9% of participants. Based on the MBI-HSS, 74.9% showed evidence of burnout with burnout subdomains as follows: depersonalization 37.0%; emotional exhaustion 64.5%; low accomplishment 43.1%. There were no differences in burnout rates based on specialization (oncology/haematology-75.6%, radiotherapy-72.1%), career stage, gender, or age groups. Lack of work-life balance was the only significant factor associated with the risk of burnout in the logistic regression (relative risk 2.6, 95% confidence interval 1.3-5.4). Only 20.9% of physicians had access to psychological support in their workplace; however, 70.1% desired such support. Three main factors impacting burnout in cancer care workers were: bureaucracy and administrative duties overload, admissions of many patients, and poor work culture. CONCLUSIONS Burnout is common among medical and radiation oncologists in Poland. There is a high demand for psychological support and organizational changes in the workplace to reduce risk and mitigate the adverse effects of burnout among health care professionals.
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Affiliation(s)
- P Sobczuk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw.
| | - A Gawlik-Urban
- Clinical Oncology Department with Chemotherapy Subunit, Provincial Hospital Saint Luke, Tarnów; Faculty of Health Sciences, University of Applied Sciences in Tarnów, Tarnów
| | - D Sigorski
- Department of Oncology, University of Warmia and Mazury, Olsztyn; Department of Oncology and Immuno-Oncology, Warmian-Masurian Cancer Center of the Ministry of the Interior and Administration's Hospital, Olsztyn
| | - J Kiszka
- Department of Clinical Oncology, Subcarpathian Cancer Center, Brzozów
| | - M Osmola
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw
| | - K Machulska-Ciuraj
- Department of Clinical Oncology and Chemotherapy, Independent Public Clinical Hospital No. 4, Lublin
| | - M Wilk
- Oncology Department, ECZ-Postgraduate Medical Center European Health Center, Otwock
| | - A Brodziak
- Department of Oncology and Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw; Laboratory of Centre for Preclinical Research, Department of Experimental and Clinical Physiology, Medical University of Warsaw, Warsaw, Poland
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Singh AP, Xiao L, O'Brien BJ, Blondeau CE, Flowers CR, Bruera E, Morris VK, Shah AY. Association of Emotional Exhaustion With Career Burnout Among Early-Career Medical Oncologists: A Single-Institution Study. JCO Oncol Pract 2024; 20:137-144. [PMID: 37235818 DOI: 10.1200/op.22.00782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/09/2023] [Accepted: 04/12/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE Burnout is a psychological occupational syndrome defined by the Maslach Burnout Inventory (MBI) as emotional exhaustion, depersonalization, and a low sense of personal accomplishment. We sought to characterize the prevalence of burnout among early-career medical oncologists at The University of Texas MD Anderson Cancer Center (MDACC). METHODS For this institutional review board-approved study, an electronic survey was developed for Assistant Professors in the MDACC Division of Cancer Medicine. All participants were involved directly in patient care. Our survey included questions assessing self-reported burnout, nine questions validated in the abbreviated MBI, and 31 questions to assess potential contributors to burnout. Each question was scaled 1-5, with higher scores associated with higher burnout. Descriptive statistics were used to estimate the prevalence of burnout, and logistic regression analyses were performed to identify contributing factors. RESULTS Among 86 Assistant Professors, 56 (65%) responded to the survey. The mean duration on faculty was 3.1 years. The mean clinical effort was 67% (range, 19-95). Fifty-four percent of respondents self-reported symptoms of burnout including 21% indicating severe burnout. Using the MBI, sentiments of being emotionally drained (54%), fatigued facing another day on the job (45%), and becoming more callous (30%) were especially notable. Twenty-five percent of respondents exhibited severe emotional exhaustion, which was more prevalent (P < .0001) than depersonalization (6%) or lack of personal accomplishment (17%). CONCLUSION Burnout exists with high prevalence among early-career medical oncologists, with emotional exhaustion being the most common manifestation of burnout. Interventions focusing on reducing emotional exhaustion are needed to reduce burnout among early-career medical oncologists.
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Affiliation(s)
- Anmol P Singh
- Hematology/Oncology Fellowship Program, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX
| | - Lianchun Xiao
- Division of Cancer Medicine, Department of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | - Barbara J O'Brien
- Division of Cancer Medicine, Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX
| | - Claire E Blondeau
- Administrative Office, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX
| | - Christopher R Flowers
- Division of Cancer Medicine, Department of Lymphoma-Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- Division of Cancer Medicine, Department of Palliative, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX
| | - Van K Morris
- Division of Cancer Medicine, Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX
| | - Amishi Y Shah
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, Houston, TX
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Böckelmann I, Zavgorodnij I, Litovchenko O, Kapustnyk V, Krasnoselskyi M, Zub K, Woitha U, Gonschor C, Thielmann B. Current incidence of professional burnout among Ukrainian oncologists in Kharkiv. Int J Occup Med Environ Health 2023; 36:717-731. [PMID: 37815128 PMCID: PMC10743352 DOI: 10.13075/ijomeh.1896.02244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVES Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and the military conflicts in Ukraine suggest that workrelated stressors increased during these crises increases work-related stress reactions. Burnout as a long-term consequence of insufficiently compensated for workloads. The regional prevalence of burnout is particularly high among oncologists. The aim of this study was to assess the current risk of burnout within this group of physicians and to examine gender differences through gender-based analysis. MATERIAL AND METHODS Thirtyseven oncologists (17 men and 20 women aged 46.5±13.6 years [range 26-74 years]) in Kharkiv, Ukraine, participated. The Maslach Burnout Inventory - General Survey (MBI-GS) questionnaire was used to determine the extent of occupational. RESULTS Gender, age, and work experience had no effect on the following results. Women demonstrated higher scores in emotional exhaustion and personal accomplishment of the MBI than men. In contrast, men offered higher cynicism scores. The MBI total score was also higher for the male oncologists. Only 1 person of the total sample had risk of burnout. CONCLUSIONS The results showed a high prevalence of burnout symptoms among Ukrainian oncologists without gender differences. From occupational health perspective behavioral and behavior-preventive measures are needed for clinics and oncologists to counteract the burnout symptoms, e.g. exhaustion or cyniscism. Further studies are needed here to examine the effectiveness of these measures. Int J Occup Med Environ Health. 2023;36(6):717-3.
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Affiliation(s)
- Irina Böckelmann
- Otto von Guericke University Magdeburg, Institute of Occupational Medicine, Faculty of Medicine, Magdeburg, Germany
| | - Igor Zavgorodnij
- Kharkiv National Medical University, Department of Hygiene and Ecology No. 2, Kharkiv, Ukraine
| | - Olena Litovchenko
- Kharkiv National Medical University, Department of Hygiene and Ecology No. 2, Kharkiv, Ukraine
| | - Valerij Kapustnyk
- Kharkiv National Medical University, Department of Internal and Occupational Diseases, Kharkiv, Ukraine
| | - Mykola Krasnoselskyi
- National Academy of Medical Sciences of Ukraine, Grigoryev Institute of Medical Radiology and Oncology, Kharkiv, Ukraine
| | - Kseniia Zub
- Kharkiv National Medical University, Department of Neurology, Kharkiv, Ukraine
| | - Ulrike Woitha
- Otto von Guericke University Magdeburg, Institute of Occupational Medicine, Faculty of Medicine, Magdeburg, Germany
| | - Cecile Gonschor
- Otto von Guericke University Magdeburg, Institute of Occupational Medicine, Faculty of Medicine, Magdeburg, Germany
| | - Beatrice Thielmann
- Otto von Guericke University Magdeburg, Institute of Occupational Medicine, Faculty of Medicine, Magdeburg, Germany
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Rizwan F, Monjur F, Rahman M, Tamanna S, Khan NM, Islam MR, Alam S, Mariyam L. Burnout risks in Bangladeshi Physicians: A multicenter, cross-sectional study. Heliyon 2023; 9:e22386. [PMID: 38125415 PMCID: PMC10730433 DOI: 10.1016/j.heliyon.2023.e22386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 11/04/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023] Open
Abstract
Physician burnout is a global concern that can lead to exhaustion, ineffectiveness, and poor health outcomes. Burnout has been linked to a variety of societal and professional variables worldwide. This cross-sectional, multi-centered study was conducted by face-to-face interviews between April 2019 and December 2021 at sixty-two (62) tertiary level hospitals to identify potential risk factors for burnout among Bangladeshi physicians, which is essential for preventing adverse impact on their well-being, improving overall quality of life, and facilitating measures to manage stress and maintain a healthy work-life balance. A simple random sampling technique in conjunction with a structured questionnaire was used to collect a total of 1434 responses, assuming 20 % of the sample as non-responsive. Univariate, bivariate, and multinomial logistic regression statistical analyses were performed to determine the risk factors and associate the level of severity. The distribution of burnout status differs significantly at distinct covariate levels, such as working place, working hour, prevalence of potential interpersonal conflicts (subsequent increase of adjusted odds ratios i.e.; 6.52, 8.82, 11.41, and 37.07 is observed for physicians having interpersonal conflicts with both co-workers & family members), job dissatisfaction, annoyed feeling while dealing with patients (adjusted odds ratios are 529.68, 518.26,983.87 and 849.57 respectively) and some other significant factors of the physicians. This study also reveals that the female physicians, physicians with age 40-49, physicians with additional liabilities, physicians with job dissatisfaction, less salary compared to the workload, less flexibility and security at the job sector as well as obese physicians are at high risk of burnout. These results are statistically significant with a p value ≤ 0.05. To reduce burnout of Bangladeshi physicians, it is necessary to address the risk factors, create supportive workplaces, maintain a healthy work-life balance, provide opportunities for self-care, and promote mental health.
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Affiliation(s)
- Farhana Rizwan
- Department of Pharmacy, East West University, A/2, Jahurul Islam Avenue, Jahurul Islam City, Aftabnagar, Dhaka, 1212, Bangladesh
| | - Forhad Monjur
- Department of Clinical Pathology, Dr. MR Khan Shishu Hospital & Child Health Institute, Mirpur-2, Dhaka, 1216, Bangladesh
| | - Mamunur Rahman
- Department of Pharmacy, East West University, A/2, Jahurul Islam Avenue, Jahurul Islam City, Aftabnagar, Dhaka, 1212, Bangladesh
| | - Samiha Tamanna
- Department of Pharmacy, East West University, A/2, Jahurul Islam Avenue, Jahurul Islam City, Aftabnagar, Dhaka, 1212, Bangladesh
| | - Noor Muhammad Khan
- Biostatistics Epidemiology and Public Health, Department of Cardio-Thoracic-Vascular Science and Public Health, University of Padua, Italy
- Department of Statistics, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Muhammad Rafiqul Islam
- Department of Medical Oncology, National Institute of Cancer Research and Hospital (NICRH), Dhaka, Bangladesh
| | - Samira Alam
- Department of Pharmacy, East West University, A/2, Jahurul Islam Avenue, Jahurul Islam City, Aftabnagar, Dhaka, 1212, Bangladesh
| | - Lamia Mariyam
- Department of Pharmacy, East West University, A/2, Jahurul Islam Avenue, Jahurul Islam City, Aftabnagar, Dhaka, 1212, Bangladesh
- Department of Healthcare Sector, Laura Fergusson Brain Injury Trust, New Zealand
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Samant R, Babadagli E, Laprade S, Locke GE, Zhang Y, McNeil A, Renaud J, Cisa-Paré E, Chan J, Song J, Meng J. Cancer Center Staff Satisfaction: Descriptive Results of a Canadian Study. Curr Oncol 2023; 30:9872-9885. [PMID: 37999137 PMCID: PMC10670850 DOI: 10.3390/curroncol30110717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
Caring for cancer patients is generally considered very rewarding work, but it can also be stressful and demanding. Therefore, it is important for oncology healthcare professionals to feel satisfied with their work environment in order to provide the best care possible. An ethics-approved 61-item staff satisfaction survey was developed in-house to gain insights regarding workplace satisfaction among all staff at The Ottawa Hospital Cancer Center. Descriptive statistics were used to analyze the responses. A total of 478 individuals completed the online survey, with 75.1% women, 23.2% men, and 1.7% preferring not to say. This represented the vast majority (>75%) of cancer center staff. The approximate breakdown according to healthcare professional type was as follows: 21% nurses, 20% radiation therapists, 18% physicians, 13% clerical staff, and 28% other types of staff. Almost all (97.4%) generally enjoyed their work, with 60% stating "very much" and 37.4% stating "a little bit", and 93.3% found working with cancer patients rewarding. The overall satisfaction level at work was high, with 30.1% reporting "very satisfied" and 54.2% "somewhat satisfied". However, in terms of their work being stressful, 18.6% stated it was "very much" and 62.1% "a little bit". Also, in terms of their workload, 61.3% stated it was "very busy" and 10% stated it was "excessively busy". The most enjoyable aspects of work were listed as interactions with colleagues, interactions with patients, and learning new things. The least enjoyable aspects of work were excessive workload, a perceived unsupportive work environment, and technology problems. Levels of satisfaction and stress at work varied according to role at the cancer center. Most cancer center staff seem to enjoy their work and find it rewarding. However, the work environment can be challenging and stressful. Areas for improvement include managing workloads, ensuring staff feel supported, and improving the user-friendliness of technology.
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Affiliation(s)
- Rajiv Samant
- The Ottawa Hospital Cancer Center, Ottawa, ON K1H 8L6, Canada; (R.S.); (S.L.); (G.E.L.); (A.M.); (J.R.); (J.M.)
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Ege Babadagli
- The Ottawa Hospital Cancer Center, Ottawa, ON K1H 8L6, Canada; (R.S.); (S.L.); (G.E.L.); (A.M.); (J.R.); (J.M.)
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Selena Laprade
- The Ottawa Hospital Cancer Center, Ottawa, ON K1H 8L6, Canada; (R.S.); (S.L.); (G.E.L.); (A.M.); (J.R.); (J.M.)
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Gordon Emil Locke
- The Ottawa Hospital Cancer Center, Ottawa, ON K1H 8L6, Canada; (R.S.); (S.L.); (G.E.L.); (A.M.); (J.R.); (J.M.)
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Yuxin Zhang
- The Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada;
| | - Angela McNeil
- The Ottawa Hospital Cancer Center, Ottawa, ON K1H 8L6, Canada; (R.S.); (S.L.); (G.E.L.); (A.M.); (J.R.); (J.M.)
| | - Julie Renaud
- The Ottawa Hospital Cancer Center, Ottawa, ON K1H 8L6, Canada; (R.S.); (S.L.); (G.E.L.); (A.M.); (J.R.); (J.M.)
| | | | - Jessica Chan
- Division of Radiation Oncology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- BC Cancer, Vancouver, BC V5Z 4E6, Canada
| | - Jiheon Song
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | - Joanne Meng
- The Ottawa Hospital Cancer Center, Ottawa, ON K1H 8L6, Canada; (R.S.); (S.L.); (G.E.L.); (A.M.); (J.R.); (J.M.)
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Pollard KJ, Gittelsohn J, Patel P, Lianov L, Freeman K, Staffier KL, Pauly KR, Karlsen MC. Lifestyle Medicine Practitioners Implementing a Greater Proportion of Lifestyle Medicine Experience Less Burnout. Am J Health Promot 2023; 37:1121-1132. [PMID: 37368959 PMCID: PMC10631282 DOI: 10.1177/08901171231182875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
PURPOSE To identify reasons for burnout, characterize the effect of lifestyle medicine (LM) practice on burnout, and assess the risk of burnout in relation to the proportion of LM practice. DESIGN Analysis of mixed methods data from a large, cross-sectional survey on LM practice. SETTING Web-based survey platform. PARTICIPANTS Members of an LM medical professional society at the time of survey administration. METHODS Practitioner members of a medical professional society were recruited to a cross-sectional, online survey. Data were collected on LM practice and experiences with burnout. Free-text data were thematically grouped and counted, and the association of burnout with the proportion of lifestyle-based medical practice was analyzed using logistic regression. RESULTS Of 482 respondents, 58% reported currently feeling burned out, 28% used to feel burned out but no longer do, and 90% reported LM had positively impacted their professional satisfaction. Among LM practitioners surveyed, practicing more LM was associated with a 43% decrease (0.569; 95% CI: 0.384, 0.845; P = 0.0051) in the odds of experiencing burnout. Top reasons for positive impact included professional satisfaction, sense of accomplishment, and meaningfulness (44%); improved patient outcomes and patient satisfaction (26%); enjoyment of teaching/coaching and engaging in relationships (22%); and helps me personally: quality of life and stress (22%). CONCLUSION Implementing LM as a greater proportion of medical practice was associated with lower likelihood of burnout among LM practitioners. Results suggest that increased feelings of accomplishment due to improved patient outcomes and reduced depersonalization contribute to reduced burnout.
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Affiliation(s)
| | - Joel Gittelsohn
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Liana Lianov
- Global Positive Health Institute, Sacramento, CA, USA
| | - Kelly Freeman
- American College of Lifestyle Medicine, Chesterfield, MO, USA
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Lee AI, Masselink LE, De Castro LM, Marshall AL, Connell NT, Dent GA, Fritz J, Homer M, Lucas TL, Naik RP, Nelson M, O’Connell CL, Rajasekhar A, Reynolds RJ, Sharma D, Smith M, Weeks LD, Erikson CE. Burnout in US hematologists and oncologists: impact of compensation models and advanced practice provider support. Blood Adv 2023; 7:3058-3068. [PMID: 35476017 PMCID: PMC10331414 DOI: 10.1182/bloodadvances.2021006140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/20/2022] Open
Abstract
Burnout is prevalent throughout medicine. Few large-scale studies have examined the impact of physician compensation or clinical support staff on burnout among hematologists and oncologists. In 2019, the American Society of Hematology conducted a practice survey of hematologists and oncologists in the AMA (American Medical Association) Masterfile; burnout was measured using a validated, single-item burnout instrument from the Physician Work-Life Study, while satisfaction was assessed in several domains using a 5-point Likert scale. The overall survey response rate was 25.2% (n = 631). Of 411 respondents with complete responses in the final analysis, 36.7% (n = 151) were from academic practices and 63.3% (n = 260) from community practices; 29.0% (n = 119) were female. Over one-third (36.5%; n = 150) reported burnout, while 12.0% (n = 50) had a high level of burnout. In weighted multivariate logistic regression models incorporating numerous variables, compensation plans based entirely on relative value unit (RVU) generation were significantly associated with high burnout among academic and community physicians, while the combination of RVU + salary compensation showed no significant association. Female gender was associated with high burnout among academic physicians. High advanced practice provider utilization was inversely associated with high burnout among community physicians. Distinct patterns of career dissatisfaction were observed between academic and community physicians. We propose that the implementation of compensation models not based entirely on clinical productivity increased support for women in academic medicine, and expansion of advanced practice provider support in community practices may address burnout among hematologists and oncologists.
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Affiliation(s)
- Alfred Ian Lee
- Section of Hematology, Yale School of Medicine, New Haven, CT
| | - Leah E. Masselink
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Laura M. De Castro
- Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Nathan T. Connell
- Hematology Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Georgette A. Dent
- Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Josel Fritz
- American Society of Hematology, Washington, DC
| | | | | | - Rakhi P. Naik
- Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Marquita Nelson
- Division of Hematology/Oncology, University of Tennessee Health Science Center, Memphis, TN
| | - Casey L. O’Connell
- Jane Anne Nohl Division of Hematology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Anita Rajasekhar
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL
| | | | - Deva Sharma
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Melody Smith
- Division of Blood & Marrow Transplantation and Cellular Therapy, Stanford University, Stanford, CA
| | | | - Clese E. Erikson
- Fitzhugh Mullan Institute for Health Workforce Equity, The George Washington University, Washington, DC
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Long H, Li Q, Zhong X, Yang L, Liu Y, Pu J, Yan L, Ji P, Jin X. The prevalence of professional burnout among dentists: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2023; 28:1767-1782. [PMID: 37138501 DOI: 10.1080/13548506.2023.2208364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/24/2023] [Indexed: 05/05/2023]
Abstract
Professional burnout refers to mental weariness caused by occupational stress. However, there is a lack of systematic studies on the prevalence of professional burnout among dentists. The purpose of this study was to investigate the prevalence of professional burnout among dentists. Databases including PubMed, PsycINFO, Embase, Cochrane, and Web of Science were systematically searched from inception to 28 October 2021. The random-effects model and forest plots were used to assess the pooled prevalence of professional burnout among dentists. A total of 15 studies with a total of 6038 study subjects were included in the meta-analysis, and the overall professional burnout among dentists was 13% (95%CI: 6-23). Subgroup analysis suggested a high prevalence of burnout in Europe, and the least in the Americas. The pooled burnout prevalence in cross-sectional surveys was significantly lower than that in longitudinal studies. In addition, the overall burnout prevalence in the last decade was significantly lower than that of a decade ago. This meta-analysis demonstrated that the prevalence of burnout was relatively low among dentists, and there was a downward trend. Therefore, it is important to continue to pay close attention to the mental health of dentists and effectively prevent and treat professional burnout to better maintain the provision of health care services.
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Affiliation(s)
- Huiqing Long
- Key Laboratory of Psychoseomadsy, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Stomatological Hospital of Chongqing Medical University, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Qingshu Li
- Department of Pathology, Molecular Medicine and Cancer Research Center, Chongqing Medical University, Chongqing, P.R. China
| | - Xiaogang Zhong
- Key Laboratory of Psychoseomadsy, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lu Yang
- Key Laboratory of Psychoseomadsy, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Stomatological Hospital of Chongqing Medical University, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yiyun Liu
- Key Laboratory of Psychoseomadsy, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juncai Pu
- Key Laboratory of Psychoseomadsy, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Yan
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Ping Ji
- Key Laboratory of Psychoseomadsy, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Stomatological Hospital of Chongqing Medical University, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Xin Jin
- Key Laboratory of Psychoseomadsy, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Stomatological Hospital of Chongqing Medical University, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
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Charlton TG, Hindocha S. Editorial Future Proofing the Clinical Oncology Workforce. Clin Oncol (R Coll Radiol) 2023; 35:314-317. [PMID: 36805130 DOI: 10.1016/j.clon.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/10/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023]
Affiliation(s)
- T G Charlton
- The Royal Marsden NHS Foundation Trust, London, UK.
| | - S Hindocha
- UKRI Centre for Doctoral Training in Artificial Intelligence in Healthcare, Imperial College London, London, UK
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Martinez DAS, Quilez-Cutillas A, Jimenez-Labaig P, Sesma A, Tarazona N, Pacheco-Barcia V, Obispo B, Paez D, Quintanar T, Sanchez-Canovas M, Montes AF, Felip E, Rodriguez-Lescure A, Elez E. Current professional standing of young medical oncologists in Spain: a nationwide survey by the Spanish Society of Medical Oncology + MIR section. Clin Transl Oncol 2023; 25:796-802. [PMID: 36418642 PMCID: PMC9685015 DOI: 10.1007/s12094-022-02989-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a lack of knowledge about the career paths and employment situation of young medical oncologists. The aim of our study was to evaluate the current professional standing of these professionals in Spain. METHODS The Spanish Society of Medical Oncology + MIR section conducted a national online survey in May 2021 of young medical oncology consultants (< 6 years of expertise) and final year medical oncology residents. RESULTS A total of 162 responses were eligible for analysis and included participants from 16 autonomous communities; 64% were women, 80% were consultants, and 20% were residents. More than half of the participants performed routine healthcare activity and only 7% research activity. Almost three quarters (73%) were subspecialized in a main area of interest and almost half of these chose this area because it was the only option available after residency. Half of the respondents (51%) considered working abroad and 81% believed the professional standing in Spain was worse than in other countries. After finishing their residency, only 22 were offered a job at their training hospital. Just 16% of participants had a permanent employment contract and 87% were concerned (score of ≥ 5 on a scale of 1-10) about their job stability. In addition, one quarter of the participants in our study showed an interest in increasing their research activity. CONCLUSIONS The choice of subspecialty in medical oncology may depend on job opportunities after residency rather than personal interest. The abundance of temporary contracts may have influenced the job stability concerns observed. Future mentoring strategies should engage in building a long-term career path for young medical oncologists.
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Affiliation(s)
- Domingo Antonio Sanchez Martinez
- grid.411372.20000 0001 0534 3000Department of Medical Oncology, IMIB, Virgen de La Arrixaca University Hospital, Murcia, Región de Murcia Spain
| | - Aliica Quilez-Cutillas
- Department of Medical Oncology, Can Misses Hospital, Área de Salud de Ibiza y Formentera (ASEF), Ibiza, Illes Balears Spain
| | - Pablo Jimenez-Labaig
- grid.411232.70000 0004 1767 5135Department of Medical Oncology, Cruces University Hospital, Barakaldo, Bizkaia Spain
| | - Andrea Sesma
- grid.411050.10000 0004 1767 4212Department of Medical Oncology, Lozano Blesa University Clinical Hospital, Zaragossa, Aragón Spain
| | - Noelia Tarazona
- grid.429003.c0000 0004 7413 8491Department of Medical Oncology, INCLIVA Biomedical Research Institute, Comunitat Valenciana, Spain ,grid.510933.d0000 0004 8339 0058Instituto de Salud Carlos III, CIBERONC, Madrid, Spain
| | - Vilma Pacheco-Barcia
- grid.411171.30000 0004 0425 3881Department of Medical Oncology, Torrejón University Hospital, Madrid, Spain
| | - Berta Obispo
- grid.414761.1Department of Medical Oncology, Infanta Leonor University Hospital, Madrid, Spain
| | - David Paez
- grid.410458.c0000 0000 9635 9413Department of Medical Oncology, Santa Creu i Sant Pau University Hospital, Barcelona, Catalunya Spain
| | - Teresa Quintanar
- grid.411089.50000 0004 1768 5165Department of Medical Oncology, Elche University General Hospital, Elche, Comunitat Valenciana Spain
| | - Manuel Sanchez-Canovas
- grid.411089.50000 0004 1768 5165Department of Hematology and Medical Oncology, Morales Meseguer University General Hospital, Murcia, Región de Murcia Spain
| | - Ana Fernandez Montes
- grid.418883.e0000 0000 9242 242XDepartment of Medical Oncology, University Hospital Complex of Ourense (CHUO), Ourense, Galicia Spain
| | - Enriqueta Felip
- grid.411083.f0000 0001 0675 8654Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology Department, Vall d’Hebron University Hospital, Univesitat Autònoma de Barcelona (UAB), 119-129, 08035 Barcelona, Catalunya Spain
| | - Alvaro Rodriguez-Lescure
- grid.411089.50000 0004 1768 5165Department of Medical Oncology, Elche University General Hospital, Elche, Comunitat Valenciana Spain
| | - Elena Elez
- Vall d'Hebron Institute of Oncology (VHIO), Medical Oncology Department, Vall d'Hebron University Hospital, Univesitat Autònoma de Barcelona (UAB), 119-129, 08035, Barcelona, Catalunya, Spain.
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Helaß M, Haag GM, Bankstahl US, Gencer D, Maatouk I. Burnout among German oncologists: a cross-sectional study in cooperation with the Arbeitsgemeinschaft Internistische Onkologie Quality of Life Working Group. J Cancer Res Clin Oncol 2023; 149:765-777. [PMID: 35152317 PMCID: PMC8852884 DOI: 10.1007/s00432-022-03937-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/29/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE Oncologists are at an increased risk of developing burnout, leading to negative consequences in patient care and in professional satisfaction and quality of life. This study was designed to investigate exhaustion and disengagement among German oncologists and assess the prevalence of burnout among oncologists within different professional settings. Furthermore, we wanted to examine possible relations between sociodemographic factors, the oncological setting, professional experience and different aspects of burnout. METHODS In a cross-sectional study design, an Internet-based survey was conducted with 121 oncologists between April and July 2020 using the Oldenburg Burnout Inventory, which contains items on exhaustion, disengagement, and burnout. Furthermore, sociodemographic data of the participants were assessed. The participants were members of the Working Group Medical Oncology (Arbeitsgemeinschaft Internistische Onkologie) within the German Cancer Society. RESULTS The survey showed a burnout prevalence of 43.8%, which correlated with age and professional experience; that is, the prevalence is particularly high among younger oncologists. Exhaustion is closely related to employment status; that is, it was significantly higher among employed oncologists. There were remarkably low levels of disengagement among oncologists, highlighting the own demand to fulfil job requirements despite imminent or actual overburdening in daily work. CONCLUSION More support is necessary to mitigate the professional stressors in the healthcare system. To ensure quality medical care, employees should be offered preventive mental health services early in their careers.
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Affiliation(s)
- Madeleine Helaß
- grid.5253.10000 0001 0328 4908Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Georg Martin Haag
- grid.5253.10000 0001 0328 4908Department of Medical Oncology, National Centre for Tumour Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - Ulli Simone Bankstahl
- Institute for Clinical-Oncological Research (IKF), Krankenhaus Nordwest gGmbH, Frankfurt, Germany
| | - Deniz Gencer
- grid.7700.00000 0001 2190 4373Department of Medicine III, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany
| | - Imad Maatouk
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany. .,Section of Psychosomatic Medicine, Psychotherapy and Psycho-Oncology, Department of Internal Medicine II, Julius-Maximilian University Würzburg, Würzburg, Germany. .,Psychosomatics, Psychotherapy and Psychooncology, University Hospital Würzburg, Medical Clinic II, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
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Pittens C, Dhont J, Petit S, Dubois L, Franco P, Mullaney L, Aznar M, Petit-Steeghs V, Bertholet J. An impact model to understand and improve work-life balance in early-career researchers in radiation oncology. Clin Transl Radiat Oncol 2022; 37:101-108. [PMID: 36186923 PMCID: PMC9523090 DOI: 10.1016/j.ctro.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose The COVID-19 pandemic had a substantial effect on mental health and work productivity of early-career researchers working in Radiation Oncology (RO). However, the underlying mechanisms of these effects are unclear. The aim of the current qualitative study was therefore to achieve a better understanding of how these effects arose and could be managed in the future. Methods This study was conducted jointly by RO and qualitative health researchers. Data was collected in four online Focus Groups with 6-11 RO researchers (total N = 31) working in Europe. The transcripts were analysed through a qualitative cross-impact analysis. Results Causal relations were identified between seventeen variables that depict the impact of disrupted working conditions. Mental health and work productivity were indeed the most important affected variables, but relations between variables towards these impacts were complex. Relations could either be positive or negative and direct or indirect, leading to a cascade of interrelated events which are highly personal and could change over time. We developed the model 'impact of disrupted working conditions' depicting the identified variables and their relations, to allow more individual assessment and personalised solutions. Conclusion The impacts of disrupted working conditions on RO researchers varied due to the complexity of interrelated variables. Consequently, collective actions are not sufficient, and a more personal approach is needed. Our impact model is recommended to help guide conversations and reflections with the aim of improving work/life balance. The participants showed high levels of personal responsibility towards their own mental health and work productivity. Although being an individual issue, a collective responsibility in developing such approaches is key due to the dependency on organizational variables.
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Affiliation(s)
- Carina Pittens
- Athena Institute, VU University Amsterdam, Amsterdam, the Netherlands
| | - Jennifer Dhont
- Department of Medical Physics, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Steven Petit
- European Society for Radiotherapy & Oncology (ESTRO) Young Committee, Brussels, Belgium
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Ludwig Dubois
- European Society for Radiotherapy & Oncology (ESTRO) Young Committee, Brussels, Belgium
- The M-Lab, Department of Precision Medicine, GROW – School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Pierfrancesco Franco
- European Society for Radiotherapy & Oncology (ESTRO) Young Committee, Brussels, Belgium
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy
| | - Laura Mullaney
- European Society for Radiotherapy & Oncology (ESTRO) Young Committee, Brussels, Belgium
- Applied Radiation Therapy Trinity Research Group, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Ireland
| | - Marianne Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Violet Petit-Steeghs
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Jenny Bertholet
- European Society for Radiotherapy & Oncology (ESTRO) Young Committee, Brussels, Belgium
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Corresponding author at: Jenny Bertholet, Inselspital, University Hospital Bern, Friedbühlschulhaus, CH-3010 Bern, Switzerland.
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Fit theory: A cancer experience grounded theory emerging from semi-structured interviews with cancer patients and informal caregivers in Manitoba Canada during the COVID-19 pandemic. PLoS One 2022; 17:e0269285. [PMID: 35867713 PMCID: PMC9307189 DOI: 10.1371/journal.pone.0269285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 05/17/2022] [Indexed: 11/19/2022] Open
Abstract
Background It is not clear how changes to healthcare delivery related to the COVID-19 pandemic, including virtual care and social distancing restrictions, have impacted the experience of living with cancer. This study aimed to discover a theory capable of describing the cancer experience, how the pandemic impacted it, and for guiding predictions about how to improve it. Methods Between October 2020 and July 2021 digitally recorded semi-structured one-on-one interviews were conducted virtually with adult cancer patients and informal caregivers in Manitoba, Canada. Transcriptions and field notes from the interviews were analyzed using classic grounded theory. Results Interviews with 33 patients and 6 informal caregivers were conducted. Fit emerged as the core concept of the theory and describes the relationship between the healthcare system and the unique combination of characteristics each patient has. Good fit results in a positive experience and poor fit in a negative experience. Virtual care improves fit in clinical situations where non-verbal communication and physical examination are not important. Support from informal caregivers improves fit. Social distancing restrictions reduce the ability of informal caregivers to provide support. Conclusions The impact of fit on the cancer experience suggests that care delivery should be tailored to both the individual needs of the patient and the intention of the clinical interaction. Developing evidence-based strategies to inform the integration of virtual care into oncology practice, with aim of promoting good fit between patients and healthcare services, is an important future direction.
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Burnout among doctors in China through 2020: A systematic review and meta-analysis. Heliyon 2022; 8:e09821. [PMID: 35855985 PMCID: PMC9287156 DOI: 10.1016/j.heliyon.2022.e09821] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/13/2022] [Accepted: 06/24/2022] [Indexed: 01/21/2023] Open
Abstract
Objective To analyze surveys measuring the prevalence of burnout among Chinese doctors and reveal the overall prevalence, characteristics, timeline, and factors related to burnout. Methods A comprehensive search was conducted on China National Knowledge Infrastructure, WANFANG, PubMed, EMBASE, PsycINFO and Cochrane Library databases from their inception to 28 February 2021. Random-effects meta-analyses, meta-regression and planned subgroup analyses were performed, and the standardized mean difference was adopted for comparisons between subgroups. Egger’s and Begg’s tests were performed to evaluate publication bias. Heterogeneity across the studies was tested using the I2 statistic. The study protocol was registered on PROSPERO (CRD42018104249). Results In total, 3,210 records were reviewed; 64 studies including 48,638 Chinese doctors were eligible for meta-analysis. The prevalence of burnout increased continuously from 2008 to 2017 and decreased significantly from 2018 to 2020, a little increase from 2020 to 2021. The overall prevalence of burnout was 75.48% (95% CI, 69.20 to 81.26; I2 = 99.23%, P < 0.001), and high burnout was 9.37% (95% CI, 4.91 to 15.05, I2 = 98.88%, P < 0.001). The prevalence of emotional exhaustion was 48.64% (95% CI, 38.73 to 58.59; I2 = 99.53%, P < 0.001), depersonalization was 54.67% (95% CI, 46.95 to 62.27; I2 = 99.20%, P < 0.001), and reduced personal accomplishment was 66.53% (95% CI, 58.13 to 74.44; I2 = 99.37%, P < 0.001). Gender, marriage, professional title and specialty all influenced burnout. Conclusions The results showed that the total prevalence of doctor burnout in China is very high. The prevalence of burnout varies by location. Gender, marital status and professional title all affect burnout scores.
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How Much Burnout and Coping Influence Quality of Life among Young Oncology Providers in Romania during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095508. [PMID: 35564906 PMCID: PMC9102177 DOI: 10.3390/ijerph19095508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 12/10/2022]
Abstract
This study aims to investigate the correlations between burnout, coping strategies, and quality of life among young oncology healthcare workers in Romania during the COVID-19 pandemic. We collected the data using an online questionnaire consisting of sociodemographic questions, the Maslach Burnout Inventory, the COPE questionnaire, and the 15D instrument. A total of 122 healthcare providers responded to our survey. We evaluated the differences in the scores among the three groups of healthcare workers in oncology under 40 years old: medical oncologists (n = 87), radiation oncologists (n = 11), and oncology nurses (n = 24). Finally, we conducted a correlation analysis between the dimensions of burnout, coping, and quality of life. Overall, the medical oncologists exhibited much higher burnout levels than nurses in the COVID-19 pandemic outbreak, having statistically significant higher levels of emotional exhaustion, depersonalization, and lack of personal achievement. Some factors were inversely associated with burnout: active approach, planning, positive interpretation and growth, and acceptance. Our findings illustrated a very good level of health-related quality of life (average = 0.93, SD = 0.06), and no statistically significant differences were found in the quality of life between the three groups. This study was the first to identify the profile of young oncology providers in Romania. Our findings may be relevant in creating preventive strategies for burnout and increasing the quality of life in Romanian young oncology providers in future crises.
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Abusanad A, Bensalem A, Shash E, Mula-Hussain L, Benbrahim Z, Khatib S, Abdelhafiz N, Ansari J, Jradi H, Alkattan K, Jazieh AR. Prevalence and Risk Factors of Burnout Among Female Oncologists From the Middle East and North Africa. Front Psychol 2022; 13:845024. [PMID: 35391953 PMCID: PMC8980775 DOI: 10.3389/fpsyg.2022.845024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Burnout (BO) is a recognized challenge among the oncology workforce. It affects both genders with a higher frequency among women. This study examined the factors contributing to the development of burnout among female oncologists from the Middle East and North Africa (MENA). Methods An online cross-sectional survey was distributed to oncology professionals from different countries in the MENA region. The validated Maslach Burnout Inventory (MBI) of emotional exhaustion (EE), Depersonalization (DE), and Personal Achievement (PA) plus questions about demography/work-related factors and attitudes toward oncology were included. Data were analyzed to measure BO prevalence and related factors. Results Between 10 February and 15 March 2020, 545 responses were submitted by female oncologists. The responses pre-dated the COVID-19 pandemic emergence in the region. BO prevalence was 71% among female professionals. Women aged <44 years represented 85% of the cohort. Sixty-two percent were married, 52% with children and one-third practiced a hobby. Two-thirds worked in medical oncology, worked for <10 years and 35% worked in academia. The majority (73%) spent >25% on administrative work daily. Nearly half of the respondents (49%) expressed a recurring thought of quitting oncology and 70% had no burnout support or education. Inability to deliver optimal care was reported as distressing for career development in 82%. Factors significantly influencing the BO risk were identified. Marital status, having children, academia and years in practice did not impact the risk of BO among female oncologists from MENA. Conclusion Female oncologists from the Middle East and North Africa (MENA) were found to have a high prevalence of BO. In this cohort, the majority of women oncology workers were young and in their early to mid-career stages. Burnout was linked to being younger, practicing in North African nations, having a heavy administrative load, and having persistent thoughts of quitting. Practicing a hobby and engaging in oncology communication, on the other hand, reduced the chance of BO. Burnout support and education, specifically for oncology women, is required.
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Affiliation(s)
- Atlal Abusanad
- Faculty of Medicine, Medical Oncology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Assia Bensalem
- Oncology Department, CHU Dr Benbadis, Constantine, Algeria
| | - Emad Shash
- Medical Oncology, National Cancer Institute - Cairo University, Cairo, Egypt
| | - Layth Mula-Hussain
- Department of Radiation Oncology, Sultan Qaboos Comprehensive Cancer and Research Center, Muscat, Oman
| | - Zineb Benbrahim
- Medical Oncology, CHU - University Hospital of Hassan II, Fez, Morocco
| | - Sami Khatib
- Oncology Department, Private Sector, Amman, Jordan
| | - Nafisa Abdelhafiz
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Jawaher Ansari
- Medical Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Hoda Jradi
- Public Health Faculty, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Khaled Alkattan
- Head of Thoracic Surgery at King Faisal Specialist Hospital and Research Center (KFSH-RC), Alfaisal University, Riyadh, Saudi Arabia
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Handley NR, Wen KY, Gomaa S, Brassil K, Shimada A, Leiby B, Jackson L, McMorris M, Calvaresi A, Dicker AP. A Pilot Feasibility Study of Digital Health Coaching for Men With Prostate Cancer. JCO Oncol Pract 2022; 18:e1132-e1140. [PMID: 35394806 DOI: 10.1200/op.21.00712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Prostate cancer is the most common cancer among men in the United States. The majority of prostate cancer treatment occurs in the ambulatory setting, and patients and their caregivers take on significant responsibility for monitoring and managing treatment and disease-related toxicity. Digital health coaching has shown promise as a tool to positively influence outcomes. We completed a single-arm pilot study to assess the feasibility of digital health coaching in men with prostate cancer. METHODS Men with a history of prostate cancer requiring treatment in the past 2 years were eligible for inclusion. Participants engaged in a 12-week health coaching program, consisting of a combination of at least one telephone call and up to four digital nudges (defined as content delivered via text, e-mail, or app on the basis of the participant's preference) per week. Prostate cancer-specific content addressed one of the following topics each week: fatigue, pain management, healthy eating, exercise, managing incontinence, sexual health, managing stress and anxiety, financial toxicity, goal setting during treatment, managing side effects, communicating with the health care team, and medication adherence. Services were provided at no cost to the participant. RESULTS A hundred patients were consented for the study, and 88 enrolled. The feasibility threshold of 60% was met with 63 of the 88 enrolled individuals completing the 3-month program (proportion = 71.6%; 90% CI, 62.6 to 79.4; P = .016). CONCLUSION Digital health coaching for men with prostate cancer is feasible. These findings support further evaluation of digital health coaching for men with prostate cancer in larger randomized controlled trials.
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Affiliation(s)
- Nathan R Handley
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA.,Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Kuang-Yi Wen
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Sameh Gomaa
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | - Ayako Shimada
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | - Benjamin Leiby
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | | | | | - Anne Calvaresi
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Adam P Dicker
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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Braun M, Naor L, Hasson-Ohayon I, Goldzweig G. Oncologists’ Locus of Control, Compassion Fatigue, Compassion Satisfaction, and the Mediating Role of Helplessness. Curr Oncol 2022; 29:1634-1644. [PMID: 35323337 PMCID: PMC8947102 DOI: 10.3390/curroncol29030137] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/18/2022] [Accepted: 03/01/2022] [Indexed: 01/22/2023] Open
Abstract
The oncology setting may give rise to significant feelings of helplessness among oncologists via patients’ inevitable deaths or suffering. The current study examines whether and how oncologists’ sense of control (locus of control; LOC) influences their compassion fatigue and satisfaction. Methods: Seventy-three oncologists completed the following questionnaires: the Professional Quality of Life scale; Levenson’s Internal, Powerful Others, and Chance scale; the Guilt Inventory, State Guilt subscale; and the Learned Helplessness scale. Results: Oncologists reported high levels of secondary traumatic stress and burnout and moderate levels of compassion satisfaction. A positive association between oncologists’ external LOC and compassion fatigue, and a negative association between oncologists’ internal LOC and compassion fatigue, were found. Helplessness, but not guilt, had a mediating role in these associations. Internal LOC was also positively associated with compassion satisfaction. Conclusions: The current study highlights oncologists as a population at risk of experiencing compassion fatigue and emphasizes oncologists’ locus of control as a predisposition that plays a role in the development of this phenomenon. Additionally, the cognitive as well as the emotional aspects of control were found to be important factors associated with compassion fatigue.
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Affiliation(s)
- Michal Braun
- Oncology Breast Unit, Sharett Institute of Oncology, Hadassah Medical Center, Jerusalem 9574401, Israel
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Yaffo 6818211, Israel; (L.N.); (G.G.)
- Correspondence:
| | - Lee Naor
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Yaffo 6818211, Israel; (L.N.); (G.G.)
| | | | - Gil Goldzweig
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Yaffo 6818211, Israel; (L.N.); (G.G.)
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20
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Snarr RL, Beasley VL. Personal, Work-, and Client-Related Burnout Within Strength and Conditioning Coaches and Personal Trainers. J Strength Cond Res 2022; 36:e31-e40. [PMID: 35080208 DOI: 10.1519/jsc.0000000000003956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Snarr, RL and Beasley, VL. Personal, work-, and client-related burnout within strength and conditioning coaches and personal trainers. J Strength Cond Res 36(2): e31-e40, 2022-The purpose of this investigation was to examine the prevalence and influencing factors of personal, work-related, and client-related burnout within strength and conditioning coaches (SCCs) and personal trainers (PTs). Two hundred fifty-six SCCs (n = 141) and PTs (n = 115) completed the Copenhagen Burnout Inventory (CBI), a 19-item survey, measuring 3 subscales of personal, work-related, and client-related burnout. Information regarding other burnout-related factors (i.e., job satisfaction, social support, fitness level, and mental toughness) was solicited through single-item or multiple-item questionnaires. Correlational analyses and independent t-tests were conducted to assess associations and between-group differences between burnout and all continuous factors. Seventy-one subjects completed the survey before March 2020; after which, a worldwide pandemic (i.e., COVID-19) occurred possibly affecting employment workloads and work-related stress. Thus, post hoc analyses were conducted to assess differences in burnout scores pre-COVID-19 and post-COVID-19. Using a CBI subscale cutoff score of ≥50, fitness professionals reported 32.8% of personal burnout, 28.5% work-related burnout, and 18.0% client-related burnout. Factored by occupation, SCCs reported 32.6% personal burnout, 27.7% work-related burnout, and 18.4% client-related burnout. Within PTs, 33.0% reported personal burnout, 29.6% reported work-related burnout, and 17.4% reported client-related burnout. Higher levels of burnout, across all scales, were observed in those who were PTs, women, unmarried, living alone, would not choose to be a fitness professional again, and took the survey post-COVID as compared to their respective counterparts. Findings suggest that fitness professionals are not exempt from the stressors associated with personal and occupational burnout. Strength and conditioning coaches and PTs may reduce the risk of burnout by increasing social support, continuing education, and allowing for personal-care time with the intention of buffering these factors.
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Affiliation(s)
- Ronald L Snarr
- Department of Health Sciences & Kinesiology, Georgia Southern University, Statesboro, Georgia; and
| | - Vista L Beasley
- Department of Kinesiology, Sport Studies & Physical Education, State University of New York-Brockport, Brockport, New York
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21
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Couillet A, Malatier M, Le Bris MP, Mastroianni B, Chvetzoff G. Issues of mindfulness implementation for oncology caregivers. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2021; 19:791-797. [PMID: 34800928 DOI: 10.1515/jcim-2021-0372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/09/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Burn out is high in oncology. We aim to evaluate the feasibility and identify the barriers for mindfulness implementation in oncology professionals. METHODS We conducted a pilot study in which voluntary oncology caregivers entered mindfulness workshops, and complete online questionnaires. We also conducted a qualitative study to better identify the practical reasons which hamper the implementation of mindfulness in oncology caregivers having refused to participate. RESULTS 83.3% of volunteers for the workshops were women, 60.00% (16/30) of caregivers completed the program. Caregivers' resistances to mindfulness practice were: a lack of availability and information, complex organisation with limited free time, and accept spending time to take care of themselves. CONCLUSIONS This work highlights the interest of mindfulness for caregivers in oncology, we have identified specific issues hindering the implementation of such technique which can be further investigated.
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Affiliation(s)
- Audrey Couillet
- Department of Supportive Care, Léon Berard Centre, Lyon, France
| | | | | | | | - Gisèle Chvetzoff
- Department of Supportive Care, Léon Berard Centre, Lyon, France
- Claude Bernard University Lyon 1, Reshape Laboratory U1290, Lyon, France
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22
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Alghanmi HA, Tashkandi EE, Mohorjy DK, Alqahtani AM. Level of Anxiety Among Healthcare Workers at a Comprehensive Cancer Center During the Coronavirus Disease 2019 Pandemic. Cureus 2021; 13:e18089. [PMID: 34692304 PMCID: PMC8524202 DOI: 10.7759/cureus.18089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/05/2022] Open
Abstract
Objective The recent coronavirus pandemic (SARS-CoV-2) has severely increased the burden on the field of oncology, leading to the implementation of new rules to overcome its negative impact. An important issue is the psychological impact of the pandemic on already vulnerable populations, such as oncology staff, as reported by oncology associations. This study assessed the anxiety level among oncology staff during the coronavirus disease 2019 pandemic and related it to its risk factors and the effectiveness of departmental interventions that seek to provide coping methods. Methods A cross-sectional survey was administered to the oncology staff at our oncology center. Generalized anxiety disorder scale "yes-or-no" questions were used to determine secondary objectives regarding the concern of infection and the impact of a departmental intervention on overcoming distress. Results Overall, 199 participants were included in the analysis; more than 60% were women, with a median age of 34 years. More than 50% had anxiety and the most significant risk factors were parenthood and contraction of infection (P-value 0.03 and 0.02, respectively). Most responders reported an increase in the workload during the pandemic, but coping methods applied by the administration had improved anxiety levels as reported by a majority of the responders. Conclusion Oncology staff members have been negatively affected by the pandemic, although coping methods helped to improve anxiety. In the future, attention must be focused on the most vulnerable groups.
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Affiliation(s)
- Hosam A Alghanmi
- Department of Medical Oncology, Oncology Center, King Abdullah Medical City, Makkah, SAU
| | - Emad E Tashkandi
- Department of Medical Oncology, Oncology Center, King Abdullah Medical City, Makkah, SAU
| | - Doaa K Mohorjy
- Research Center - Science and Technology Unit, King Abdullah Medical City, Makkah, SAU
| | - Abdullah M Alqahtani
- Department of Mental Health, Neuroscience Center, King Abdullah Medical City, Makkah, SAU
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23
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Alabi RO, Hietanen P, Elmusrati M, Youssef O, Almangush A, Mäkitie AA. Mitigating Burnout in an Oncological Unit: A Scoping Review. Front Public Health 2021; 9:677915. [PMID: 34660505 PMCID: PMC8517258 DOI: 10.3389/fpubh.2021.677915] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: The purpose of this study was to provide a scoping review on how to address and mitigate burnout in the profession of clinical oncology. Also, it examines how artificial intelligence (AI) can mitigate burnout in oncology. Methods: We searched Ovid Medline, PubMed, Scopus, and Web of Science, for articles that examine how to address burnout in oncology. Results: A total of 17 studies were found to examine how burnout in oncology can be mitigated. These interventions were either targeted at individuals (oncologists) or organizations where the oncologists work. The organizational interventions include educational (psychosocial and mindfulness-based course), art therapies and entertainment, team-based training, group meetings, motivational package and reward, effective leadership and policy change, and staff support. The individual interventions include equipping the oncologists with adequate training that include-communication skills, well-being and stress management, burnout education, financial independence, relaxation, self-efficacy, resilience, hobby adoption, and work-life balance for the oncologists. Similarly, AI is thought to be poised to offer the potential to mitigate burnout in oncology by enhancing the productivity and performance of the oncologists, reduce the workload and provide job satisfaction, and foster teamwork between the caregivers of patients with cancer. Discussion: Burnout is common among oncologists and can be elicited from different types of situations encountered in the process of caring for patients with cancer. Therefore, for these interventions to achieve the touted benefits, combinatorial strategies that combine other interventions may be viable for mitigating burnout in oncology. With the potential of AI to mitigate burnout, it is important for healthcare providers to facilitate its use in daily clinical practices. Conclusion: These combinatorial interventions can ensure job satisfaction, a supportive working environment, job retention for oncologists, and improved patient care. These interventions could be integrated systematically into routine cancer care for a positive impact on quality care, patient satisfaction, the overall success of the oncological ward, and the health organizations at large.
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Affiliation(s)
- Rasheed Omobolaji Alabi
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Industrial Digitalization, School of Technology and Innovations, University of Vaasa, Vaasa, Finland
| | | | - Mohammed Elmusrati
- Department of Industrial Digitalization, School of Technology and Innovations, University of Vaasa, Vaasa, Finland
| | - Omar Youssef
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Alhadi Almangush
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Pathology, University of Helsinki, Helsinki, Finland.,University of Turku, Institute of Biomedicine, Pathology, Turku, Finland
| | - Antti A Mäkitie
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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24
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Burnout prevalence among European physicians: a systematic review and meta-analysis. Int Arch Occup Environ Health 2021; 95:259-273. [PMID: 34628517 DOI: 10.1007/s00420-021-01782-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/16/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Our objective was to assess burnout prevalence rates among physicians practicing in Europe (regardless of their specialty) taking into account the main approaches used to define burnout with the Maslach Burnout Inventory (MBI) tool. METHODS A systematic review was carried out from 2006 to 2018. A keyword request was obtained using the PubMed/Medline, Web of Science and Banque de Données en Santé Publique search engine. Studies written in English measuring burnout with the MBI tool among a population of practicing European physicians were selected. Data were extracted and classified according to burnout's definition provided by the authors. Three definitions using the MBI dimensions were considered: tri-, bi- and unidimensional definition. A meta-analysis was then performed on burnout prevalence rates according to the dimensional definition of burnout. RESULTS From 2378 search results, we selected 56 studies including from up to 41 European countries. Depending upon the study, physicians' burnout prevalence rates ranged from 2.5% to 72.0%. The pooled prevalence rate of burnout was estimated at 7.7% [5.3-10.4%] with the tridimensional definition, 19.7% [13.5-26.3%] with the bidimensional definition and 43.2% [29.0-57.6%] with the unidimensional definition. CONCLUSION Burnout pooled prevalence among physicians varies from single to fivefold depending on the method employed to assess burnout with the MBI tool. Medical community should determine a standardized method to assess burnout prevalence rates to best evaluate this phenomenon.
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25
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Alorabi M, Abdelhafiz AS, Mostafa N, Ali A, Elghazawy H, Mesbah A, Jazieh AR. Virtual educational meetings and activities during the COVID-19 pandemic and beyond: Egyptian oncologists' experience. Ecancermedicalscience 2021; 15:1275. [PMID: 34567260 PMCID: PMC8426005 DOI: 10.3332/ecancer.2021.1275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Indexed: 01/23/2023] Open
Abstract
The COVID-19 pandemic has had ramifications for most healthcare activities, including medical education and communication aspects. Virtual educational meetings and activities (VEMAs) have been utilised tremendously in the pandemic era, reflecting a transition to new horizons of cyberspace. This creates the need to explore possible challenges for the implementation of such services in the rapidly evolving field of oncology. The aim of our study is to explore the impact of the COVID-19 pandemic on VEMAs in the oncology community in Egypt. It focused on the evaluation of current attitudes, satisfaction and expectations of Egyptian oncologists during and beyond the COVID-19 era. The study is a cross-sectional study using a survey that was distributed through social media. It targeted Egyptian oncologists during the months of May and June 2020. A total of 118 participants completed the survey and most of them were younger than 35 years (71%). Most participants (93.2%) agreed that COVID-19 affected the stream of live medical educational meetings. About three-quarters of them attended VEMAs during the COVID-19 period compared to 50% prior to the pandemic. The majority reported that evening hours after 8 PM was the best time to attend VEMAs and 1 hour is the optimal duration for a virtual meeting. Although the COVID-19 pandemic appeared as an unprecedented challenge for medical education, it can be a catalyst for VEMAs, especially in a rapidly evolving field such as oncology. Further research is needed to assess whether learners are ready and willing to make greater use of online educational platforms and investigate the possible barriers and strategies to enhance their use.
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Affiliation(s)
- Mohamed Alorabi
- Department of Clinical Oncology, Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt
| | - Ahmed Samir Abdelhafiz
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, 11792, Egypt
| | - Nermen Mostafa
- Department of Clinical Oncology, Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt
| | - Asmaa Ali
- Department of Pulmonary Medicine, Abbassia Chest Hospital, MOH, Cairo, 11517, Egypt
| | - Hagar Elghazawy
- Department of Clinical Oncology, Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt
| | - Ahmed Mesbah
- Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt
| | - Abdul Rahman Jazieh
- Department of Oncology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, 11426, Saudi Arabia
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26
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Jiménez-Labaig P, Pacheco-Barcia V, Cebrià A, Gálvez F, Obispo B, Páez D, Quílez A, Quintanar T, Ramchandani A, Remon J, Rogado J, Sánchez DA, Sánchez-Cánovas M, Sanz-García E, Sesma A, Tarazona N, Cotés A, González E, Bosch-Barrera J, Fernández A, Felip E, Vera R, Rodríguez-Lescure Á, Élez E. Identifying and preventing burnout in young oncologists, an overwhelming challenge in the COVID-19 era: a study of the Spanish Society of Medical Oncology (SEOM). ESMO Open 2021; 6:100215. [PMID: 34325108 PMCID: PMC8332651 DOI: 10.1016/j.esmoop.2021.100215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/07/2021] [Accepted: 06/25/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Young oncologists are at particular risk of professional burnout, and this could have a significant impact on their health and care of their patients. The coronavirus disease 2019 (COVID-19) pandemic has forced rapid changes in professionals' jobs and training, with the consequent physical and psychological effects. We aimed to characterize burnout levels and determinants in young oncologists, and the effects of the pandemic on their training and health. METHODS Two online surveys were conducted among oncology residents and young oncology specialists in Spain. The first addressed professional burnout and its determinants before the COVID-19 pandemic, while the second analyzed the impact of the pandemic on health care organization, training, and physical and psychological health in the same population. RESULTS In total, 243 respondents completed the first survey, and 263 the second; 25.1% reported significant levels of professional burnout. Burnout was more common among medical oncology residents (28.2%), mainly in their second year of training. It was significantly associated with a poor work-life balance, inadequate vacation time, and the burnout score. Nearly three-quarters of respondents (72%) were reassigned to COVID-19 care and 84.3% of residents missed part of their training rotations. Overall, 17.2% of this population reported that they had contracted COVID-19, 37.3% had scores indicating anxiety, and 30.4% moderate to severe depression. Almost a quarter of young oncologists (23.3%) had doubts about their medical vocation. CONCLUSIONS Burnout affects a considerable number of young oncologists. The COVID-19 pandemic has had a profound impact on causes of burnout, making it even more necessary to periodically monitor it to define appropriate detection and prevention strategies.
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Affiliation(s)
- P Jiménez-Labaig
- Department of Medical Oncology, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - V Pacheco-Barcia
- Department of Medical Oncology, Gómez Ulla Military Hospital, Madrid, Spain
| | - A Cebrià
- Department of Mental Health, Parc Taulí University Hospital, Sabadell, Catalunya, Spain
| | - F Gálvez
- Department of Medical Oncology, Jaén University Hospital, Jaén, Andalucía, Spain
| | - B Obispo
- Department of Medical Oncology, Infanta Leonor University Hospital, Madrid, Spain
| | - D Páez
- Department of Medical Oncology, Santa Creu i Sant Pau University Hospital, Barcelona, Catalunya, Spain
| | - A Quílez
- Department of Medical Oncology, Can Misses Hospital, Área de salud de Ibiza y Formentera (ASEF), Ibiza, Illes Balears, Spain
| | - T Quintanar
- Department of Medical Oncology, Elche University General Hospital, Elche, Comunitat Valenciana, Spain
| | - A Ramchandani
- Department of Medical Oncology, University Hospital Complex, Insular-Materno Infantil de Gran Canaria, Las Palmas de Gran Canaria, Islas Canarias, Spain
| | - J Remon
- Department of Medical Oncology, HM Delfos Hospital, Barcelona, Catalunya, Spain
| | - J Rogado
- Department of Medical Oncology, Infanta Leonor University Hospital, Madrid, Spain
| | - D A Sánchez
- Department of Medical Oncology, Virgen de La Arrixaca University Hospital, Murcia, Región de Murcia, Spain
| | - M Sánchez-Cánovas
- Department of Hematology and Medical Oncology, Morales Meseguer University General Hospital, Murcia, Región de Murcia, Spain
| | - E Sanz-García
- Department of Medical Oncology, HM Sanchinarro Hospital-Centro Integral Oncológico Clara Campal (CIOOC), Madrid, Spain
| | - A Sesma
- Department of Medical Oncology, Lozano Blesa University Clinical Hospital, Zaragoza, Aragón, Spain
| | - N Tarazona
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, Comunitat Valenciana, Spain; Instituto de Salud Carlos III, CIBERONC, Madrid, Spain
| | - A Cotés
- Department of Medical Oncology, Elda General Hospital, Elda, Comunitat Valenciana, Spain
| | - E González
- Department of Medical Oncology, Virgen de las Nieves University Hospital, Granada, Andalucía, Spain
| | - J Bosch-Barrera
- Department of Medical Oncology, Dr. Josep Trueta University Hospital, Institut Català d'Oncologia (ICO), Girona, Catalunya, Spain
| | - A Fernández
- Department of Medical Oncology, University Hospital Complex of Ourense (CHUO), Ourense, Galicia, Spain
| | - E Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital & Institute of Oncology (VHIO), Vall d'Hebron Hospital Campus, Barcelona, Catalunya, Spain
| | - R Vera
- Department of Medical Oncology, University Hospital Complex of Navarra, Pamplona, Navarra, Spain
| | - Á Rodríguez-Lescure
- Department of Medical Oncology, Elche University General Hospital, Elche, Comunitat Valenciana, Spain
| | - E Élez
- Department of Medical Oncology, Vall d'Hebron University Hospital & Institute of Oncology (VHIO), Vall d'Hebron Hospital Campus, Barcelona, Catalunya, Spain.
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Bui S, Pelosi A, Mazzaschi G, Tommasi C, Rapacchi E, Camisa R, Binovi C, Leonardi F. Burnout and Oncology: an irreparable paradigm or a manageable condition? Prevention strategies to reduce Burnout in Oncology Health Care Professionals. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021091. [PMID: 34212933 PMCID: PMC8343755 DOI: 10.23750/abm.v92i3.9738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Burnout is a stress-induced occupational related syndrome, characterized by Emotional Exhaustion (EE), feeling of depersonalization (DP) and low sense of professional accomplishment (PA). The aim of this study is to analyse the effectiveness of interventions in decreasing health professionals Burnout as well as work and life-style risk factors. Methods: A survey in Medical Oncology Department in the University Hospital of Parma was conducted using the validated Maslach Burnout Inventory (MBI) and two additional questionnaires exploring lifestyle and work factors. An 8-months intervention involved fortnight meetings by facilitators, incorporated elements of reflection, shared experiences and managing emotions. Six months after the end of the intervention a second survey was performed among the participants using MBI and the same questionnaires mentioned above. Results: EE resulted the most problematic score in Day Hospital: after the 8-month intervention we described a significant decreasing in EE score especially for Day Hospital operators (from 16.7 to 10.9) and a considerable reduction in DP score. In the Oncology Ward a correlation between lack of collaboration among different health categories and DE score was detected; in the Day Hospital the absence of solid working teams was related to higher EE scores. Conclusion: The Oncology professional health care personnel are at the greatest risk of Burnout. Our study in Oncology Department shows that specific intervention should be used to prevent and reduce Burnout. Effective personal health care strategies should be incorporated into routine oncology care to prevent and treat Burnout.
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Affiliation(s)
- Simona Bui
- azienda ospedaliero universitario di Parma.
| | | | | | | | | | | | - Cinzia Binovi
- Medical Oncology Unit, University Hospital of Parma.
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28
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Burnout, compassion fatigue and suicidal ideation in oncology healthcare professionals. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.796290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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29
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Lim KHJ, Murali K, Kamposioras K, Punie K, Oing C, O'Connor M, Thorne E, Amaral T, Garrido P, Lambertini M, Devnani B, Westphalen CB, Morgan G, Haanen JBAG, Hardy C, Banerjee S. The concerns of oncology professionals during the COVID-19 pandemic: results from the ESMO Resilience Task Force survey II. ESMO Open 2021; 6:100199. [PMID: 34217129 PMCID: PMC8256184 DOI: 10.1016/j.esmoop.2021.100199] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/25/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022] Open
Abstract
Background The COVID-19 pandemic has resulted in significant changes to professional and personal lives of oncology professionals globally. The European Society for Medical Oncology (ESMO) Resilience Task Force collaboration aimed to provide contemporaneous reports on the impact of COVID-19 on the lived experiences and well-being in oncology. Methods This online anonymous survey (July-August 2020) is the second of a series of global surveys launched during the course of the pandemic. Longitudinal key outcome measures including well-being/distress (expanded Well-being Index—9 items), burnout (1 item from expanded Well-being Index), and job performance since COVID-19 were tracked. Results A total of 942 participants from 99 countries were included for final analysis: 58% (n = 544) from Europe, 52% (n = 485) female, 43% (n = 409) ≤40 years old, and 36% (n = 343) of non-white ethnicity. In July/August 2020, 60% (n = 525) continued to report a change in professional duties compared with the pre-COVID-19 era. The proportion of participants at risk of poor well-being (33%, n = 310) and who reported feeling burnout (49%, n = 460) had increased significantly compared with April/May 2020 (25% and 38%, respectively; P < 0.001), despite improved job performance since COVID-19 (34% versus 51%; P < 0.001). Of those who had been tested for COVID-19, 8% (n = 39/484) tested positive; 18% (n = 7/39) felt they had not been given adequate time to recover before return to work. Since the pandemic, 39% (n = 353/908) had expressed concerns that COVID-19 would have a negative impact on their career development or training and 40% (n = 366/917) felt that their job security had been compromised. More than two-thirds (n = 608/879) revealed that COVID-19 has changed their outlook on their work-personal life balance. Conclusion The COVID-19 pandemic continues to impact the well-being of oncology professionals globally, with significantly more in distress and feeling burnout compared with the first wave. Collective efforts from both national and international communities addressing support and coping strategies will be crucial as we recover from the COVID-19 crisis. In particular, an action plan should also be devised to tackle concerns raised regarding the negative impact of COVID-19 on career development, training, and job security. Compared with survey I, more oncology professionals were at risk of poor well-being (33% versus 25%) and burnout (49% versus 38%). Job performance since COVID-19 (JP-CV) has improved from 34% to 51%. About 1 in 5 who tested positive for COVID-19 felt they had not been given adequate time to recover before return to work. Some 39% expressed concerns that COVID-19 would have a negative impact on their career development or training. More than two-thirds revealed that COVID-19 had changed their outlook on work-personal life balance.
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Affiliation(s)
- K H J Lim
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Department of Immunology and Inflammation, Imperial College London, London, UK; Immunobiology Laboratory, The Francis Crick Institute, London, UK
| | - K Murali
- Victorian Clinical Genetics Services, The Royal Children's Hospital, Melbourne, Australia
| | - K Kamposioras
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - K Punie
- Department of General Medical Oncology and Multidisciplinary Breast Center, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - C Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, Mildred Scheel Cancer Career Centre HaTriCs4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M O'Connor
- University Hospital Waterford, Waterford, Ireland
| | - E Thorne
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - T Amaral
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany; Portuguese Air Force Health Care Direction, Lisbon, Portugal
| | - P Garrido
- Medical Oncology, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Madrid, Spain
| | - M Lambertini
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - B Devnani
- Department of Radiotherapy and Oncology, All India Institute of Medical Sciences, Jodhpur, India
| | - C B Westphalen
- Department of Internal Medicine III, University Hospital, LMU Munich and Comprehensive Cancer Center, Munich, Germany
| | - G Morgan
- Department of Medical and Radiation Oncology, Skåne University Hospital, Lund, Sweden
| | - J B A G Haanen
- Division of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - C Hardy
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - S Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
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Boulier S, Baumann C, Rousseau H, Horrach P, Bourion-Bédès S. Burnout profiles among French workers in health units for inmates: results of the EHCAU study. BMC Health Serv Res 2021; 21:595. [PMID: 34158026 PMCID: PMC8218524 DOI: 10.1186/s12913-021-06600-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health care personnel who work in penitentiary environments are at risk of burnout due to a variety of factors. Latest research have brought forward a classification system consisting of five burnout profiles on a continuum between engagement and burnout. The objective of this study was to measure the prevalence of these profiles among professionals working in French health units providing health services for inmates according to the three levels of care and to investigate their characteristics to propose appropriate management and prevention approaches. METHODS This study involved a cross-sectional analysis of data from the Evaluation of Health CAre in Units for inmates (EHCAU) study, a multicentric cohort study of professionals practising in health units for inmates in eastern France. Burnout was assessed by the Maslach Burnout Inventory (MBI) at the levels of emotional exhaustion, depersonalization and personal accomplishment. Job conditions and characteristics were measured using the Karasek Job Content Questionnaire and the Effort-Reward Imbalance Questionnaire. Data on sociodemographic characteristics and self-reported health status were also collected. Differences between MBI profiles were identified using Fisher's exact test and the Wilcoxon test. RESULTS Of the 350 professionals surveyed, 150 responded (42.9%). The most frequent profiles were ineffective (36.9%) and engagement (34.8%). The burnout (7.8%), overextended (15.6%) and disengaged (5.0%) profiles made up the remaining quarter. Significant differences in the burnout profiles were observed in regard to professional occupation (p = 0.01), irregular eating hours (p = 0.04), history of complaint procedures (p = 0.05), anxiety (p < 0.0001), depression (p < 0.0001) and the mental component of self-reported quality of life (p < 0.0001). CONCLUSIONS These results confirm that special attention should be given to professionals working in these challenging settings. The results have important implications for theory and research and for more customized approach interventions. TRIAL REGISTRATION ID RCB: 2018-A03029-46.
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Affiliation(s)
| | - Cédric Baumann
- Unit of Methodology, Data Management and Statistics, University Hospital of Nancy, 54500 Vandoeuvre-lès, Nancy, France
- EA4360 APEMAC (Health adjustment, measurement and assessment, interdisciplinary approaches) MICS team, University of Lorraine, 54500 Vandoeuvre-lès, Nancy, France
| | - Hélène Rousseau
- Unit of Methodology, Data Management and Statistics, University Hospital of Nancy, 54500 Vandoeuvre-lès, Nancy, France
| | | | - Stéphanie Bourion-Bédès
- EA4360 APEMAC (Health adjustment, measurement and assessment, interdisciplinary approaches) MICS team, University of Lorraine, 54500 Vandoeuvre-lès, Nancy, France.
- Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, 78000, Versailles, France.
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Singh A, Garg A, Mandlik D, Vander Poorten V, Patel SG, O'Neill JP, Spriano G, Shaha A, Chaturvedi P, Cernea C, Shah J. Assessing the quality of life of head and neck healthcare workers during the COVID-19 pandemic-A self-reported global cross-sectional questionnaire study by the International Federation of Head and Neck Oncologic Societies. J Surg Oncol 2021; 124:476-482. [PMID: 34109640 DOI: 10.1002/jso.26571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Considering the pandemic's mode of transmission, the impact on quality of life (QOL) is likely to be exaggerated among healthcare workers (HCWs) who treat head and neck diseases (hHCWs). METHODS A cross-sectional self-reported QOL assessment was undertaken between July and September 2020 using the World Health Organization Quality of Life instrument sent out to hHCWs. Factors that predicted a poorer QOL were identified using regression models and mediation analysis. RESULTS Responses from 979 individuals across 53 countries were analyzed with 62.4% participation from low- and middle-income countries. The physical domain had the highest mean scores of 15 ± 2.51, while the environmental domain was the lowest (14.17 ± 2.42). Participants from low- and middle-income countries had a significantly worse physical (p < 0.001) and environmental (p < 0.001) domains, while a low coronavirus disease 2019-related mortality significantly impacted the environmental domain (p-0.034). CONCLUSION QOL-related issues among hHCWs are a vexing problem and need intervention at an individual and systems level in all parts of the world.
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Affiliation(s)
- Arjun Singh
- Department of Head and Neck Oncology, Tata Memorial Hospital and HBNI, Mumbai, Maharashtra, India
| | - Apurva Garg
- Department of Surgical Oncology, Choithram Hospital and Research Center, Indore, Madhya Pradesh, India
| | | | | | - Snehal G Patel
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - James Paul O'Neill
- Department of Otolaryngology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | - Ashok Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Pankaj Chaturvedi
- Department of Head and Neck Oncology, Tata Memorial Hospital and HBNI, Mumbai, Maharashtra, India
| | - Claudio Cernea
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Jatin Shah
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States
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Routine Oncology Treatment and Its Human Deficits. Recent Results Cancer Res 2021. [PMID: 34019172 DOI: 10.1007/978-3-030-63749-1_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Working with cancer patients is a highly demanding task. Both, caring for physical, social and spiritual needs of cancer patients as well as an overwhelming bureaucratisation, and technologisation challenge oncologists in a way that may cause mental and physical exhaustion, often-paradoxically-despite high job and specialty satisfaction. This article (i) summarises research findings with a special focus on oncologists' burnout (including factors associated with the phenomffenon), job satisfaction and physical health; (ii) describes potential consequences of burnout and distress, e.g., shortcomings in the physician-patient interaction in oncological treatment settings, financial implications on the health-care system, etc.; and (iii) reviews published data for interventions that may prevent or alleviate oncologists' burnout on an organisational and/or individual level.
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Gribben L, Semple CJ. Prevalence and predictors of burnout and work-life balance within the haematology cancer nursing workforce. Eur J Oncol Nurs 2021; 52:101973. [PMID: 34015591 DOI: 10.1016/j.ejon.2021.101973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/23/2021] [Accepted: 04/23/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE The effects of burnout can have serious consequence for individual nurse's, patients and healthcare organisations. The aim of this study was to assess prevalence and predictors of burnout and work-life balance amongst haemato-oncology nurses. METHODS This study employed a cross-sectional survey design. Haematology cancer nurses attending a 2-day conference in Ireland, during Oct 2019 were recruited. Anonymised data were collected on: 1) socio-demographics and occupational variables, 2) burnout using Maslach Burnout Inventory and 3) satisfaction with work-life balance. RESULTS There was an 80.4% survey completion rate (n = 78 of 97). One-third of haemato-oncology nurses reported high levels of emotional exhaustion, with an additional 46% experiencing moderate levels. Despite this, 64% of nurses highlighted a moderate or high level of personal accomplishment. Demographics such as <40yrs old, unmarried, working ≥25hrs per week and having 6-10 years' experience in haemato-oncology, all showed trends towards increased burnout, although none reached statistical significance. Over half (58%) surveyed were dissatisfied with their work-life balance. Nurses with dependent children had statistically significant poorer work-life balance scores. In addition, one-third reported they did not receive adequate support or reasonable adjustments from their organisation, with inpatient nurses finding this particularly challenging. RELEVANCE TO CLINICAL PRACTICE Taking into consideration the high levels of burnout, healthcare organisations should have a responsibility to teach approaches of stress management, self-care and foster resilience within their workforce. Oncology nurses with dependent children, working in in-patient settings, have identified a need for greater flexibility with working conditions, to improve work-life balance.
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Affiliation(s)
- Louise Gribben
- Southern Health and Social Care Trust, Craigavon Area Hospital, Craigavon, Northern Ireland, United Kingdom
| | - Cherith J Semple
- Ulster University*/ South Eastern Health and Social Care Trust, *Newtownabbey, Co. Antrim, United Kingdom.
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Khechine W, Ezzaairi F, Sahli J, Belaid I, Daldoul A, Zaied S, Chabchoub I, Ammar N, Hochlaf M, Ben Fatma L, Ben Ahmed S. Burn-out of the Medical Oncology Health Care Professionals
and Associated Factors in Tunisia. PSYCHO-ONCOLOGIE 2021. [DOI: 10.3166/pson-2020-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Burn-out is defined as a syndrome of emotional exhaustion, depersonalization and diminished self-achievement that affects individuals exposed to chronic occupational stress. Physicians and caregivers faced with the death of their patients, such as oncology, are particularly vulnerable to this syndrome.
Objectives: To evaluate the burn-out of medical professionals in medical oncology, to research the predisposing factors and to analyze the functional complaints and the behavior of the staff associated with this syndrome.
Methods: A descriptive and analytical cross-sectional study among medical oncology professionals practicing in public hospitals in the Tunisian territory who exercise more than two years in oncology; with the Maslach Burnout Inventory (MBI).
Results: Our study population was predominantly female (81%). 53% are doctors and 47% are paramedical health care professionals. A high degree of emotional exhaustion, depersonalization and personal achievement were found in 63%, 53% and 59% in our population, respectively. With 21% global high burn-out. The female sex was associated with high emotional exhaustion and low personal accomplishment as well as global burn-out. This burn-out was attributed to factors associated with working conditions and professional climate, mainly: overwork, poor organization of service, lack of resources and time, lack of recognition, lack of communication, lack of respect, conflicts with colleagues, report unsatisfactory salary effort and aggressions by patients and their families. Functional complaints and health care professional’s behavior associated with burn-out were: feelings of sadness, blockage, and irritability, sleep disorders, unexplained pain, epigastralgia, addictive behaviors, psychotropic consumption, suicidal thoughts, decreased performance and desire for a job transfer.
Conclusions: By its impact on professionals, burn-out in medical oncology represents a major threat to the quality of health care. Its etiologies, although complex and intricate, are well known. Its prevention and its support are possible, but involve mobilization at all levels.
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Yust-Katz S, O'Brien B, Vera E, Acquaye A, Weller M, Armstrong T. Burnout and career satisfaction in neuro-oncology: a survey of the Society for Neuro-Oncology and the European Association of Neuro-Oncology memberships. Neuro Oncol 2021; 22:838-850. [PMID: 31832657 DOI: 10.1093/neuonc/noz229] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Professional burnout is a syndrome characterized by emotional exhaustion, depersonalization, and loss of personal achievement. Burnout is a significant issue among health care providers, and neuro-oncology providers may be at high risk. We conducted a survey to evaluate burnout and career satisfaction among those caring for patients with brain tumors, and to identify risk factors for burnout. METHODS We distributed an anonymous online survey to Society for Neuro-Oncology (SNO) members in 2016 and to European Association of Neuro-Oncology (EANO) members in 2017. The survey comprised questions about personal and professional characteristics and the validated Maslach Burnout Inventory-Human Services Survey (MBI-HSS) questionnaire. Statistical analysis included descriptive statistics, univariate and multivariate analyses, and incorporation of recently defined burnout profiles. RESULTS Sixty-three percent of SNO and 61% of EANO participants were identified as having high burnout according to MBI-HSS. Among SNO participants, physicians had a lower rate of high burnout (61%) compared with allied health professionals (68%, P < 0.01) and basic scientists (83%, P < 0.01). Regarding the factors most commonly contributing to high burnout, SNO participants most commonly experienced high emotional exhaustion (48% of SNO participants vs 34% of EANO participants), whereas EANO participants most commonly experienced low personal achievement (40% vs 28%). Among both SNO and EANO participants, increasing job satisfaction reduced the likelihood of high burnout. CONCLUSIONS The prevalence of burnout among neuro-oncology professionals is high and personal risk factors were identified. Burnout profiles recognize a continuum of well-being and warrant further research.
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Affiliation(s)
- Shlomit Yust-Katz
- Neuro-Oncology Unit, Davidoff Cancer Center at Rabin Medical Center and Sackler Faculty of Medicine-Tel Aviv University, Israel
| | - Barbara O'Brien
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth Vera
- National Institutes of Health Neuro-Oncology Branch, Bethesda, Maryland, USA
| | - Alvina Acquaye
- National Institutes of Health Neuro-Oncology Branch, Bethesda, Maryland, USA
| | - Michael Weller
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zürich, Zurich, Switzerland
| | - Terri Armstrong
- National Institutes of Health Neuro-Oncology Branch, Bethesda, Maryland, USA
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Banerjee S, Lim KHJ, Murali K, Kamposioras K, Punie K, Oing C, O'Connor M, Thorne E, Devnani B, Lambertini M, Westphalen CB, Garrido P, Amaral T, Morgan G, Haanen JBAG, Hardy C. The impact of COVID-19 on oncology professionals: results of the ESMO Resilience Task Force survey collaboration. ESMO Open 2021; 6:100058. [PMID: 33601295 PMCID: PMC7900705 DOI: 10.1016/j.esmoop.2021.100058] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/15/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The impact of the coronavirus disease 2019 (COVID-19) pandemic on well-being has the potential for serious negative consequences on work, home life, and patient care. The European Society for Medical Oncology (ESMO) Resilience Task Force collaboration set out to investigate well-being in oncology over time since COVID-19. METHODS Two online anonymous surveys were conducted (survey I: April/May 2020; survey II: July/August 2020). Statistical analyses were performed to examine group differences, associations, and predictors of key outcomes: (i) well-being/distress [expanded Well-being Index (eWBI; 9 items)]; (ii) burnout (1 item from eWBI); (iii) job performance since COVID-19 (JP-CV; 2 items). RESULTS Responses from survey I (1520 participants from 101 countries) indicate that COVID-19 is impacting oncology professionals; in particular, 25% of participants indicated being at risk of distress (poor well-being, eWBI ≥ 4), 38% reported feeling burnout, and 66% reported not being able to perform their job compared with the pre-COVID-19 period. Higher JP-CV was associated with better well-being and not feeling burnout (P < 0.01). Differences were seen in well-being and JP-CV between countries (P < 0.001) and were related to country COVID-19 crude mortality rate (P < 0.05). Consistent predictors of well-being, burnout, and JP-CV were psychological resilience and changes to work hours. In survey II, among 272 participants who completed both surveys, while JP-CV improved (38% versus 54%, P < 0.001), eWBI scores ≥4 and burnout rates were significantly higher compared with survey I (22% versus 31%, P = 0.01; and 35% versus 49%, P = 0.001, respectively), suggesting well-being and burnout have worsened over a 3-month period during the COVID-19 pandemic. CONCLUSION In the first and largest global survey series, COVID-19 is impacting well-being and job performance of oncology professionals. JP-CV has improved but risk of distress and burnout has increased over time. Urgent measures to address well-being and improve resilience are essential.
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Affiliation(s)
- S Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
| | - K H J Lim
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Department of Immunology and Inflammation, Imperial College London, London, UK
| | - K Murali
- Austin Health, Heidelberg, Australia
| | - K Kamposioras
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - K Punie
- Department of General Medical Oncology and Multidisciplinary Breast Center, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - C Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M O'Connor
- University Hospital Waterford, Waterford, Ireland
| | - E Thorne
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - B Devnani
- Department of Radiotherapy and Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - M Lambertini
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - C B Westphalen
- Department of Internal Medicine III, University Hospital, LMU Munich and Comprehensive Cancer Center, Munich, Germany
| | - P Garrido
- Medical Oncology, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Madrid, Spain
| | - T Amaral
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany; Portuguese Air Force Health Care Direction, Lisbon, Portugal
| | - G Morgan
- Department of Medical and Radiation Oncology, Skåne University Hospital, Lund, Sweden
| | - J B A G Haanen
- Division of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C Hardy
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Vici P, Krasniqi E, Pizzuti L, Ciliberto G, Mazzotta M, Marinelli D, Barba M. Burnout of health care providers during the COVID-19 pandemic: Focus on Medical Oncologists. Int J Med Sci 2021; 18:2235-2238. [PMID: 33859532 PMCID: PMC8040416 DOI: 10.7150/ijms.54025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/04/2021] [Indexed: 01/12/2023] Open
Abstract
The spread of the coronavirus disease 2019 (Covid-19) has challenged hard the national health system worldwide. At any level, the role of health care providers has been rapidly revisited and eventually modified to face the pandemic. The search of the balance between the provision of the most appropriate health-related services and safety of both patients and health care providers has become an indisputable necessity. The consequently increased work load, along with a widespread feeling of intellectual isolation, emotional overload, sense of inadequacy for involvement in tasks and disciplines which are not always familiar have all been proposed as factors related to the onset and/or worsening of the burnout phenomenon. This latter is sadly renown among care givers and is particularly common among medical oncologists. We herein share our perspectives on the burnout phenomenon over the course of the Covid-19 pandemic, with a specific focus on medical oncologists. Results from the most recent and inherent studies are presented and commented in light of hints provided by the experience matured by a quite restricted, still potentially representative, number of professionals figures from the medical oncologists' category. Reasons are proposed to explain the sense of inadequacy currently perceived in relation to the limits imposed by the current pandemic. In more detail, we illustrate the nature and extents of some of the most relevant difficulties in the optimal management of cancer patients and constant efforts towards the scientific upgrade which allows for the improvement of the professional performance. The need for a deeper understanding of the roots and consequences of the Covid-19 pandemic on the mental health of medical oncologists is finally stressed.
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Affiliation(s)
- Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 00144 Rome, Italy
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 00144 Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 00144 Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Marco Mazzotta
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 00144 Rome, Italy
| | - Daniele Marinelli
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Azienda Ospedaliera Sant'Andrea, 00189 Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 00144 Rome, Italy
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Cagnazzo C, Filippi R, Zucchetti G, Cenna R, Taverniti C, Guarrera ASE, Stabile S, Federici I, Monti M, Pirondi S, Testoni S, Fagioli F. Clinical research and burnout syndrome in Italy - only a physicians' affair? Trials 2021; 22:205. [PMID: 33712055 PMCID: PMC7953807 DOI: 10.1186/s13063-021-05158-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 02/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background The burnout phenomenon has been extensively investigated among health care professionals, particularly focusing on physicians and nurses. However, literature concerning burnout in clinical research is poor and often neglects the other professional categories involved. Methods In March 2019, all members of Italian Group of Clinical Research Coordinator were invited to participate to a web survey, consisting of three sections: general information and workload; Maslach Burnout Inventory (MBI) test; subjective perception of oneself’s work stress and possible causes. Results The majority of respondents felt a form of distress. The main source was contract type (31.2%), followed by workload (20.5%) and lack of skills recognition (17.8%). Results from MBI test confirmed the interviewees’ subjective perception: an intermediate level of emotional exhaustion (19.1 points) and a very high sense of reduced professional achievement (26.8 points) were observed. Both depersonalization and sense of reduced professional achievement showed weak to moderate correlations with emotional exhaustion. Emotional exhaustion was associated with contract type with high significance. Conclusion It is necessary to act on those qualitative factors that are greatly increasing the level of perceived stress, jeopardizing the quality of clinical research coordinators work and significantly amplifying the phenomenon of migration towards the private sector. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05158-z.
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Affiliation(s)
- Celeste Cagnazzo
- Unità di Ricerca e Sviluppo Clinico SC Oncoematologia Pediatrica, AOU Città della Salute e della Scienza, Presidio Ospedaliero Infantile Regina Margherita, Piazza Polonia 94, 10126, Turin, Italy. .,Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino, Turin, Italy. .,Gruppo Italiano Data Manager - CRC, Meldola, FC, Italy.
| | - Roberto Filippi
- Oncologia Medica 1, AOU Città della Salute e della Scienza, Presidio Molinette, Turin, Italy
| | - Giulia Zucchetti
- Unità di Ricerca e Sviluppo Clinico SC Oncoematologia Pediatrica, AOU Città della Salute e della Scienza, Presidio Ospedaliero Infantile Regina Margherita, Piazza Polonia 94, 10126, Turin, Italy.,Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino, Turin, Italy
| | - Rosita Cenna
- Unità di Ricerca e Sviluppo Clinico SC Oncoematologia Pediatrica, AOU Città della Salute e della Scienza, Presidio Ospedaliero Infantile Regina Margherita, Piazza Polonia 94, 10126, Turin, Italy.,Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino, Turin, Italy
| | - Cristiana Taverniti
- Gruppo Italiano Data Manager - CRC, Meldola, FC, Italy.,Oncologia Medica 1, AOU Città della Salute e della Scienza, Presidio Molinette, Turin, Italy
| | - Agata Sue Ellen Guarrera
- Gruppo Italiano Data Manager - CRC, Meldola, FC, Italy.,Terapie Cellulari e Medicina Trasfusionale, AOU Careggi, Florence, Italy
| | - Stefano Stabile
- Gruppo Italiano Data Manager - CRC, Meldola, FC, Italy.,SC Oncologia Falck, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Irene Federici
- Gruppo Italiano Data Manager - CRC, Meldola, FC, Italy.,Clinica di Ematologia, AOU Ospedali Riuniti Umberto I, G.M. Lancisi, G. Salesi, Ancona, Italy
| | - Manuela Monti
- Gruppo Italiano Data Manager - CRC, Meldola, FC, Italy.,Biostatistics and Clinical Trials Unit, IRCCS Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, FC, Italy
| | - Sara Pirondi
- Gruppo Italiano Data Manager - CRC, Meldola, FC, Italy.,UOSD Oncologia, AUSL Modena Area Sud Ospedale di Sassuolo (MO), Modena, Italy
| | - Sara Testoni
- Gruppo Italiano Data Manager - CRC, Meldola, FC, Italy.,Biostatistics and Clinical Trials Unit, IRCCS Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, FC, Italy
| | - Franca Fagioli
- Unità di Ricerca e Sviluppo Clinico SC Oncoematologia Pediatrica, AOU Città della Salute e della Scienza, Presidio Ospedaliero Infantile Regina Margherita, Piazza Polonia 94, 10126, Turin, Italy.,Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino, Turin, Italy
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Hlubocky FJ, Symington BE, McFarland DC, Gallagher CM, Dragnev KH, Burke JM, Lee RT, El-Jawahri A, Popp B, Rosenberg AR, Thompson MA, Dizon DS, Srivastava P, Patel MI, Kamal AH, Daugherty CK, Back AL, Dokucu ME, Shanafelt TD. Impact of the COVID-19 Pandemic on Oncologist Burnout, Emotional Well-Being, and Moral Distress: Considerations for the Cancer Organization's Response for Readiness, Mitigation, and Resilience. JCO Oncol Pract 2021; 17:365-374. [PMID: 33555934 DOI: 10.1200/op.20.00937] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fay J Hlubocky
- University of Chicago Medicine, Maclean Center for Clinical Medical Ethics, Chicago, IL
| | | | - Daniel C McFarland
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry, New York, NY
| | - Colleen M Gallagher
- MD Anderson Cancer Center, Section of Integrated Ethics in Cancer Care, Houston, TX
| | | | | | - Richard T Lee
- Case Comprehensive Cancer Center, Department of Medicine, Division of Hematology/Oncology, School of Medicine, Cleveland OH
| | - Areej El-Jawahri
- Massachusetts General Hospital, Cancer Center, Harvard Medical School, Boston MA
| | - Beth Popp
- Ichan School of Medicine, Geriatrics and Palliative Medicine, Mount Sinai, New York, NY
| | - Abby R Rosenberg
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine; Seattle WA; Seattle Children's Research Institute, Seattle, WA
| | | | - Don S Dizon
- Lifespan Cancer Institute, Rhode Island Hospital, Brown University Providence, RI
| | | | - Manali I Patel
- Stanford University, VA Palo Alto Health Care System, Palo Alto, CA
| | - Arif H Kamal
- Duke University, Duke Cancer Institute, Population Health Sciences, Durham, NC
| | - Christopher K Daugherty
- University of Chicago Medicine, Department of Medicine, Section Hematology/Oncology, Maclean Center for Clinical Medical Ethics, Chicago, IL Chicago, IL
| | - Anthony L Back
- University of Washington, Department of Medicine/Oncology, Seattle, WA
| | - Mehmet E Dokucu
- Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL
| | - Tait D Shanafelt
- Stanford University, Department of Medicine, Med/Hematology, Chief Wellness Officer, Palo Alto, CA
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Abusanad A, Bensalem A, Shash E, Mula-Hussain L, Benbrahim Z, Khatib S, Abdelhafiz N, Ansari J, Jradi H, Alkattan K, Jazieh AR. Burnout in oncology: Magnitude, risk factors and screening among professionals from Middle East and North Africa (BOMENA study). Psychooncology 2021; 30:736-746. [PMID: 33427352 DOI: 10.1002/pon.5624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Burnout (BO) among oncology professionals (OP) is increasingly being recognized. Early recognition and intervention can positively affect the quality of care and patient safety. This study investigated the prevalence, work and lifestyle factors affecting BO among OPs in the Middle East and North Africa (MENA). METHODS An online survey was conducted among MENA OPs between 10 February and 15 March 2020, using the validated Maslach Burnout Inventory of emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA), including questions regarding demography/work-related factors and attitudes towards oncology. Data were analysed to measure BO prevalence and risk factors and explore a screening question for BO. RESULTS Of 1054 respondents, 1017 participants (64% medical oncologists, 77% aged less than 45 years, 55% female, 74% married, 67% with children and 40% practiced a hobby) were eligible. The BO prevalence was 68% with high levels of EE and DP (35% and 57% of participants, respectively) and low PA scores (49%). BO was significantly associated with age less than 44 years, administrative work greater than 25% per day and the thought of quitting oncology (TQ). Practising a hobby, enjoying oncology communication and appreciating oncology work-life balance were associated with a reduced BO score and prevalence. North African countries reported the highest BO prevalence. Lack of BO education/support was identified among 72% of participants and TQ-predicted burnout in 77%. CONCLUSIONS This is the largest BO study in MENA. The BO prevalence was high and several modifiable risk factors were identified, requiring urgent action. TQ is a simple and reliable screening tool for BO.
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Affiliation(s)
- Atlal Abusanad
- Department of Medical Oncology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Assia Bensalem
- Oncology Department, CHU Dr Benbadis, Constantine, Algeria
| | - Emad Shash
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Layth Mula-Hussain
- Radiation Oncology Department, University of Ottawa, Ottawa, Ontario, Canada
| | - Zineb Benbrahim
- Faculty of Medicine and Pharmacy of Fez, University Sidi Mohammed Ben Abdellah
| | - Sami Khatib
- Department of Oncology, Private Sector, Amman, Jordan
| | - Nafisa Abdelhafiz
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Jawaher Ansari
- Department of Medical Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Hoda Jradi
- Public Health Faculty, Department of public health, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Khaled Alkattan
- Thoracic surgery department, King Faisal Specialist Hospital and Research Center (KFSH-RC), Alfaisal University, Riyadh, Saudi Arabia
| | - Abdul R Jazieh
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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41
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Wu Y, Jiang F, Ma J, Tang YL, Wang M, Liu Y. Experience of Medical Disputes, Medical Disturbances, Verbal and Physical Violence, and Burnout Among Physicians in China. Front Psychol 2021; 11:556517. [PMID: 33584400 PMCID: PMC7878671 DOI: 10.3389/fpsyg.2020.556517] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/21/2020] [Indexed: 11/29/2022] Open
Abstract
Background Medical disputes, medical disturbances, verbal and physical violence against physicians, and burnout have reached epidemic levels. They may negatively impact both physicians and the healthcare system. The experience of medical disputes, medical disturbances, verbal, and physical violence, and burnout and the correlates in physicians working in public hospitals in China needed to be investigated. Methods A nationwide cross-sectional survey study was conducted between 18 and 31 March 2019. An anonymous online questionnaire was administered. The questionnaire included the 22-item Maslach Burnout Inventory-Human Services Survey (Chinese version). We also collected data on demographic and job-related factors, as well as physicians’ experiences of medical disputes, medical disturbances, verbal and physical violence from patients and the patients’ family members. Findings In total, 22,213 physicians from 144 tertiary public hospitals in all of China’s 31 provinces completed the survey. The overall burnout rate among the surveyed physicians was 31.28%. Moreover, 33.48% of physicians experienced disputes, 20.86% experienced disturbances, 48.52% experienced verbal violence, and 5.84% experienced physical violence in the past 12 months. Factors found to be significantly associated with burnout included younger age, being divorced or widowed, having a lower educational background, working in internal medicine departments, longer working hours per day, working in general hospitals, being in East China, as well as having experienced disputes, disturbances, and physical and verbal violence. Interpretation Close to a third of the Chinese doctors working in the tertiary hospitals reportedly experienced burnout, and the problem is related to the unsafe working environment caused by the worsening doctor-patient relationship.
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Affiliation(s)
- Yinuo Wu
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Jiang
- Institute of Health Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Ma
- Department of Population Medicine, Harvard Medical School, Boston, MA, United States
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States.,Atlanta VA Medical Center, Decatur, GA, United States
| | - Mingxiao Wang
- Department of Cardiology, Emergency General Hospital, Beijing, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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42
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Neal MT, Lyons MK. Burnout and work-life balance in neurosurgery: Current state and opportunities. Surg Neurol Int 2021; 11:456. [PMID: 33408941 PMCID: PMC7771504 DOI: 10.25259/sni_736_2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/25/2020] [Indexed: 01/14/2023] Open
Abstract
Background: Burnout is a syndrome characterized by emotional exhaustion, depersonalization, and reduced sense of personal accomplishment. The syndrome has been recognized as a pandemic among physicians. The demanding nature of neurosurgery makes neurosurgeons, particularly prone to burnout. In recent years, pioneering work has shed light on burnout in the field of neurosurgery. Methods: We have reviewed the literature in PUBMED on burnout in physicians, focusing on neurosurgical publications. Results: In this manuscript, we explore the topic of burnout in neurosurgery by reviewing definitions, magnitude, etiologies, sequelae, and mitigation strategies. Conclusion: Ongoing education, recognition, and targeted interventions for neurosurgeons at different career stages are needed to manage burnout proactively and ensure a resilient neurosurgery workforce.
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Affiliation(s)
- Matthew T Neal
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States
| | - Mark K Lyons
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States
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43
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Prevalence of burnout among healthcare professionals at the Serbian National Cancer Center. Int Arch Occup Environ Health 2021; 94:669-677. [PMID: 33387030 DOI: 10.1007/s00420-020-01621-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the level of burnout and identify who is at highest risk among healthcare professionals (HCPs) working at the largest referent national institution. METHODS A cross-sectional survey was conducted at the Institute of Oncology and Radiology of Serbia from May 2019 to July 2019, evaluating the level of burnout, depression, fatigue, socio-demographic, behavioral and professional characteristics, and quality of life among healthcare professionals. Of the 576 distributed questionnaires among physicians, nurses/technicians and healthcare coworkers, 432 participants returned their questionnaires (75%). All instruments used in our study had been validated and cross-culturally adapted to Serbian language. RESULTS The overall prevalence of burnout was 42.4%, with the greatest proportion of burned out in emotional exhaustion domain (66.9%). The multivariable-adjusted model analysis showed that nurses/technicians had a 1.41 times greater chance of experiencing burnout, compared to physicians (OR = 1.41, 95% CI 1.16-7.10), and that with each year of work experience, the chance of burnout increased by about 2% (OR = 1.02, 95% CI 1.00-1.92). Furthermore, it was shown that, with each point in the PHQ-9 score for depression, probability of burnout increased by 14% (OR = 1.14, 95% CI 1.07-1.94). Finally, after controlling all these potential confounders, the Mental Composite Score of SF-36 score showed an independent prognostic value in exploring the burnout presence among HCPs (OR = 1.17, 95% CI 1.03-2.47). CONCLUSION Our research showed a significant level of burnout among healthcare professionals working in oncology, especially among nurses/technicians. The development of effective interventions at both individual and organizational level toward specific risk groups is needed.
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44
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Franceschi E, Brandes AA. Burnout in medical oncology during the COVID-19 pandemic. Expert Rev Anticancer Ther 2020; 21:351-353. [PMID: 33353446 DOI: 10.1080/14737140.2021.1866549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Enrico Franceschi
- Medical Oncology Department, Azienda USL/IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italia
| | - Alba A Brandes
- Medical Oncology Department, Azienda USL/IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italia
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45
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Gribben L, Semple CJ. Factors contributing to burnout and work-life balance in adult oncology nursing: An integrative review. Eur J Oncol Nurs 2020; 50:101887. [PMID: 33338741 DOI: 10.1016/j.ejon.2020.101887] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Occupational stress and burnout are highlighted as the most prevalent workplace issues for adult oncology nurses. With today's global nursing workforce shortage; coupled with oncology being an inherently challenging and complex speciality, this clearly indicates the need to understand factors that contribute to burnout in adult oncology nurses and improve work-life balance. The aim of this integrative review is to synthesis the evidence on burnout and work-life balance for adult oncology nurses. METHOD A systematic search of four databases (CINAHL, Ovid Medline, PsycINFO and Scopus), identified 17 quantitative and three mixed-method studies. Studies were critically appraised using the Mixed Methods Appraisal Tool. Following data extraction, a qualitative evidence synthesis utilising an inductive approach was adopted to better understand influential factors, generating analytical themes. RESULTS One study had a specific focus on what ameliorates work-life balance for oncology nurses; depicting an area that warrants further study. All studies reported on burnout, of which six analytical themes were further categorised into two broad themes, namely: (1) 'Inability to thrive': struggling with workplace burnout due to organisational challenges and (2) 'Personal perspectives influencing burnout', for adult oncology nurses. Burnout was influenced by multiple oncology-specific factors due to quantitative workload demands and disease acuity. Workplace culture, shift in additional hours being worked remotely and personal characteristics of the nurse, also influenced susceptibility for the development of burnout in oncology nurses. CONCLUSION Confronting burnout and promoting wellness are the shared responsibility of both individual adult oncology nurses and their organisations to build resilience and help sustain and build workforce capacity.
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Affiliation(s)
- Louise Gribben
- Southern Health and Social Care Trust, Craigavon Area Hospital, 68 Lurgan Rd, Portadown, Craigavon, Northern Ireland, BT63 5QQ, United Kingdom
| | - Cherith Jane Semple
- Ulster Univeristy, Jordanstown Campus, Shore Road, Newtownabbey, Co. Antrim, BT37 0QB, United Kingdom; South Eastern Health Social Care Trust, Belfast, Northern Irealnd, BT16 1RH, United Kingdom.
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46
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Hilmi M, Boilève A, Ducousso A, Michalet M, Turpin A, Neuzillet C, Naoun N. Professional and Psychological Impacts of the COVID-19 Pandemic on Oncology Residents: A National Survey. JCO Glob Oncol 2020; 6:1674-1683. [PMID: 33151771 PMCID: PMC7713519 DOI: 10.1200/go.20.00376] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE The COVID-19 pandemic has severely affected clinical practice in oncology, leading to organizational, ethical, and medical issues. In particular, it has raised challenges in the context of competing care priorities between COVID-19 and cancer treatment. Residents on the front line face difficulties related to increasing care needs and urgent reorganization of health care systems while managing psychological stress and uncertainty. We aimed to evaluate the impact of the COVID-19 pandemic on oncology residents. METHODS AND MATERIALS We conducted a national survey (39 questions) in France among oncology and radiation therapy residents to determine the psychological impact and professional difficulties (eg, reassignment, training/research time, supervision, teleworking, management of patients) associated with the first peak of the COVID-19 pandemic. RESULTS Overall, 222 residents (medical oncologists, 61%; radiation therapists, 39%) participated in our survey, representing approximately one third of all residents and fellows in France. One third of respondents had been reassigned to a COVID-19 ward. Training and research activity decreased for 89% and 41% of respondents, respectively. Two thirds (70%) of respondents declared that they had faced ethical issues, 35% felt worried about their own health, and 23% experienced psychological distress. According to the Hospital Anxiety and Depression Scale, 32% were anxious and 17% depressed. Consumption of tobacco, psychostimulants, and alcohol increased in 31%, 24%, and 29% of respondents, respectively. CONCLUSION French oncology residents were highly affected by the first peak of the COVID-19 pandemic in terms of professional activity and psychological impact. This national survey can be used as a basis for improved management, medical reorganization, and training of residents during the ongoing COVID-19 pandemic.
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Affiliation(s)
- Marc Hilmi
- Department of Medical Oncology, Institut Curie Saint-Cloud, Saint-Cloud, France.,Association pour l'Enseignement et la Recherche des Internes d'Oncologie, Paris, France
| | - Alice Boilève
- Association pour l'Enseignement et la Recherche des Internes d'Oncologie, Paris, France.,Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Anabelle Ducousso
- Association pour l'Enseignement et la Recherche des Internes d'Oncologie, Paris, France
| | - Morgan Michalet
- Société Française des Jeunes Oncologues Radiothérapeutes, Paris, France.,Department of Radiation Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Anthony Turpin
- Department of Medical Oncology, Centre Hôpital-Universitaire Lille, Lille, France
| | - Cindy Neuzillet
- Department of Medical Oncology, Institut Curie Saint-Cloud, Saint-Cloud, France
| | - Natacha Naoun
- Association pour l'Enseignement et la Recherche des Internes d'Oncologie, Paris, France.,Department of Medical Oncology, Institut de Cancérologie de Lorraine, Nancy, France
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Cheli S, Zagonel V, Oliani C, Blasi L, Fioretto L. Is burnout affecting life satisfaction in oncologists? The moderating role of family concerns in an Italian sample. Psychooncology 2020; 30:385-391. [PMID: 33151607 DOI: 10.1002/pon.5589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Burnout may represent a significant source of distress in health care professionals. Many studies have reported its negative effect on career satisfaction and personal life. The aim of the present study was to investigate the relation between burnout and life satisfaction in a large sample of Italian oncologists. METHODS An online survey was conducted of 14.5% of the Italian oncologists' population (n = 533) using Copenhagen Burnout Inventory, Satisfaction with Life Scale and additional questions exploring professional and personal factors. Moderated regression analysis was carried out to explore how burnout may relate to life satisfaction. RESULTS One out of 10 (10.5%) oncologists showed significant burnout symptoms, whereas 1 out of 3 (33.8%) reported being at least slightly dissatisfied with their own life. Family concerns significantly moderated the relationship between burnout and life satisfaction. Men and chiefs of cancer units or departments showed lower rates of burnout and life dissatisfaction than women and other oncologists, respectively. CONCLUSIONS Reported results are in line with existing data about a limited burnout prevalence in Italian oncologists. We discuss the potential role of gender inequality in explaining our findings. The present study suggests that family concerns may be considered a risk factor for both burnout and life dissatisfaction in oncologists.
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Affiliation(s)
- Simone Cheli
- School of Human Health Sciences, University of Florence, Florence, Italy.,Center for Psychology & Health, Tages Charity, Florence, Italy
| | - Vittorina Zagonel
- Oncology Unit 1, Istituto Oncologico Veneto, IOV-IRCCS Padova, Italy
| | | | - Livio Blasi
- Oncologia Medica, ARNAS Ospedale Civico, Palermo, Italy
| | - Luisa Fioretto
- Dipartimento Oncologico, USL Toscana Centro, Florence, Italy
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Handley NR, Tomescu O, Lopez AM. Well-Being During a Time of Crisis and Beyond: Supporting a Culture of Mindfulness in Oncology Practices. JCO Oncol Pract 2020; 16:713-717. [DOI: 10.1200/op.20.00334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nathan R. Handley
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Oana Tomescu
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ana Maria Lopez
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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49
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Sutherland M, Kinslow K, Boneva D, McKenney M, Elkbuli A. Perceived Burnout Among Burn Surgeons: Results From a Survey of American Burn Association Members. J Burn Care Res 2020; 42:186-192. [PMID: 32845002 DOI: 10.1093/jbcr/iraa146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Burnout is a significant and increasingly recognized issue. They aimed to investigate burn surgeons'(BSurg) perceptions regarding burnout, contributing factors, and implications to better identity possible targeted interventions. A 42-question anonymous online survey was distributed by the ABA to BSurg members. Respondents included BSurgs in university or nonuniversity hospital settings. Experience of burnout was reported among 89.8% of university and 84.6% of nonuniversity hospital-affiliated respondents. After adjusting for confounders, university BSurgs exhibited a higher risk of perceived burnout compared with nonuniversity settings (aOR: 1.081, 95% CI: 0.237, 4.937). Women BSurgs were at 5 times higher risk of reporting burnout compared with men (aOR: 5.048, 95% CI: 0.488, 52.255). BSurgs aged 40 to 44 had twice the risk of reporting burnout as ≥50 (aOR: 1.985, 95% CI:0.018, 216.308). Practicing for 21 to 30 years had 12 times higher risk of reporting burnout than practicing >30 (aOR: 12.264, 95% CI: 0.611, 246.041). Those working <50 hr/wk reported burnout more frequently than those who work ≥80 hr/wk (aOR: 2.469, 95% CI: 0.80, 76.662). Overall reports of burnout were high amongst burn surgeon respondents. Those with 21 to 30 years of clinical practice were at significantly higher risk of reporting burnout despite believing that their colleagues' burnout was more frequent than their own. Interventions addressing perceived burnout in younger burn surgeons may be limited by lack of participation due to fear of repercussions from administration or peers. Future administration-led burnout initiatives should acknowledge the differences between burn surgeon groups and offer resources unique to the individual physician's needs for burnout prevention to be successful.
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Affiliation(s)
- Mason Sutherland
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
| | - Kyle Kinslow
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
| | - Dessy Boneva
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida.,Department of Surgery, University of South Florida, Tampa, Florida
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida.,Department of Surgery, University of South Florida, Tampa, Florida
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
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50
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Lee YG, Maeng CH, Kim DY, Kim BS. Perspectives on Professional Burnout and Occupational Stress among Medical Oncologists: A Cross-sectional Survey by Korean Society for Medical Oncology (KSMO). Cancer Res Treat 2020; 52:1002-1009. [PMID: 32683840 PMCID: PMC7577827 DOI: 10.4143/crt.2020.190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/09/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aimed to investigate the prevalence and risk factors of burnout and occupational stress among medical oncologists in Korea. Materials and Methods A survey was conducted of medical oncologists who were members of Korean Society for Medical Oncology (KSMO) using the Korean Occupational Stress Scale, the validated Maslach Burnout Inventory (MBI) and supplemental questions about work and lifestyle factors. Results Among 220 active KSMO members, 111 responses were collected. The median age was 42 years (range, 32 to 63 years). Two-thirds of responders worked 6 days per week and half of them worked a total of 60-80 hours per week. Each medical oncologist treated a median of 90-120 patients per week in outpatient clinics and 20-30 patients per week in patient practices. MBI subscales indicated a high level of emotional exhaustion in 74%, a high level of depersonalization in 86%, and a low level of personal accomplishment in 65%: 68% had professional burnout according to high emotional exhaustion and high depersonalization scores. The risk of burnout was higher for medical oncologists aged from 30-39 than 40-49 years, and unmarried than married. Considering personal accomplishment, females had a higher risk of burnout. The median score of occupational stress was 63 (range, 43 to 88). Having night-duty call was the strongest risk factor on more stress. A higher stress score was associated with a higher prevalence of burnout. Conclusion Burnout and occupational stress are quite common amongst Korean medical oncologists. Achieving a healthy work-life balance, ensuring balanced workload distribution, and engaging in proper stress relief solutions are necessary.
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Affiliation(s)
- Yun-Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi Hoon Maeng
- Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Do Yeun Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Bong-Seog Kim
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
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