Creating a Blueprint of Well-Being in Oncology: An Approach for Addressing Burnout From ASCO's Clinician Well-Being Taskforce

Implementation of a pharmacogenetic panel-based test for pharmacotherapy-based supportive care in an adult oncology clinic

The University of Florida Health conducted a pragmatic implementation of a pharmacogenetics (PGx) panel-based test to guide medications used for supportive care prescribed to patients undergoing chemotherapy. The implementation was in the context of a pragmatic clinical trial for patients with non-hematologic cancers being treated with chemotherapy. Patients were randomized to either the intervention arm or control arm and received PGx testing immediately or at the end of the study, respectively. Patients completed the MD Anderson Symptom Inventory (MDASI) to assess quality of life (QoL). A total of 150 patients received PGx testing and enrolled in the study. Clinical decision support and implementation infrastructure were developed. While the study was originally planned for 500 patients, we were underpowered in our sample of 150 patients to test differences in the patient-reported MDASI scores. We did observed a high completion rate (92%) of the questionnaires; however, there were few medication changes (n = 6 in the intervention arm) based on PGx test results. Despite this, we learned several lessons through this pragmatic implementation of a PGx panel-based test in an outpatient oncology setting. Most notably, patients were less willing to undergo PGx testing if the cost of the test exceeded $100. In addition, to enhance PGx implementation success, reoccurring provider education is necessary, clinical decision support needs to appear in a more conducive way to fit in with oncologists' workflow, and PGx test results need to be available earlier in treatment planning.

The joint impact of burnout and neurotic personality on career satisfaction and intention to leave among health workers during the first 2 years of COVID-19

PURPOSE

The purpose of the study is to examine the psychological impact of COVID-19 on health workers' career satisfaction and intention to leave the health profession, with neurotic personality type as a moderator.

DESIGN/METHODOLOGY/APPROACH

A total of 277 health workers in two public hospitals in Ghana were included in this study. Purposive and convenience sampling techniques were adopted for the study, focusing on eight departments that were involved in the management of COVID-19 cases. Validated instruments were used to measure burnout, intention to leave, neurotic personality and career satisfaction. Using AMOS and partial least squares structural equation modeling (PLS-SEM), various techniques were employed to analyze mediating and moderating mechanisms.

FINDINGS

The departments had staff sizes ranging from 19 to 40, with 67% female and 33% male, with an average age of 31. Nurses accounted for the majority of responses (67.8%), followed by physicians (13.9%), sonographers (0.9%), lab technicians (0.9%) and other respondents (16.5%). The study found that health workers' level of burnout during COVID-19 had a positive effect on their intention to leave the health profession. Career satisfaction does not mediate this relationship; however, career satisfaction negatively influences the intention to leave the health profession. A neurotic personality does not moderate this relationship.

ORIGINALITY/VALUE

This study provides validation of burnout and intention to leave among health workers in Ghana during COVID-19 and supports the proposition that threats to resources (burnout) and having a resource (career satisfaction) have effects on the intention to leave one's profession.

Communication and collaboration skills training in radiation oncology: A quantitative validation survey

INTRODUCTION

Communication and collaboration are integral in radiation oncology practice. A recently published qualitative study identified several deficiencies in skills development for Australian/New Zealand trainees. We aim to validate these findings to guide curriculum development.

METHODS

A quantitative survey was developed through an iterative process, using themes identified in the previous qualitative investigation. This survey was distributed to radiation oncologists and trainees across Australia and New Zealand via email. Data collection and management utilised the REDCap system. Question types varied to maximise richness of data, including ranking, likert-scales and free-text questions. Results are primarily reported descriptively.

RESULTS

Totally 35 participants submitted completed survey responses with broad representation across geography, gender and clinician seniority. To learn communication, participants reported strong preferences towards informal observation (60% agreement) and self-reflection (49% agreement), and against online learning (77% disagreement) methodologies. Nearly 35% acknowledge poor communication at least weekly, with time pressure being a major barrier (63% agreement). Clinical uncertainty and existing patient/family assumptions (both 74% agreement) contribute to difficulties in breaking bad news, with online learning being the only negatively perceived training modality (23% agreement). No participants reported any formal training/mentoring in multi-disciplinary team (MDT) engagement. Conflict was commonly witnessed/experienced (97%) and 26% of participants avoid MDTs due to difficulties experienced.

CONCLUSIONS

This study validates the themes previously identified. We identified a strong preference for informal learning methodologies and against online modules, discordant to published literature. Effective collaboration within MDTs is identified as a particular area of need. We recommend future curriculum modification considers these results to maximise efficacy.

Advanced practice providers in hematology: actionable findings from national paired APP and physician surveys

ABSTRACT

Advanced practice providers (APPs) are critical to the hematology workforce. However, there is limited knowledge about APPs in hematology regarding specialty-specific training, scope of practice, challenges and opportunities in APP-physician interactions, and involvement with the American Society of Hematology (ASH). We conducted APP and physician focus groups to elucidate major themes in these areas and used results to inform development of 2 national surveys, 1 for APPs and 1 for physicians who work with APPs. The APP survey was distributed to members of the Advanced Practitioner Society of Hematology and Oncology, and the physician survey was distributed to physician members of ASH. A total of 841 APPs and 1334 physicians completed the surveys. APPs reported most hematology-specific knowledge was obtained via on-the-job training and felt additional APP-focused training would be helpful (as did physicians). Nearly all APPs and physicians agreed that APPs were an integral part of their organizations and that physician-APP collaborations were generally positive. A total of 42.1% of APPs and 29.3% of physicians reported burnout, and >50% of physicians felt that working with APPs had reduced their burnout. Both physicians and APPs reported interest in additional resources including "best practice" guidelines for APP-physician collaboration, APP access to hematology educational resources (both existing and newly developed resources for physicians and trainees), and greater APP integration into national specialty-specific professional organizations including APP-focused sessions at conferences. Professional organizations such as ASH are well positioned to address these areas.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

PROTOCOL REGISTRATION

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

Prevalence and factors associated with professional burnout in Polish oncologists-results of a nationwide survey

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.

Burnout Among US Gastroenterologists and Fellows in Training: Identifying Contributing Factors and Offering Solutions

BACKGROUND

Consequences of physician burnout include medical errors, higher rate of staff turnover, and decreased patient satisfaction. We examined the prevalence of burnout and identified the contributing factors in gastroenterologists and fellows in training.

METHODS

We performed 3 separate surveys through the American College of Gastroenterology. (1) A national survey of practicing gastroenterologists in the United States that measured burnout and contributing factors, (2) a survey of gastroenterology fellows in training to determine self-identified burnout, as well as mitigating and exacerbating factors, and (3) a follow-up survey of fellows during the COVID-19 pandemic.

RESULTS

One thousand and twenty-one persons responded (9.2% response rate) to the first survey, including 756 individuals who completed the Maslach Burnout Inventory survey. Overall, the prevalence of high burnout was 49.3%. Factors associated with high burnout included female sex, younger age, shorter duration in practice, considering the electronic health record non-user-friendly, 2 or more hours of patient-related work at home per day, 8 or more hours of outpatient time per day, 6 or more inpatient consults per day, taking call with procedures 10 or more times per year, and having children at home. With regard to lifestyle factors, taking 20 days or more of vacation time was associated with a lower rate of burnout. The level of burnout for fellows was observed to be high (42.7% in survey 2 and 35.3% in survey 3).

CONCLUSIONS

Burnout is high in gastroenterologists and fellows in training. Specific contributing factors were both systems based and personal and provide insight into changes that can be made to address burnout.

Burnout and Appreciation: A Cross-Sectional Study Assessing Preferences for Appreciation Among Oncology Clinicians

PURPOSE

Feeling appreciated is related to increased well-being/reduced burnout. We developed a health care-specific appreciation assessment for clinicians, exploring what impactful appreciation looks like and whether it differs across a diverse provider population.

METHODS

The cross-sectional study was conducted with a diverse oncology clinician population in academic medicine as part of a general well-being survey. A total of 28 different methods of appreciation were assessed for their impact on feeling appreciated.

RESULTS

A total of 405 clinicians participated (response rate, 58%). No single method of appreciation showed high/low impact for everyone, although seven methods received high impact ratings from 60% or more, including inclusion in decision making (76%), private words of affirmation (64%), positive feedback about skills (63%), positive comments about clinical care from patients/families (62%), efforts to reduce daily frustrations (62%), signs of trust in medical skills (62%), and time for self-care (62%). The least impactful methods of appreciation describe public expression of accomplishments, leadership rounding, and awards but each still receive a rating of moderate/high impact from 33% of participants.

CONCLUSION

Appreciation comes from many different places and takes on multiple forms, suggesting that making healthcare workers (HCWs) feel valued takes the efforts of colleagues, leaders, the system as well as patients. There exists no one perfect way of showing appreciation, and no one method is meaningless for all. The impact on feeling valued is primarily a function of the specific appreciation method and not the demographic/personal characteristics of the recipient. The findings highlight modifiable factors that-when intervened upon-can reduce burnout and address organization-level determinants of burnout impactfully.

Evolution of the Oncologist Clinician Educator

Today’s oncologist clinician educator must promote DEI, well-being, and educational scholarship.

Development, Feasibility, and Acceptability of an Oncologist Group Peer Support Program From ASCO's Clinician Well-Being Task Force

PURPOSE

The COVID-19 pandemic has had deleterious effects on oncologist professional and personal well-being, the optimal delivery of quality cancer care, and the future cancer care workforce, with many departing the field. Hence, the identification of evidence-based approaches to sustain oncologists is essential to promote well-being.

MATERIALS AND METHODS

We developed a brief, oncologist-centered, virtual group peer support program and tested its feasibility, acceptability, and preliminary impact on well-being. Trained facilitators provided support to peers on the basis of burnout research in oncology with available resources to enhance oncologist resilience. Peers completed pre- and postsurvey assessment of well-being and satisfaction.

RESULTS

From April to May 2022, 11 of 15 (73%) oncologists participated in its entirety: mean age 51.1 years (range, 33-70), 55% female, 81.8% Ca, 82% medical oncologists, 63.6% trained ≥15 years, average 30.3 patients/wk (range, 5-60), and 90.9% employed in hospital/health system practice. There was a statistically significant difference in pre- and postintervention well-being (7.0 ± 3.6 v 8.2 ± 3.0, P = .03) with high satisfaction with postgroup experience (9.1 ± 2.5). These quantitative improvements were affirmed by qualitative feedback. These themes included (1) an enhanced understanding of burnout in oncology, (2) shared experience in practice of oncology, and (3) fostering connections with diverse colleagues. Future recommendations proposed included (1) restructuring group format and (2) tailoring groups according to practice setting (academic v community).

CONCLUSION

Preliminary results suggest that a brief, innovative oncologist-tailored group peer support program is feasible, acceptable, and beneficial for enhancing well-being dimensions including burnout, engagement, and satisfaction. Additional study is required to refine program components (optimal timing, format) to support oncologist well-being, now during the pandemic and well into recovery.

ASCO Ethical Guidance for the US Oncology Community Where Reproductive Health Care Is Limited by Law

The decision in Dobbs v Jackson Women's Health Organization overturned federal protections for abortion rights, making way for states to enact abortion bans with or without exceptions for the health or life of the pregnant patient. Patient care across many areas of medicine including oncology continues to be affected. Although the change in the legal landscape is widely felt, the core ethical considerations for physicians do not change because of restrictions on the practice of medicine. ASCO offers this guidance to assist US oncologists and institutions who must balance limitations with established ethical duties. This paper articulates principles for cancer care and pregnancy, offers a framework for ethical reflection and action for oncologists who care for pregnant patients, and makes recommendations for individual and institutional action to support evidence-based, patient-centered care in the United States where abortion is illegal or access is limited.

Tıbbi Onkoloji Çalışanlarında Tükenmişlik: Ulusal Gerçeklerle Yüzleşmek

Objectives: This study aimed to reveal the prevalence of burnout syndrome among physicians, nurses and biologists working in oncology clinics in Turkey. Sociodemographic factors affecting burnout were revealed . The adequacy of institutional measures was questioned and their participation in solution proposals was examined. Material and Methods: This cross-sectionally designed study aimed to reach all actively working medical oncology staff in Turkey. 323 of them agreed to participate in the study. Maslach Burnout Inventory (MBI) was used to measure the burnout status of the participants. Clinical burnout reduction solutions were also questioned. The burnout prevention questions were prepared. Statistical significance was considered, and all statistical tests were two-sided (p < 0.05). Results: Of 323 participants, 38% were medical oncologists, 58% were nurses and 4% were biologists. The median age was 37±9. According to the MBI subscales, the mean±SD burnout levels of the oncology staff are 19.7±7.8 (high) for EE, 6±4.3 (moderate) for DP and 20.9±5.1 (high) for PA. Respondents under 41 age has higher risk. The participants who are having a hobby, good sleep pattern, making regular exercises has significantly lower burnout scores. Conclusion: Burnout syndrome was detected in more than half of oncology workers. Personal factors such as young age, family type, sleep, exercise and having a hobby affect burnout. preventive measures and interventions are required for health workers

Oncology provider experiences during the COVID-19 pandemic

PURPOSE

The COVID-19 pandemic upended nearly all aspects of daily life and of medical care, placing a double burden of professional and personal concerns on those who provide medical care. We set out to assess the burden of the pandemic on provider outlook and understand how cancer survivorship providers experienced rapid changes to practice.

METHODS

We distributed a survey through the American College of Surgeons Commission on Cancer (CoC) to its accredited organizations in mid-October 2020. We included questions on provider characteristics, changes in patient care practices resulting from the pandemic, worry about COVID-19, and concern about impact on cancer survivors.

RESULTS

Of the n = 607 participants, three-quarters were female and three-quarters were White. Only 2.1% of participants reported having had COVID-19, but 43% reported anxiety about getting COVID-19 and over a quarter experienced sadness or depression, anxiety about the future, changes to sleep, difficulty concentrating, or social isolation. Approximately half of providers also expressed significant concern about progression of cancer in patients who experienced care delays or were afraid of accessing in-person care. In terms of changes to survivorship care, respondents reported changes to visitor policies, delays or cancellations, and efforts to reduce in-person visits.

CONCLUSIONS

COVID-19 has taken a significant toll on front-line healthcare professionals, including oncologists and cancer care allied health professionals. Findings support proactive mental health support of healthcare professionals as well as emergency preparedness to manage delays to care for cancer patients in the event of future unexpected pandemics.

Assessment of the prevalence of burnout and well-being in solid organ transplant pharmacists

BACKGROUND

Solid organ transplant (SOT) pharmacist burnout and well-being has not been described.

METHODS

A survey of SOT pharmacists was distributed to transplant pharmacy organization listervs. Burnout was assessed with the full 22 item Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS-MP) and well-being was assessed with the Mayo Well-Being Index (WBI). Logistic multivariate regression was constructed to identify risk factors for a composite burnout assessment.

RESULTS

In total, 230 responses were included (estimated response rate 36.2%). Survey participants were predominantly Caucasian (80.4%), female (79.1%), married/partnered (67.4%), and were within the first 5 years of practice (32.2%) as clinical pharmacist/specialists (87%). According to the MBI-HSS-MP, 63% met criteria for burnout. Comparing the groups with or without burnout, low quality of life (40.4% vs 9.5%; p<0.001), extreme fatigue (52.1% vs 19%; p<0.001), and likelihood of leaving the job for reasons other than retirement (38.5% vs 10.7%; p<0.001) were more common. The incidence of SOT pharmacists with WBI scores ≥ 5 (decreased well-being) was 26.5%. Among clinical pharmacists, risk factors for burnout included > 10 hours per week of clinical duties outside of transplant (OR 2.669, p = 0.021) and extreme fatigue (OR 3.473, p<0.001).

CONCLUSIONS

Pharmacist burnout in SOT practice was similar to that reported in various pharmacy specialties (53-61%), which impacts clinical workforce retention and personal well-being. This article is protected by copyright. All rights reserved.

Mitigating Burnout in an Oncological Unit: A Scoping Review

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.