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Gabbard T, Perissinotti AJ, Benitez LL, Fraga M, Pettit KM, Bixby DL, Burke PW, Marini BL. Impact of Chemotherapy Educational Videos for Patients with Acute Myeloid Leukemia. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02473-2. [PMID: 38955941 DOI: 10.1007/s13187-024-02473-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2024] [Indexed: 07/04/2024]
Abstract
Patient education in acute myeloid leukemia (AML) has become increasingly complex with the introduction of new treatments and chemotherapy regimens. Video education presents an opportunity to supplement traditional patient education and address some of the gaps associated with standard methods. This single-center study sought to assess the potential impact of supplemental video education on patients receiving induction chemotherapy for AML. Participants were consented to be randomized to receive their education with or without a supplemental video designed for their treatment regimen. We then provided a survey to each participant to assess knowledge retention, anxiety, and overall satisfaction with their care. Patients that received video education were found to have significantly improved knowledge retention compared to those that did not. There were no differences detected in anxiety or patient satisfaction. Video education appears to be an effective supplemental method for patient education in AML. Limitations include the single-center nature of the study at an urban academic medical center with a relatively well-educated, primarily Caucasian, younger population. Future research is warranted to assess the video in a diverse set of languages and to explore its broader benefits.
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Affiliation(s)
- Taylor Gabbard
- Department of Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, Ann Arbor, USA
| | - Anthony J Perissinotti
- Department of Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, Ann Arbor, USA
| | - Lydia L Benitez
- Department of Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, Ann Arbor, USA
| | - Martina Fraga
- Department of Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, Ann Arbor, USA
| | - Kristen M Pettit
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan Medical School, Ann Arbor, USA
| | - Dale L Bixby
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan Medical School, Ann Arbor, USA
| | - Patrick W Burke
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan Medical School, Ann Arbor, USA
| | - Bernard L Marini
- Department of Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, Ann Arbor, USA.
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Barnbrock A, Schäfer K, Stursberg J, Siebald B, Graf N, Mücke U, Schneider DT, Bochennek K, Füller M. Committed Lone Fighters And Group Experiences: An International Survey On Pediatric Hematology And Oncology Training In German-Speaking Countries. KLINISCHE PADIATRIE 2024. [PMID: 38428466 DOI: 10.1055/a-2260-4374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
INTRODUCTION In German-speaking countries children with cancer are treated in about 70 hospitals. While national and European curricula for pediatric oncology and hematology (POH) have been developed, little is known, how far these curricula have been implemented into daily training and what topics are deemed urgent by instructors. METHODS AND MATERIALS In 2022 the Didactics and Educational working party of the German Pediatric Hematology/Oncology Society conducted a survey plus interview by phone call on local educational conditions in POH and needs of educators. RESULTS Thirty-two (45%) POH centers answered the questionary, half have appointed persons overseeing the training. A wide range educational scenarios were described in some centers. Trainees identified urgent needs in areas such as hybrid education and demanded training workshops on specific topics and intensified networking and a general curriculum implemented into daily care as mandatory. CONCLUSION This is the first survey on educational issues in POH in German speaking centers, describing the current situation before and under pandemic conditions. Great individual efforts have already been achieved by dedicated teachers. A comprehensive training program in POH is still missing, which translates the national curriculum into daily practice, while improving networking and balancing the resources of the individual centers.
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Affiliation(s)
- Anke Barnbrock
- Centre for Paediatrics and Adolescent Medicine, Pediatric Hematology and Oncology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Kristine Schäfer
- Pediatric Hematology and Oncology, University Hospital Giessen, Giessen, Germany
| | - Jana Stursberg
- Pediatric Hematology and Oncology, Ulm University Hospital, Ulm, Germany
| | - Benjamin Siebald
- Centre for Paediatrics and Adolescent Medicine, Pediatric Hematology and Oncology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Norbert Graf
- Pediatric Hematology and Oncology, Saarland University Hospital, Homburg/Saar, Germany
| | - Urs Mücke
- Pediatric Hematology and Oncology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Germany
| | - Dominik T Schneider
- Centre for Paediatrics and Adolescent Medicine, Pediatric Hematology and Oncology, Hospital Dortmund, Dortmund, Germany
| | - Konrad Bochennek
- Centre for Paediatrics and Adolescent Medicine, Pediatric Hematology and Oncology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Miriam Füller
- Bone marrow transplantation and Pediatric Hematology and Oncology, University Hospital Münster, Munster, Germany
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Tal A, Moerdler S, Fernández CR, Dome JS, Sakamoto KM. Can you hear me now? Tools for cultivating a culture of respect, value, and appreciation within pediatric hematology, oncology, and cellular therapy. Pediatr Blood Cancer 2023; 70:e30127. [PMID: 36495252 DOI: 10.1002/pbc.30127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 12/14/2022]
Abstract
The American Society of Pediatric Hematology/Oncology (ASPHO) conducted a workshop "Can you hear me now? Cultivating a culture of respect, value, and appreciation within pediatric hematology/oncology" at their annual meeting in May 2022 in hopes of exploring how the members can enhance wellness in a climate of increasing diversity. Initiatives in the past have focused on personal care, but it has been widely shown that administrative and institutional driven initiatives are essential to create an environment of wellness. In this interactive workshop, we discovered that 22% of participants felt their institution does not instill a culture of respect. We offered tools to the audience on multiple levels: graceful self-promotion, diversity and inclusion, and leadership perspective on creating a culture of respect to address the individual, local community, and top-down leadership approaches. Here, we offer a summary on the content of the workshop, and expand upon many of the discussion points that were raised during the workshop. We bring forth novel information on each topic individually from diverse points of view, specific to the field of pediatric hematology/oncology (PHO). We aim to highlight the importance of creating a diverse and respectful work environment in PHO in hopes of ensuring motivated, satisfied, and fulfilled healthcare providers who feel appreciated and valued.
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Affiliation(s)
- Adit Tal
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Scott Moerdler
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Cristina R Fernández
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York, USA
| | - Jeffrey S Dome
- Division of Oncology, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Kathleen M Sakamoto
- Department of Pediatrics, Division of Hematology/Oncology, Stanford University, Stanford, California, USA
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Hasan F, Pabari R, Wilejto M. Training for Wellness in Pediatric Oncology: A Focus on Education and Hidden Curricula. Curr Oncol 2022; 29:5579-5584. [PMID: 36005178 PMCID: PMC9406305 DOI: 10.3390/curroncol29080440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Pediatric oncologists have the privilege of caring for children and families facing serious, often life-threatening, illnesses. Providing this care is emotionally demanding and associated with significant risks of stress and burnout for oncologists. Traditional approaches to physician burnout and wellbeing have not emphasized the potential roles of education and training in mitigating this stress. In this commentary, we discuss the contribution that education, particularly in the areas of palliative and psychosocial oncology, can make in preparing oncologists for the work that they do. We argue that by adequately providing oncologists with the skills they need for their work, we can reduce their risk of burning out. We also discuss the importance of paying attention to hidden and formal curricula to ensure that messages provided in formal education programs are supported by informal training experiences.
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Affiliation(s)
- Fyeza Hasan
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Correspondence:
| | - Reena Pabari
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Marta Wilejto
- Division of Hematology/Oncology, Department of Pediatrics, London Health Sciences Center, London, ON N6A 5W9, Canada
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Silverman H, Wilson T, Tisherman S, Kheirbek R, Mukherjee T, Tabatabai A, McQuillan K, Hausladen R, Davis-Gilbert M, Cho E, Bouchard K, Dove S, Landon J, Zimmer M. Ethical decision-making climate, moral distress, and intention to leave among ICU professionals in a tertiary academic hospital center. BMC Med Ethics 2022; 23:45. [PMID: 35439950 PMCID: PMC9017406 DOI: 10.1186/s12910-022-00775-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Commentators believe that the ethical decision-making climate is instrumental in enhancing interprofessional collaboration in intensive care units (ICUs). Our aim was twofold: (1) to determine the perception of the ethical climate, levels of moral distress, and intention to leave one's job among nurses and physicians, and between the different ICU types and (2) determine the association between the ethical climate, moral distress, and intention to leave. METHODS We performed a cross-sectional questionnaire study between May 2021 and August 2021 involving 206 nurses and physicians in a large urban academic hospital. We used the validated Ethical Decision-Making Climate Questionnaire (EDMCQ) and the Measure of Moral Distress for Healthcare Professionals (MMD-HP) tools and asked respondents their intention to leave their jobs. We also made comparisons between the different ICU types. We used Pearson's correlation coefficient to identify statistically significant associations between the Ethical Climate, Moral Distress, and Intention to Leave. RESULTS Nurses perceived the ethical climate for decision-making as less favorable than physicians (p < 0.05). They also had significantly greater levels of moral distress and higher intention to leave their job rates than physicians. Regarding the ICU types, the Neonatal/Pediatric unit had a significantly higher overall ethical climate score than the Medical and Surgical units (3.54 ± 0.66 vs. 3.43 ± 0.81 vs. 3.30 ± 0.69; respectively; both p ≤ 0.05) and also demonstrated lower moral distress scores (both p < 0.05) and lower "intention to leave" scores compared with both the Medical and Surgical units. The ethical climate and moral distress scores were negatively correlated (r = -0.58, p < 0.001); moral distress and "intention to leave" was positively correlated (r = 0.52, p < 0.001); and ethical climate and "intention to leave" were negatively correlated (r = -0.50, p < 0.001). CONCLUSIONS Significant differences exist in the perception of the ethical climate, levels of moral distress, and intention to leave between nurses and physicians and between the different ICU types. Inspecting the individual factors of the ethical climate and moral distress tools can help hospital leadership target organizational factors that improve interprofessional collaboration, lessening moral distress, decreasing turnover, and improved patient care.
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Affiliation(s)
- Henry Silverman
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
| | - Tracey Wilson
- University of Maryland Medical Center, Baltimore, USA
| | - Samuel Tisherman
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Raya Kheirbek
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | | | - Ali Tabatabai
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | | | | | | | - Eunsung Cho
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | | | - Samantha Dove
- University of Maryland Medical Center, Baltimore, USA
| | - Julie Landon
- University of Maryland Medical Center, Baltimore, USA
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Laronne A, Granek L, Wiener L, Feder-Bubis P, Golan H. Organizational and individual barriers and facilitators to the integration of pediatric palliative care for children: A grounded theory study. Palliat Med 2021; 35:1612-1624. [PMID: 34219546 PMCID: PMC10087284 DOI: 10.1177/02692163211026171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pediatric palliative care has established benefits for children with cancer and their families. Overcoming organizational and healthcare provider barriers have been demonstrated as central for the provision of palliative care in pediatric oncology. A deeper understanding is needed of the influence of these barriers and the interactions between them, specifically in primary palliative care in hospital settings. AIM To identify the organizational and healthcare provider barriers to the provision of primary pediatric palliative care. DESIGN This study utilized the grounded theory method. Semi-structured interviews were conducted and analyzed line by line, using NVivo software. SETTING/PARTICIPANTS Forty-six pediatric oncologists, nurses, psychosocial team members, and other healthcare providers from six academic hospital centers participated in the research. RESULTS Organizational and healthcare provider factors were identified, each of which acted as both a barrier and facilitator to the provision of pediatric palliative care. Organizational barriers included lack of resources and management. Facilitators included external resources, resource management, and a palliative care center within the hospital. Individual barriers included attitudes toward palliative care among pediatric oncologists, pediatric oncologists' personalities, and the emotional burden of providing palliative care. Facilitators include dedication and commitment, initiative, and sense of meaning. Provider facilitators for palliative care had a buffering effect on organizational barriers. CONCLUSION Organizational and healthcare provider factors influence the quality and quantity of palliative care given to children and their families. This finding has implications on interventions structured to promote primary palliative care for children, especially in healthcare systems and situations where resources are limited.
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Affiliation(s)
- Anat Laronne
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Leeat Granek
- School of Health Policy and Management and Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Paula Feder-Bubis
- Department of Health Policy and Management, Faculty of Health Sciences and Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Hana Golan
- Pediatric Hematology Oncology Department, Safra Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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7
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Kong M, Zhou T, Xiang B. Expression of the axon guidance factor Slit2 and its receptor Robo1 in patients with Hirschsprung disease: An observational study. Medicine (Baltimore) 2021; 100:e26981. [PMID: 34414975 PMCID: PMC8376357 DOI: 10.1097/md.0000000000026981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/12/2021] [Accepted: 07/27/2021] [Indexed: 02/05/2023] Open
Abstract
ABSTRACT Hirschsprung disease (HD) is a common form of digestive tract malformation in children. However, the pathogenesis of HD is not very clear. This study aimed to investigate the expression of slit guidance ligand 2 (Slit2) and roundabout 1 (Robo1) in patients with HD.From January 2018 to January 2019, 30 colon specimens from children with HD undergoing surgical resection at the Department of Surgery in Qilu Children's Hospital of Shandong University were obtained. These specimens were divided into the normal segment group, the transitional segment group and the spastic segment group. Immunohistochemical staining, Western blotting, and real-time polymerase chain reaction were used to measure the expression of Slit2 and Robo1 in the intestinal walls of normal, transitional, and spastic segments.Immunohistochemical staining and Western blot analyses showed high levels of the Slit2 and Robo1 proteins in normal ganglion cells in children with HD, lower levels in transitional ganglion cells, and no expression in spastic segments, with significant differences between groups (P < .05). Similarly, the real-time polymerase chain reaction results were consistent with the Western blot analysis results.The expression of Slit2 and Robo1 decreases significantly in the spastic segment of the intestinal tract in patients with HD.
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Affiliation(s)
- Meng Kong
- Department of Pediatric Surgery, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Tao Zhou
- Department of Pediatric Surgery, Dazhou Central Hospital, Dazhou, China
| | - Bo Xiang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
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8
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Lejeune J, Fouquereau E, Chênevert D, Coillot H, Chevalier S, Gillet N, Michon JM, Gandemer V, Colombat P. The Participatory Approach: A Specific French Organizational Model at the Department Level to Serve the Quality of Work Life of Healthcare Providers and the Quality of Care in Pediatric Oncology. Cancer Manag Res 2021; 13:2763-2771. [PMID: 33790650 PMCID: PMC8006951 DOI: 10.2147/cmar.s284439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background Care providers ‘psychological health at work is an important issue because it directly affects the quality of patient care. So far, few studies have studied the psychological health at work of care providers in paediatric oncology. The participatory approach (PA) is an innovative organizational model of department specific to France and previously associated with quality of work life (QWL) and job performance. The aim of the present study was to explore the relationships between the participatory approach, care providers’ QWL and quality of care of children in pediatric oncology departments in France. Methods A multicentre survey was carried out in pediatric cancer units in France. Care providers completed a questionnaire assessing PA, QWL, consequences of QWL, and their perception of quality of care. The children or their parents completed a questionnaire assessing their perception of quality of care. Results Five hundred and ten healthcare professionals working in French pediatric oncology centres (more than 40% of the healthcare staff in paediatric oncology in France), 142 children and 298 parents responded to the survey. PA was associated with the care providers’ QWL (β = 0.274; p <0.001), work engagement (β = 0.167; p<0.001), job satisfaction (β = 0.166; p<0.001) and perception of quality of care (β = 0.236; p<0.001). PA was also related to patients’ perception of quality of care notably regarding quality of communication (β = 0.161; p<0.001) and information (β = 0.226; p<0.001). Conclusion PA is an innovative organizational model that appears to play a role in all aspects of healthcare providers’ QWL, and in the quality of care perceived by both care providers and patients.
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Affiliation(s)
- Julien Lejeune
- Service d'Onco-Hématologie Pédiatrique, Hôpital Clocheville, Tours, France
| | | | | | | | | | | | - Jean M Michon
- Département de Pédiatrie, Institut Curie, Paris, France
| | - Virginie Gandemer
- Service d'Onco-Hématologie Pédiatrique, CHU Hôpital Sud, Rennes, France
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Moynihan KM, Taylor L, Crowe L, Balnaves MC, Irving H, Ozonoff A, Truog RD, Jansen M. Ethical climate in contemporary paediatric intensive care. JOURNAL OF MEDICAL ETHICS 2021; 47:medethics-2020-106818. [PMID: 33431646 DOI: 10.1136/medethics-2020-106818] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
Ethical climate (EC) has been broadly described as how well institutions respond to ethical issues. Developing a tool to study and evaluate EC that aims to achieve sustained improvements requires a contemporary framework with identified relevant drivers. An extensive literature review was performed, reviewing existing EC definitions, tools and areas where EC has been studied; ethical challenges and relevance of EC in contemporary paediatric intensive care (PIC); and relevant ethical theories. We surmised that existing EC definitions and tools designed to measure it fail to capture nuances of the PIC environment, and sought to address existing gaps by developing an EC framework for PIC founded on ethical theory. In this article, we propose a Paediatric Intensive Care Ethical Climate (PICEC) conceptual framework and four measurable domains to be captured by an assessment tool. We define PICEC as the collective felt experience of interdisciplinary team members arising from those factors that enable or constrain their ability to navigate ethical aspects of their work. PICEC both results from and is influenced by how well ethical issues are understood, identified, explored, reflected on, responded to and addressed in the workplace. PICEC encompasses four, core inter-related domains representing drivers of EC including: (1) organisational culture and leadership; (2) interdisciplinary team relationships and dynamics; (3) integrated child and family-centred care; and (4) ethics literacy. Future directions involve developing a PICEC measurement tool, with implications for benchmarking as well as guidance for, and evaluation of, targeted interventions to foster a healthy EC.
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Affiliation(s)
- Katie M Moynihan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Lisa Taylor
- Office of Ethics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Liz Crowe
- Department of Pediatric Intensive Care, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Mary-Claire Balnaves
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Helen Irving
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Centre for Children's Health Ethics and Law, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Al Ozonoff
- Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Robert D Truog
- Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Melanie Jansen
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Pediatric Intensive Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Raney L, McManaman J, Elsaid M, Morgan J, Bowman R, Mohamed A, Russo CL. Multisite Quality Improvement Initiative to Repair Incomplete Electronic Medical Record Documentation As One of Many Causes of Provider Burnout. JCO Oncol Pract 2020; 16:e1412-e1416. [PMID: 32758084 DOI: 10.1200/op.20.00294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Provider burnout is a challenge adversely affecting the quality, safety, and cost of health care. We measured burnout among pediatric oncology providers in the St Jude Affiliate network and used a Plan-Do-Study-Act (PDSA) improvement cycle to address one of the factors contributing to burnout. METHODS Within the framework of the ASCO Thematic Quality Training Program, we sent the Mini Z 2.0 Survey to 47 pediatric oncology providers. Applying a fishbone diagram and Pareto chart, we analyzed potential causes of provider burnout. On the basis of the analysis, we used a PDSA approach to address documentation of oral chemotherapy adherence for children with acute lymphoblastic leukemia to mitigate burnout among providers. RESULTS The burnout survey response rate was 44.6%. Burnout was identified in 42.9% of providers. Documentation in the electronic medical record (EMR) was cited as the second most common contributor to burnout, and it was this issue we chose to address according to a priority matrix. We improved the completeness of oral chemotherapy documentation from a baseline of 13% compliance to 87% compliance within 3 months. The improved compliance was achieved by standardizing the documentation process in the EMR for content and location. CONCLUSION The EMR was one of the contributing factors in the burnout survey of the pediatric oncology providers in the St Jude Affiliate network. A PDSA improvement model to improve clinical research documentation was successful in addressing one of several contributing factors to provider burnout.
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Affiliation(s)
- Lauren Raney
- Department of Pediatrics, St Jude Affiliate Clinic at Our Lady of the Lake Children's Hospital, Baton Rouge, LA
| | - Joanne McManaman
- Department of Pediatrics, St Jude Affiliate Clinic at Novant Health Hemby Children's Hospital, Charlotte, NC
| | - Mohamed Elsaid
- Department of Pediatrics, St Jude Affiliate Clinic at Mercy Kids Hospital, Springfield, MO
| | - Jennifer Morgan
- Affiliate Program Office, St Jude Children's Research Hospital, Memphis, TN
| | - Ronda Bowman
- Clinical Affairs Department, ASCO, Alexandria, VA
| | - Ashraf Mohamed
- Department of Pediatric Hematology, Oncology, Cook Children's Medical Center, Fort Worth, TX
| | - Carolyn L Russo
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN
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11
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Nadel AL, Barbach N, Fish JD. How I approach peer support in pediatric hematology/oncology. Pediatr Blood Cancer 2020; 67:e28297. [PMID: 32524737 DOI: 10.1002/pbc.28297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 11/10/2022]
Abstract
Peer support has begun to gain traction as a mechanism for improving well-being in medicine. In this paper, we share our experience building, training, and piloting a peer support team based on a "critical incident stress management" model. The HOPES team (Helping Our Peers Endure Stress) is dedicated to, and composed entirely of, members of our division of pediatric hematology/oncology. Peer support will not solve all the well-being problems afflicting medicine. It is, however, a very good place to start.
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Affiliation(s)
- Amy L Nadel
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, East Garden City, New York.,Division of Pediatric Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, Northwell Health, New York City, New York
| | - Nancy Barbach
- Division of Pediatric Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, Northwell Health, New York City, New York.,Department of Social Work, Cohen Children's Medical Center, Northwell Health, New York City, New York
| | - Jonathan D Fish
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, East Garden City, New York.,Division of Pediatric Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, Northwell Health, New York City, New York
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12
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Mahon P. A critical ethnographic evaluation of pediatric haematology/oncology physicians and burn-out. Pediatr Hematol Oncol 2020; 37:153-163. [PMID: 31870205 DOI: 10.1080/08880018.2019.1702127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This qualitative study aims to ascertain what it is that affects pediatric hematology/oncology physicians professional and personal attitudes within their work environment. This research is based in one pediatric oncology unit in western Canada using a critical ethnographic research approach. Critical ethnography was the methodology used to conduct this study. Critical Ethnography (CE) is an interpretative research methodology that allows the researcher to evaluate the cultural aspects of a group, or an organization 'within their setting'; to understand and expose the meaning of the relationships in that environment; without meaning being imposed on them externally. 11 physicians (N = 11) participated in this study, this represents approximately 80% of the physician population in this unit. Semi-structured interviews were conducted which lasted an average of 36 minutes per interview. Physicians described their relationships with colleagues, patients and families as both rewarding but also producing symptoms of burn-out. The majority agreed that they enjoy their job because of the constantly evolving research and scientific updates in oncology research. There is a paradox of conflicting satisfiers and dissatisfiers mainly pertaining to patient, parent, physician relationships. Consideration to offering sabbatical leave should be assessed.
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Affiliation(s)
- Paula Mahon
- Hematology/Oncology, British Columbia's Children's Hospital, Vancouver, Canada.,School of Nursing, University of British Columbia, Vancouver, Canada
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A Cross-sectional Analysis of Compassion Fatigue, Burnout, and Compassion Satisfaction in Pediatric Hematology-Oncology Physicians in the United States. J Pediatr Hematol Oncol 2020; 42:e50-e55. [PMID: 31259831 DOI: 10.1097/mph.0000000000001548] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Compassion fatigue (CF), burnout (BO), and compassion satisfaction (CS) are interrelated phenomena that impact personal and professional performance. The CF and Satisfaction Self-Test and a demographic questionnaire were distributed electronically to pediatric hematology-oncology physicians nationally. Linear regression models for CF, BO, and CS as a function of potential predictors were constructed. Survey response rate was 28%. Female sex, BO score, distress about a "clinical situation," and "teaching" were associated with higher CF scores. "Administrative activities" were associated with lower CF scores. CF score, and distress about "administrative burden/academic stress" and "coworkers" were associated with higher BO scores. CS score and "socializing" were associated with lower BO scores. "Exercise," "socializing," and "talking with partner" were associated with higher CS scores. CF and BO scores, emotional depletion, and distress about the "work environment" and "administrative/academic burden" were associated with lower CS scores. Our data highlights the importance of strong social connections at work and at home to decrease BO and enhance CS. Professional development in leadership, communication, and conflict resolution, as well as "team building" events may perpetuate coworker relationships. Education about the importance of connectedness and self-care should begin early in medical education to cultivate robust coping mechanisms in trainees.
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Mukherjee S, Tennant A, Beresford B. Measuring Burnout in Pediatric Oncology Staff: Should We Be Using the Maslach Burnout Inventory? J Pediatr Oncol Nurs 2019; 37:55-64. [PMID: 31526056 DOI: 10.1177/1043454219873638] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Burnout in health service staff is a cause for concern since it has negative consequences for the individual affected, the wider organization, and patients. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) has been widely used to assess the prevalence of burnout within oncology services. The MBI-HSS is a self-report measure comprising three subscales-Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA). This article reports on the first study to investigate the psychometric properties of the MBI-HSS when administered to pediatric oncology staff. Two hundred and three pediatric oncology staff recruited through seven UK Principal Treatment Centers (PTCs) and a children's cancer charity completed the MBI-HSS. The factor structure of the instrument was tested using confirmatory and exploratory factor analysis, with Rasch analysis applied to assess whether the measure meets the requirements of an interval-level scale. Cronbach alpha was used to assess internal reliability. Factor analysis did not support the traditional three-factor structure of the MBI-HSS but instead suggested seven factors. Rasch analysis and alpha coefficients indicated that while the EE and the PA subscales fulfilled the requirements of an interval-level measure for group-level diagnosis, DP did not. Further investigation revealed a "floor effect" on many DP items. Whereas the EE and PA subscales of the MBI-HSS can be used in research with pediatric oncology staff working in PTCs, there are considerable problems with the DP subscale, and researchers should be cautious in interpreting data from this subscale.
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15
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Krystal JI. Time well spent. Pediatr Blood Cancer 2019; 66:e27582. [PMID: 30548386 DOI: 10.1002/pbc.27582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/14/2018] [Accepted: 11/26/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Julie I Krystal
- Department of Pediatric Hematology-Oncology, Cohen Children's Medical Center, New Hyde Park, New York
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16
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Kazak AE, Scialla MA, Patenaude AF, Canter K, Muriel AC, Kupst MJ, Chen FF, Wiener L. The multidisciplinary pediatric psycho-oncology workforce: A national report on supervision for staff and training opportunities. Psychooncology 2018; 27:2802-2808. [PMID: 30242934 DOI: 10.1002/pon.4892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This paper presents data on licensure/certification status, supervision of multidisciplinary pediatric psychosocial staff, and training opportunities in pediatric cancer programs in the United States, data that are critical to provide care aligned with the Standards of Psychosocial Care in Pediatric Cancer (Psychosocial Standards). METHODS An online survey of psychosocial care consistent with the Psychosocial Standards was completed from a national sample of pediatric cancer programs (144/200). Licensure/certification status, availability and format of supervision for multidisciplinary staff (social workers, psychologists, psychiatrists, child life specialists/recreational therapists), and types and number of psychosocial trainees were reported. RESULTS Nearly all pediatric psychosocial providers were licensed/certified. Peer consultation was the most frequently endorsed form of staff supervision although a sizeable group of centers reported no systematic ongoing supervision. Trainees in social work and child life were most common although the size of trainee cohorts is generally small. Psychosocial trainees are more prevalent in sites with pediatric hematology/oncology medical fellowship programs and in larger programs. CONCLUSIONS A properly trained and supported psychosocial workforce is essential to providing evidence-based care consistent with the Psychosocial Standards. Psychosocial providers are appropriately licensed. However, supervision opportunities are variable and may be inadequate for the intensity of the work. It is important to address the limited opportunities for trainees in pediatric cancer programs, which may influence the pipeline for ongoing and future work in this area.
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Affiliation(s)
- Anne E Kazak
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE, USA.,Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Michele A Scialla
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE, USA
| | | | - Kimberly Canter
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE, USA.,Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Anna C Muriel
- Dana-Farber Cancer Center, Harvard Medical School, Boston, MA, USA
| | | | - Fang Fang Chen
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE, USA.,Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Lori Wiener
- National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA
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