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Sommerlatte S, Hense H, Nadolny S, Kraeft AL, Lugnier C, Schmitt J, Schoffer O, Reinacher-Schick A, Schildmann J. What does "urgency" mean when prioritizing cancer treatment? Results from a qualitative study with German oncologists and other experts during the COVID-19 pandemic. J Cancer Res Clin Oncol 2024; 150:352. [PMID: 39009898 PMCID: PMC11249432 DOI: 10.1007/s00432-024-05863-7] [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: 04/16/2024] [Accepted: 06/19/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE Cancer care in Germany during the COVID-19 pandemic was affected by resource scarcity and the necessity to prioritize medical measures. This study explores ethical criteria for prioritization and their application in cancer practices from the perspective of German oncologists and other experts. METHODS We conducted fourteen semi-structured interviews with German oncologists between February and July 2021 and fed findings of interviews and additional data on prioritizing cancer care into four structured group discussions, in January and February 2022, with 22 experts from medicine, nursing, law, ethics, health services research and health insurance. Interviews and group discussions were digitally recorded, transcribed verbatim and analyzed using qualitative content analysis. RESULTS Narratives of the participants focus on "urgency" as most acceptable criterion for prioritization in cancer care. Patients who are considered curable and those with a high level of suffering, were given a high degree of "urgency." However, further analysis indicates that the "urgency" criterion needs to be further distinguished according to at least three different dimensions: "urgency" to (1) prevent imminent harm to life, (2) prevent future harm to life and (3) alleviate suffering. In addition, "urgency" is modulated by the "success," which can be reached by means of an intervention, and the "likelihood" of reaching that success. CONCLUSION Our analysis indicates that while "urgency" is a well-established criterion, its operationalization in the context of oncology is challenging. We argue that combined conceptual and clinical analyses are necessary for a sound application of the "urgency" criterion to prioritization in cancer care.
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Affiliation(s)
- Sabine Sommerlatte
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany.
| | - Helene Hense
- Center for Evidence-Based Healthcare, Medical Faculty and University Hospital Carl Gustav Carus , TUD Dresden University of Technology, Dresden, Germany
| | - Stephan Nadolny
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany
- Institute for Educational and Health-Care Research in the Health Sector, Faculty of Health, Hochschule Bielefeld - University of Applied Sciences and Arts, Interaktion 1, 33619, Bielefeld, Germany
| | - Anna-Lena Kraeft
- Department of Hematology, Oncology and Palliative Care, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Celine Lugnier
- Department of Hematology, Oncology and Palliative Care, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Medical Faculty and University Hospital Carl Gustav Carus , TUD Dresden University of Technology, Dresden, Germany
| | - Olaf Schoffer
- Center for Evidence-Based Healthcare, Medical Faculty and University Hospital Carl Gustav Carus , TUD Dresden University of Technology, Dresden, Germany
| | - Anke Reinacher-Schick
- Department of Hematology, Oncology and Palliative Care, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Schildmann
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany
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Thompson PW. Impact of COVID-19 on Ethnically Minoritised Carers in UK's Care Home Settings: a Systematic Scoping Review. J Racial Ethn Health Disparities 2024; 11:1651-1659. [PMID: 37410355 PMCID: PMC11101518 DOI: 10.1007/s40615-023-01640-3] [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: 04/07/2023] [Revised: 05/06/2023] [Accepted: 05/11/2023] [Indexed: 07/07/2023]
Abstract
COVID-19 has impacted disproportionately two groups in the UK: healthcare workers and people from ethnically minoritised groups. However, there is a lack of evidence on how COVID-19 affected ethnically minoritised carers in care homes. Therefore, the present study aimed to explore the available evidence regarding the impact of COVID-19 on ethnically minoritised carers in UK. The relevant records were systematically searched in Cochrane COVID-19 Study Register and WHO COVID-19 global literature. A total of 3164 records were retrieved. Following duplicate elimination and abstract, title, and full-text screening, 10 studies were identified as eligible for the present scoping review. Most of the studies were conducted in the UK and USA, involving diverse healthcare occupations and methodologies. Multiple studies found anxiety, depression, stress, and post-traumatic stress disorder among carers with high odds among ethnically minoritised carers. Limited access to personal protective equipment and workplace discrimination was noted and linked with poor mental health. The carers reported difficulties in care delivery and managing extra workload arising from staff shortages. The risk of infection and clinically significant mental disorders was higher among carers from the ethnically minoritised background. They exhibited fear about care homes' uncertain futures and consequential financial losses. Conclusively, COVID-19 appeared to exert adverse effects on practices and experiences of ethnically minoritised carers in the UK's care homes; however, further studies are warranted to increase the understanding of COVID-19-related experiences of this group of carers which significantly contribute to the country's healthcare system.
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Siegel RD, LeFebvre KB, Temin S, Evers A, Barbarotta L, Bowman RM, Chan A, Dougherty DW, Ganio M, Hunter B, Klein M, Miller TP, Mulvey TM, Ouzts A, Polovich M, Salazar-Abshire M, Stenstrup EZ, Sydenstricker CM, Tsai S, Oslen MM. Antineoplastic Therapy Administration Safety Standards for Adult and Pediatric Oncology: ASCO-ONS Standards. JCO Oncol Pract 2024:OP2400216. [PMID: 38776491 DOI: 10.1200/op.24.00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE To update the ASCO-Oncology Nursing Society (ONS) standards for antineoplastic therapy administration safety in adult and pediatric oncology and highlight current standards for antineoplastic therapy for adult and pediatric populations with various routes of administration and location. METHODS ASCO and ONS convened a multidisciplinary Expert Panel with representation of multiple organizations to conduct literature reviews and add to the standards as needed. The evidence base was combined with the opinion of the ASCO-ONS Expert Panel to develop antineoplastic safety standards and guidance. Public comments were solicited and considered in preparation of the final manuscript. RESULTS The standards presented here include clarification and expansion of existing standards to include home administration and other changes in processes of ordering, preparing, and administering antineoplastic therapy; the advent of immune effector cellular therapy; the importance of social determinants of health; fertility preservation; and pregnancy avoidance. In addition, the standards have added a fourth verification. STANDARDS Standards are provided for which health care organizations and those involved in all aspects of patient care can safely deliver antineoplastic therapy, increase the quality of care, and reduce medical errors.Additional information is available at www.asco.org/standards and www.ons.org/onf.
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Affiliation(s)
| | | | - Sarah Temin
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Amy Evers
- University of Pennsylvania Health System, Philadelphia, PA
| | - Lisa Barbarotta
- Smilow Cancer Hospital and Yale Cancer Center, New Haven, CT
| | - Ronda M Bowman
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Alexandre Chan
- University of California, Irvine, Chao Family Comprehensive Cancer Center, National Cancer Centre Singapore, Irvine, CA
| | | | - Michael Ganio
- ASHP (American Society of Health-System Pharmacists), Bethesda, MD
| | | | - Meredith Klein
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Tamara P Miller
- Emory University/Children's Healthcare of Atlanta, Atlanta, GA
| | | | | | | | - Maritza Salazar-Abshire
- Department of Nursing Education, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Susan Tsai
- Ohio State University Comprehensive Cancer Center, Columbus, OH
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Round T, Sethuraman L, Ashworth M, Purushotham A. Transforming post pandemic cancer services. Br J Cancer 2024; 130:1233-1238. [PMID: 38491174 PMCID: PMC11014976 DOI: 10.1038/s41416-024-02596-9] [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: 10/22/2022] [Revised: 11/15/2023] [Accepted: 01/19/2024] [Indexed: 03/18/2024] Open
Abstract
This paper outlines the impact of the COVID-19 pandemic on cancer services in the UK including screening, symptomatic diagnosis, treatment pathways and projections on clinical outcomes as a result of these care disruptions. A restoration of cancer services to pre-pandemic levels is not likely to mitigate this adverse impact, particularly with an ageing population and increased cancer burden. New cancer cases are projected to rise to over 500,000 per year by 2035, with over 4 million people living with and beyond cancer. This paper calls for a strategic transformation to prioritise effort on the basis of available datasets and evidence-in particular, to prioritise cancers where an earlier diagnosis is feasible and clinically useful with a focus on mortality benefit by preventing emergency presentations by harnessing data and analytics. This could be delivered by a focus on underperforming groups/areas to try and reduce inequity, linking near real-time datasets with clinical decision support systems at the primary and secondary care levels, promoting the use of novel technologies to improve patient uptake of services, screening and diagnosis, and finally, upskilling and cross-skilling healthcare workers to expand supply of diagnostic and screening services.
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Affiliation(s)
- Thomas Round
- School of Life Course and Population Sciences, King's College London, London, UK.
| | | | - Mark Ashworth
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Arnie Purushotham
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
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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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Fernandez Montes A, Elez E, de la Haba-Rodriguez J, Paez D, Mendez-Vidal MJ, Felip E, Rodriguez-Lescure A. Medical oncology workload, workforce census, and needs in Spain: two nationwide studies by the Spanish Society of medical oncology. Clin Transl Oncol 2024; 26:98-108. [PMID: 37316754 PMCID: PMC10266958 DOI: 10.1007/s12094-023-03225-2] [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: 04/18/2023] [Accepted: 05/22/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE Growing complexity and demand for cancer care entail increased challenges for Medical Oncology (MO). The Spanish Society of Medical Oncology (SEOM) has promoted studies to provide updated data to estimate the need for medical oncologists in 2040 and to analyse current professional standing of young medical oncologists. METHODS Two national, online surveys were conducted. The first (2021) targeted 146 Heads of MO Departments, and the second (2022), 775 young medical oncologists who had completed their MO residency between 2014 and 2021. Participants were contacted individually, and data were processed anonymously. RESULTS Participation rates reached 78.8% and 48.8%, respectively. The updated data suggest that 87-110 new medical oncologist full-time equivalents (FTEs) should be recruited each year to achieve an optimal ratio of 110-130 new cases per medical oncologist FTE by 2040. The professional standing analysis reveals that 9.1% of medical oncologists trained in Spain do not work in clinical care in the country, with tremendous employment instability (only 15.2% have a permanent contract). A high percentage of young medical oncologists have contemplated career paths other than clinical care (64.5%) or working in other countries (51.7%). CONCLUSIONS Optimal ratios of medical oncologists must be achieved to tackle the evolution of MO workloads and challenges in comprehensive cancer care. However, the incorporation and permanence of medical oncologists in the national healthcare system in Spain could be compromised by their current sub-optimal professional standing.
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Affiliation(s)
- Ana Fernandez Montes
- Department of Medical Oncology, University Hospital Complex of Ourense (CHUO), Ourense, Galicia, Spain.
| | - Elena Elez
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Univesitat Autònoma de Barcelona (UAB), Barcelona, Catalunya, Spain
| | - Juan de la Haba-Rodriguez
- Medical Oncology Department, Reina Sofia University Hospital, Maimonides Institute for Biomedical Research in Cordoba, Córdoba, Spain
| | - David Paez
- Department of Medical Oncology, Santa Creu I Sant Pau University Hospital, U705, ISCIII Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Catalunya, Spain
| | - Maria Jose Mendez-Vidal
- Medical Oncology Department, Maimonides Institute for Biomedical Research in Cordoba, Reina Sofia University Hospital, Córdoba, Spain
| | - Enriqueta Felip
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Catalunya, Spain
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Sommerlatte S, Lugnier C, Schoffer O, Jahn P, Kraeft AL, Kourti E, Michl P, Reinacher-Schick A, Schmitt J, Birkner T, Schildmann J, Herpertz S. Mental burden and moral distress among oncologists and oncology nurses in Germany during the third wave of the COVID-19 pandemic: a cross-sectional survey. J Cancer Res Clin Oncol 2023; 149:6211-6223. [PMID: 36700979 PMCID: PMC9878480 DOI: 10.1007/s00432-023-04580-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/07/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE There is evidence for mental burden and moral distress among healthcare workers during the pandemic. However, there is scarcity of analyses regarding possible correlations of mental burden and moral distress in this context. This study provides data to quantify mental burden and possible associations with moral distress among physicians and nurses working in oncology in Germany. METHODS We conducted a cross-sectional online survey with physicians and nurses working in oncology in Germany between March and July 2021. Next to sociodemographic characteristics and working conditions, mental burden and moral distress were assessed using standardized instruments. Binary multivariate logistic regression using the enter method was performed in order to explore the relationship between mental burden and moral distress. RESULTS 121 physicians and 125 nurses were included in the study. Prevalence of clinically relevant depressive symptoms, anxiety, somatic symptoms, burnout symptoms and moral distress was 19.2, 14.5, 12.7, 46.0 and 34.7% in physicians and 41.4, 24.0, 46.8, 46.6 and 60.0% in nurses respectively. Mental burden was significantly associated with moral distress, being female/diverse, younger age < 40 and increase in workload. Nurses who felt sufficiently protected from COVID-19 reported significantly less moral distress. CONCLUSION To improve pandemic resilience, there is a need to ensure safe working environment including psychosocial support. Further evidence on risk and protective factors for moral distress is needed to be able to develop and implement strategies to protect healthcare workers within and beyond the pandemic.
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Affiliation(s)
- Sabine Sommerlatte
- Faculty of Medicine, Institute for History and Ethics of Medicine, Interdisciplinary Centre for Health Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Celine Lugnier
- Department of Hematology, Oncology and Palliative Care, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Olaf Schoffer
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Patrick Jahn
- Health Services Research Working Group, Department of Internal Medicine, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Anna-Lena Kraeft
- Department of Hematology, Oncology and Palliative Care, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Eleni Kourti
- Department of Hematology, Oncology and Palliative Care, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Patrick Michl
- Department of Medicine, Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Anke Reinacher-Schick
- Department of Hematology, Oncology and Palliative Care, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Thomas Birkner
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Jan Schildmann
- Faculty of Medicine, Institute for History and Ethics of Medicine, Interdisciplinary Centre for Health Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic, Ruhr University Bochum, Bochum, Germany
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Hlubocky FJ, McFarland DC, Back AL, Friese CR, Lyckholm L, Gallagher CM, McGinnis M, Spence R, Lynch L, Tomkins J, Shanafelt T, Srivastava P. Development, Feasibility, and Acceptability of an Oncologist Group Peer Support Program From ASCO's Clinician Well-Being Task Force. JCO Oncol Pract 2023; 19:669-675. [PMID: 37327462 DOI: 10.1200/op.23.00068] [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: 02/02/2023] [Revised: 04/05/2023] [Accepted: 05/08/2023] [Indexed: 06/18/2023] Open
Abstract
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.
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Affiliation(s)
- Fay J Hlubocky
- Department of Medicine, Section Hematology/Oncology, Maclean Center for Clinical Medical Ethics, Supportive Oncology Program, University of Chicago Medicine, Chicago, IL
| | - Daniel C McFarland
- Department of Psychiatry, Wilmot Cancer Center, University of Rochester, Rochester, NY
| | - Anthony L Back
- Department of Medicine/Oncology, University of Washington, Seattle, WA
| | - Christopher R Friese
- Health Management and Policy, University of Michigan School of Nursing, Ann Arbor, MI
| | - Laurel Lyckholm
- Department of Medicine, Section of Hematology/Oncology, WVU Cancer Institute, West Virginia University, Morgantown, WV
| | - Colleen M Gallagher
- Section of Integrated Ethics in Cancer Care, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Laura Lynch
- American Society of Clinical Oncology, Alexandria, VA
| | - Julia Tomkins
- American Society of Clinical Oncology, Alexandria, VA
| | - Tait Shanafelt
- VA Palo Alto Health Care System, Stanford University, Palo Alto, CA
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Tremblay D, Beaupère S, Biaudet J, Castel P, Fervers B, Galvez C, Sontag P, Usher S, Wilhelmy C. Resilience at Work among Healthcare Professionals in Oncology during and beyond the Pandemic: Report from A Deliberative Multi-Stakeholder Reflexive Symposium. Curr Oncol 2023; 30:6986-6995. [PMID: 37504366 PMCID: PMC10377963 DOI: 10.3390/curroncol30070506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
The chronic distress faced by healthcare professionals (HCPs) in oncology was exacerbated by the COVID-19 pandemic, heightening the need to improve their resilience. The Entretiens Jacques Cartier symposium provided an opportunity for participants from France and Quebec to share perspectives on resilience at work and discuss interventions at individual and organizational levels to support HCP health and well-being. Fifty-eight stakeholders were invited to the symposium, including HCPs, government decision-makers, researchers, and patient representatives. The symposium began with presentations on the nature of professional resilience at work in oncology and promising interventions developed in France and Quebec. Participants were then engaged in deliberation on how evidence and experiential knowledge could contribute to workplace strategies to strengthen resilience. Small-group reflexive sessions using the photovoice method, and an intersectoral roundtable, elicited the expression and deliberation of multiple perspectives on the nature and building blocks of resilience. Four main themes emerged from the discussions: (1) that resilience remains a muddy concept and can be associated pejoratively with "happycracy"; (2) that resilience must contend with bounded autonomy and captors; (3) that it relies on a sense of coherence at work; and (4) that patients play a role in improving HCP resilience. Stakeholders from healthcare systems in different countries view resilience at work as a means of equipping teams to handle chronic and punctual stresses in cancer care. The symposium emphasized the importance of better defining what resilience at work means and pursuing explorations of multicomponent interventions to support oncology HCPs and the patients they care for. The themes raised by participants at the symposium suggest pathways for furthering this exploration.
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Affiliation(s)
- Dominique Tremblay
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC J4K 0A8, Canada
- Centre de Recherche Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada
| | | | - Julien Biaudet
- Cancéropôle Lyon Auvergne Rhône-Alpes, 69007 Lyon, France
| | - Patrick Castel
- Sciences Po, Centre de Sociologie des Organisations (CSO), CNRS, 75007 Paris, France
| | - Béatrice Fervers
- Département Prévention Cancer Environnement, Centre Léon Bérard, 69008 Lyon, France
| | | | | | - Susan Usher
- Commissaire à la Santé et au Bien-Être, Quebec, QC G1S 2L2, Canada
| | - Catherine Wilhelmy
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
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Thomas E, Kennedy A, Walsh W, Carpentier M, Adeyinka H, Patel S, Gerber J, Cerny J, Mittal K. Telehealth through the pandemic at a safety net hospital: observations and next steps for cancer care delivery. Front Public Health 2023; 11:1186350. [PMID: 37333537 PMCID: PMC10272595 DOI: 10.3389/fpubh.2023.1186350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
The COVID-19 pandemic revolutionized cancer care delivery leading to rapid adoption of digital technology for telehealth in the United States. In this study, we describe telehealth utilization trends across the three largest waves of the pandemic at a safety net academic center. We also provide a perspective on lessons learnt and our vision for cancer care delivery using digital technology in the near future. The integration of interpreter services within the video platform and its integration within the electronic medical record system is crucial for safety net institutes that service a diverse patient population. Pay-parity for telehealth, especially ongoing support for audio-only visits, will be critical in overcoming health disparities for patients without access to smartphone technology. Use of telehealth in clinical trials, widespread adoption of hospital at home programs, electronic consults for rapid access, and structured telehealth slots in clinic templates will be crucial in making cancer care more equitable and efficient.
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Affiliation(s)
- Erin Thomas
- Hospital Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Alice Kennedy
- Division of Hematology-Oncology, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - William Walsh
- Division of Hematology-Oncology, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Michelle Carpentier
- Division of Hematology-Oncology, University of Massachusetts Memorial Medical Center, Worcester, MA, United States
| | - Hannah Adeyinka
- Division of Hematology-Oncology, University of Massachusetts Memorial Medical Center, Worcester, MA, United States
| | - Shyam Patel
- Division of Hematology-Oncology, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Jonathan Gerber
- Division of Hematology-Oncology, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Jan Cerny
- Division of Hematology-Oncology, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Kriti Mittal
- Division of Hematology-Oncology, University of Massachusetts Chan Medical School, Worcester, MA, United States
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11
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Trapani D, Kraemer L, Rugo HS, Lin NU. Impact of Prior Authorization on Patient Access to Cancer Care. Am Soc Clin Oncol Educ Book 2023; 43:e100036. [PMID: 37220314 DOI: 10.1200/edbk_100036] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Prior authorization (PA) is a type of utilization review that health insurers apply to control service delivery, payments, and reimbursements of health interventions. The original stated intent of PA was to ensure high-quality standards in treatment delivery while encouraging evidence-based and cost-effective therapeutic choices. However, as currently implemented in clinical practice, PA has been shown to affect the health workforce, adding administrative burden to authorize needed health interventions for patients and often requiring time-consuming peer-to-peer reviews to challenge initial denials. PA is presently required for a wide range of interventions, including supportive care medicines and other essential cancer care interventions. Patients who are denied coverage are commonly forced to receive second-choice options, including less effective or less tolerable options, or are exposed to financial toxicity because of substantial out-of-pocket expenditures, affecting patient-centric outcomes. The development of tools informed by national clinical guidelines to identify standard-of-care interventions for patients with specific cancer diagnoses and the implementation of evidence-based clinical pathways as part of quality improvement efforts of cancer centers have improved patient outcomes and may serve to establish new payment models for health insurers, thereby also reducing administrative burden and delays. The definition of a set of essential interventions and guidelines- or pathways-driven decisions could facilitate reimbursement decisions and thus reduce the need for PAs. Structural changes in how PA is applied and implemented, including a redefinition of its real need, are needed to optimize patient-centric outcomes and support high-quality care of patients with cancer.
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Affiliation(s)
- Dario Trapani
- Division of Early Drug Development for Innovative Therapy, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, Italy
| | - Lianne Kraemer
- Breast Oncology Program, Dana-Farber Cancer Insittute, Boston, MA
| | - Hope S Rugo
- University of California, San Francisco, CA
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
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12
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Tetzlaff ED, Hylton HM, Ruth KJ, Hasse Z, Hall MJ. Moral Distress, Organizational Climate, and the Risk of Burnout Among Physician Assistants in Oncology. JCO Oncol Pract 2023; 19:e639-e649. [PMID: 36780593 PMCID: PMC10414748 DOI: 10.1200/op.22.00641] [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: 09/13/2022] [Revised: 11/09/2022] [Accepted: 01/06/2023] [Indexed: 02/15/2023] Open
Abstract
PURPOSE Moral distress (MD) is the result of barriers or constraints that prevent providers from carrying out what they believe to be ethically appropriate care. This study was initiated to explore associations between MD, burnout, and the organizational climate (OC) for oncology physician assistants (PAs). METHODS A national survey of oncology PAs was conducted to explore the associations between MD, OC, and burnout. The Nurse Practitioner-Primary Care OC Questionnaire was revised for oncology PAs to assess OC for PA practice. MD and burnout were assessed using the Measure of MD-Healthcare Professionals (MMD-HP) and the Maslach Burnout Inventory. RESULTS One hundred forty-six oncology PAs are included in the analysis. PAs were mostly female (90%), White/Caucasian (84%), married/partnered (78%), and in medical oncology (73%), with mean age 41.0 years. The mean MMD-HP score for oncology PAs was 71.5 and there was no difference in MD scores on the basis of oncology subspecialty, practice setting, practice type, or hours worked per week. PAs currently considering leaving their position because of MD had significantly higher mean scores on the MMD-HP compared with those not considering leaving their position (108.2 v 64.8; P = .001). PAs with burnout also had significantly higher mean scores for MD compared with PAs without burnout (97.6 v 54.3; P < .001). A negative relationship between OC for PA practice and MD was only found for the PA-administration relations subscale, whereas all subscales were negatively associated with burnout. CONCLUSION This study demonstrates that the risk of professional burnout increases significantly with increasing levels of MD. Additional research exploring the relationship between MD and burnout is needed.
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Affiliation(s)
| | - Heather M. Hylton
- Association of Physician Assistants in Oncology, Altamonte Springs, FL
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13
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Harvey H, Carroll H, Murphy V, Ballot J, O'Grady M, O'Hare D, Lawler G, Bennett E, Connolly M, Noone E, Kelly MG, Bazin A, Daly A, Mulroe E, McDermott R, O'Reilly S. The Impact of a National Cyberattack Affecting Clinical Trials: The Cancer Trials Ireland Experience. JCO Clin Cancer Inform 2023; 7:e2200149. [PMID: 37053539 PMCID: PMC10281450 DOI: 10.1200/cci.22.00149] [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: 09/20/2022] [Revised: 12/18/2022] [Accepted: 02/22/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE Cyberattacks are increasing in health care and cause immediate disruption to patient care, have a lasting impact, and compromise scientific integrity of affected clinical trials. On the May 14, 2021, the Irish health service was the victim of a nationwide ransomware attack. Patient care was disrupted across 4,000 locations, including 18 cancer clinical trials units associated with Cancer Trials Ireland (CTI). This report analyses the impact of the cyberattack on the organization and proposes steps to mitigate the impact of future cyberattacks. METHODS A questionnaire was distributed to the units within the CTI group; this examined key performance indicators for a period of 4 weeks before, during, and after the attack, and was supplemented by minutes of weekly conference call with CTI units to facilitate information sharing, accelerate mitigation, and support affected units. A total of 10 responses were returned, from three private and seven public hospitals. RESULTS The effect of the attack on referrals and enrollment to trials was marked, resulting in a drop of 85% in referrals and 55% in recruitment before recovery. Radiology, radiotherapy, and laboratory systems are heavily reliant on information technology systems. Access to all was affected. Lack of preparedness was highlighted as a significant issue. Of the sites surveyed, two had a preparedness plan in place before the attack, both of these being private institutions. Of the eight institutions where no plan was in place, three now have or are putting a plan in place, whereas no plan is in place at the five remaining sites. CONCLUSION The cyberattack had a dramatic and sustained impact on trial conduct and accrual. Increased cybermaturity needs to be embedded in clinical trial logistics and the units conducting them.
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Affiliation(s)
- Harry Harvey
- UCC Cancer Trials Group, Cork University Hospital, Cork, Ireland
| | - Hailey Carroll
- UCC Cancer Trials Group, Cork University Hospital, Cork, Ireland
| | | | - Jo Ballot
- St Vincents University Hospital, Dublin, Ireland
| | | | - Debra O'Hare
- UCC Cancer Trials Group, Cork University Hospital, Cork, Ireland
| | - Gavin Lawler
- Irish Research Radiation Oncology Group, Dublin, Ireland
| | - Erica Bennett
- Bon Secours Radiotherapy Centre in association with UPMC Hillman Cancer Center, Cork, Ireland
| | | | - Emma Noone
- St Lukes Radiation Oncology Trials Unit, Dublin, Ireland
| | | | | | | | | | | | - Seamus O'Reilly
- UCC Cancer Trials Group, Cork University Hospital, Cork, Ireland
- Cancer Trials Ireland, Dublin, Ireland
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14
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Budisavljevic A, Kelemenic-Drazin R, Silovski T, Plestina S, Plavetic ND. Correlation between psychological resilience and burnout syndrome in oncologists amid the Covid-19 pandemic. Support Care Cancer 2023; 31:207. [PMID: 36897484 PMCID: PMC9999072 DOI: 10.1007/s00520-023-07660-3] [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: 10/25/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Oncologists are predisposed to developing burnout syndrome. Like other health care professionals worldwide, oncologists have endured additional, extreme challenges during the Covid-19 pandemic. Psychological resilience presents a potential protective mechanism against burnout. This cross-sectional study examines whether psychological resilience eased burnout syndrome among Croatian oncologists during the pandemic. METHODS An anonymized self-reporting questionnaire was electronically distributed by the Croatian Society for Medical Oncology to 130 specialist and resident oncologists working in hospitals. Available for completion from September 6-24, 2021, the survey comprised demographic questions; the Oldenburg Burnout Inventory (OLBI), covering exhaustion and disengagement; and the Brief Resilience Scale (BRS). The response rate was 57.7%. RESULTS Burnout was moderate or high for 86% of respondents, while 77% had moderate or high psychological resilience. Psychological resilience was significantly negatively correlated with the OLBI exhaustion subscale (r = - .54; p < 0.001) and the overall OLBI score (r = - .46; p < 0.001). Scheffe's post hoc test showed that oncologists with high resilience scored significantly lower on the overall OLBI (M = 2.89; SD = 0.487) compared to oncologists with low resilience (M = 2.52; SD = 0.493). CONCLUSION The findings thus indicate that oncologists with high psychological resilience are at significantly lower risk of developing burnout syndrome. Accordingly, convenient measures to encourage psychological resilience in oncologists should be identified and implemented.
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Affiliation(s)
- Anuska Budisavljevic
- Department of Medical Oncology and Hematology, General Hospital Pula, Pula, Croatia
| | - Renata Kelemenic-Drazin
- Department of Hematology, Oncology and Clinical Immunology, General Hospital Varazdin, Varazdin, Croatia.
| | - Tajana Silovski
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Stjepko Plestina
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
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15
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Ramanakumar AV, Annie B, Frederic L, Christine B, Cathy R, Jean L. Evaluating the impact of COVID-19 on cancer declarations in Quebec, Canada. Cancer Med 2023; 12:6260-6269. [PMID: 36385491 PMCID: PMC10028061 DOI: 10.1002/cam4.5389] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/24/2022] [Accepted: 10/16/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND COVID-19 affected healthcare worldwide, limited access to healthcare, and delayed cancer screening and diagnosis. In this study, the effect of the first year of COVID-19 was determined on cancer diagnoses in the province of Quebec, Canada. METHODS Data were collected from the 13 Quebec Cancer Registry health institutions. Newly diagnosed cancer declarations in the first year of the COVID-19 (April 2020-March 2021) were compared with the reference periods (averages of 3 previous years). The main focus was on four leading cancers: lung, prostate, colorectal, and breast cancers. Generalized regression models with a poisson approximation and interrupted time series (ITS) analysis were used. Underestimated cases were presented in terms of relative risk (RR) and 95% confidence intervals (CI). The changes in the stage-specific counts were also assessed in each of the four cancers. Results were illustrated separately for the first 4 months of the pandemic (first wave). FINDINGS This study estimated an overall under-reporting of 15.3% (29,019 vs. 24,584) of declarations. This under-reporting was evident across all age groups above 35 years (p < 0.0001), four primary cancers (p < 0.0001), all stages of cancers (p < 0.0001), and both sexes (p < 0.0001). Based on the relative risks, stage-specific lung cancer counts were underestimated by 5%-34% in the first wave (0%-11% in the first year), prostate cancer by 16%-46% in the first wave (0%-25% in the first year), colorectal cancer 15%-45% in the first wave (0%-24% in the first year), and breast cancer 3%-45% in the first wave and (0%-28% in the first year). However, no stage-IV cancers were statically under-reported compared to the pre-pandemic era and not even in the first wave. INTERPRETATION Cancer diagnosis was underestimated due to the COVID-19 pandemic in the first year; this effect was more evident in the first phase of the pandemic in Quebec. Further research is required to determine the accurate burden of the disease in the long term.
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Affiliation(s)
- Agnihotram V Ramanakumar
- Québec Tumor Registry, Québec City, QC, Canada
- Research Institute-McGill University Health Center, Montréal, QC, Canada
| | | | - Lamonde Frederic
- Québec Tumor Registry, Québec City, QC, Canada
- Research Institute-McGill University Health Center, Montréal, QC, Canada
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16
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The Mental Health Burden of Patients with Colorectal Cancer Receiving Care during the COVID-19 Pandemic: Results of the PICO-SM Study. Cancers (Basel) 2023; 15:cancers15041226. [PMID: 36831568 PMCID: PMC9954113 DOI: 10.3390/cancers15041226] [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: 01/20/2023] [Revised: 02/07/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
The COVID-19 pandemic has resulted in unprecedented changes to the lives of patients with cancer. To evaluate the impact of the COVID-19 pandemic on the mental health and well-being of patients with colorectal cancer, we conducted a prospective longitudinal questionnaire study at a UK tertiary cancer centre. In total, 216 participants were included: mean age 65 years, 57% (n = 122) male, 92% (n = 198) of white ethnicity. Amongst participants who completed the screening psychometric questionnaire, 24% (n = 48/203) reported anxiety (GAD-7 ≥ 5), 15% (n = 31/204) depressive symptoms (PHQ-9 ≥ 10), 3% (n = 5/190) probable post-traumatic stress disorder (PC-PTSD-5 ≥ 4), and 31% (n = 66/213) poor well-being (WHO-5 < 50). In the subgroup (n = 95/216, 44%) who consented to and completed a follow-up survey 6 months later, there was a significant increase in the number of participants at risk of depression (4% vs. 13%, p = 0.021). Self-reported concern about the COVID-19 pandemic impacting one's mental health is associated with increased likelihood of anxiety, depression, and poor well-being, in respective multivariate analyses. In conclusion, screening for the mental health impact of the COVID-19 pandemic is essential to ensure timely action from all key stakeholders and to avoid potentially longer-term detrimental consequences.
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17
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Mano MS. If you can't kill the beast, tame it: Tips for surviving WhatsApp® in medical practice. Clinics (Sao Paulo) 2023; 78:100156. [PMID: 36669425 PMCID: PMC9868886 DOI: 10.1016/j.clinsp.2022.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/04/2022] [Accepted: 12/08/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
- Max S Mano
- Breast Cancer Group Leader, Grupo Oncoclínicas; Faculty ‒ ESMO Breast Cancer Group; Faculty ‒ Academy of Leadership Sciences Switzerland (ALSS); Vice-chair, LACOG Breast Cancer Group, São Paulo, SP, Brazil.
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18
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Cyr S, Marcil MJ, Houchi C, Marin MF, Rosa C, Tardif JC, Guay S, Guertin MC, Genest C, Forest J, Lavoie P, Labrosse M, Vadeboncoeur A, Selcer S, Ducharme S, Brouillette J. Evolution of burnout and psychological distress in healthcare workers during the COVID-19 pandemic: a 1-year observational study. BMC Psychiatry 2022; 22:809. [PMID: 36539718 PMCID: PMC9763813 DOI: 10.1186/s12888-022-04457-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Long-term psychological impacts of the COVID-19 pandemic on healthcare workers remain unknown. We aimed to determine the one-year progression of burnout and mental health since pandemic onset, and verify if protective factors against psychological distress at the beginning of the COVID-19 pandemic (Cyr et al. in Front Psychiatry; 2021) remained associated when assessed several months later. METHODS We used validated questionnaires (Maslach Burnout Inventory, Hospital Anxiety and Depression and posttraumatic stress disorder [PTSD] Checklist for DSM-5 scales) to assess burnout and psychological distress in 410 healthcare workers from Quebec, Canada, at three and 12 months after pandemic onset. We then performed multivariable regression analyses to identify protective factors of burnout and mental health at 12 months. As the equivalent regression analyses at three months post-pandemic onset had already been conducted in the previous paper, we could compare the protective factors at both time points. RESULTS Prevalence of burnout and anxiety were similar at three and 12 months (52% vs. 51%, p = 0.66; 23% vs. 23%, p = 0.91), while PTSD (23% vs. 11%, p < 0.0001) and depression (11% vs. 6%, p = 0.001) decreased significantly over time. Higher resilience was associated with a lower probability of all outcomes at both time points. Perceived organizational support remained significantly associated with a reduced risk of burnout at 12 months. Social support emerged as a protective factor against burnout at 12 months and persisted over time for studied PTSD, anxiety, and depression. CONCLUSIONS Healthcare workers' occupational and mental health stabilized or improved between three and 12 months after the pandemic onset. The predominant protective factors against burnout remained resilience and perceived organizational support. For PTSD, anxiety and depression, resilience and social support were important factors over time.
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Affiliation(s)
- Samuel Cyr
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Faculty of Pharmacy, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada
| | - Marie-Joelle Marcil
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, Québec, H3C 3J7 Canada
| | - Cylia Houchi
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, Québec, H3C 3J7 Canada
| | - Marie-France Marin
- grid.14848.310000 0001 2292 3357Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, Québec, H3C 3J7 Canada ,grid.38678.320000 0001 2181 0211Department of Psychology, UQAM, 100 Sherbrooke Street West, Montréal, Québec, H2X 3P2 Canada ,grid.414210.20000 0001 2321 7657Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Québec, H1N 3V2 Canada
| | - Camille Rosa
- Montreal Health Innovations Coordinating Centre, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada
| | - Jean-Claude Tardif
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada
| | - Stéphane Guay
- grid.14848.310000 0001 2292 3357Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, Québec, H3C 3J7 Canada ,grid.414210.20000 0001 2321 7657Centre d’étude sur le Trauma, Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Québec, H1N 3V2 Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Centre, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada
| | - Christine Genest
- grid.414210.20000 0001 2321 7657Centre d’étude sur le Trauma, Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Québec, H1N 3V2 Canada ,grid.14848.310000 0001 2292 3357Faculty of Nursing, Université de Montréal, Marguerite-d’Youville Pavilion, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada
| | - Jacques Forest
- Department of Organization and Human Resources, ESG UQAM, P.O. Box 8888, Downtown Branch, Montreal, Québec, H3C 3P8 Canada
| | - Patrick Lavoie
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Faculty of Nursing, Université de Montréal, Marguerite-d’Youville Pavilion, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada
| | - Mélanie Labrosse
- grid.14848.310000 0001 2292 3357Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada ,grid.411418.90000 0001 2173 6322Department of Pediatrics, Division of Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, 3175 Côte-Sainte-Catherine Road, Montreal, Québec, H3T 1C5 Canada
| | - Alain Vadeboncoeur
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada
| | - Shaun Selcer
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada
| | - Simon Ducharme
- grid.412078.80000 0001 2353 5268Department of Psychiatry, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Verdun, Québec, H4H 1R3 Canada ,grid.416102.00000 0004 0646 3639McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, 3801 University St, Montreal, Québec, H3A 2B4 Canada
| | - Judith Brouillette
- Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8, Canada. .,Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, Québec, H3C 3J7, Canada.
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Núñez-Peña E, Siller-Garcia P, Vaca-Cartagena BF, Lucio-Lozada J, Villafuerte-Manrique S, Barrera López M, Mesa-Chavez F, Villarreal-Garza C. Activities Performed by ASCO-Sponsored Oncology Student Interest Groups in Latin America: Assessing Members' Preferences and Leaders' Challenges. JCO Glob Oncol 2022; 8:e2200050. [PMID: 36265095 PMCID: PMC9812479 DOI: 10.1200/go.22.00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE In response to the worldwide shortage of oncologists, ASCO established Oncology Student Interest Groups (OSIGs) to increase oncology exposure at medical schools. However, there is limited guidance on the activities they should undergo. The main purposes of this study were (1) to assess the preferences and perceptions of OSIG members about their group events and (2) to describe the difficulties faced by leaders to carry out OSIGs' tasks. METHODS In this multicenter, cross-sectional study, group members and leaders from five active Latin American OSIGs were invited to answer anonymous web-based surveys exploring members' attitudes toward group activities and leaders' challenges when carrying them out. Data collection was conducted from March to June 2021. RESULTS Responses from 142 medical students and four OSIGs leaders were analyzed. In total, 83% of student members considered that lectures with an oncology-related expert was very useful for increasing their overall interest in oncology. For increasing interest in cancer research, 87% deemed that participating in oncology research projects was very useful. Shadowing oncology professionals was very useful for at least 70% of members to increase their oncology knowledge and their interest in following an oncology-related career. Moreover, leaders' main challenges were having a high academic load, little response from members, lack of interesting ideas and protected time for OSIGs' events, and limited support from their school. CONCLUSION OSIGs' leaders, medical schools, and international oncology organizations should work together to design activities that increase medical students' exposure to oncology-related professionals and encourage their participation in international oncological events. These schools and organizations should actively support OSIG leaders when facing difficulties to prevent members' disengagement and groups' discontinuation.
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Affiliation(s)
- Emilia Núñez-Peña
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico
| | - Paloma Siller-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo Leon, Mexico
| | - Bryan F. Vaca-Cartagena
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Jose Lucio-Lozada
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Mirelle Barrera López
- Facultad de Ciencias de la Salud, Universidad Anahuac México Norte, Naucalpan, Mexico
| | - Fernanda Mesa-Chavez
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico,Cynthia Villarreal-Garza, MD, DSc, Batallon de San Patricio 112, Real de San Agustin, 66278, San Pedro Garza Garcia, Nuevo Leon, Mexico; Twitter: @Dra_CVillarreal; e-mail:
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20
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Tagliamento M, Poggio F, Perachino M, Pirrone C, Fregatti P, Lambertini M. The evolving scenario of cancer care provision across the COVID-19 pandemic in Europe. Curr Opin Support Palliat Care 2022; 16:110-116. [PMID: 35929557 PMCID: PMC9451604 DOI: 10.1097/spc.0000000000000601] [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] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Over the past 2 years, the COVID-19 pandemic has had short-term and long-term effects on the delivery of cancer care. Some European countries faced an unprecedented widespread crisis during the first year of the SARS-CoV-2 pandemic, only being able afterwards to gradually recover, thanks to the improvement in preventive measures, changes in public health and reactive processes in cancer care and a better understanding of the ongoing heath emergency. RECENT FINDINGS The development of SARS-CoV-2 vaccines and COVID-19 specific treatments, the growing testing and tracking capability to limit virus diffusion, and research efforts to better define areas of action have all greatly limited the negative impact of the health emergency on routine cancer care.The need to protect those more vulnerable and to ensure continuity of care for oncology patients has been balanced across the pandemic, with the aim to guarantee an optimal standard of care. SUMMARY This article aims to provide an overview on the evolving scenario of cancer care throughout the COVID-19 pandemic in Europe, focusing on the particular features that characterized the pandemic course as well as the main differences that were observed across it.
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Affiliation(s)
- Marco Tagliamento
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Francesca Poggio
- Department of Medical Oncology, Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marta Perachino
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Pirrone
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Piero Fregatti
- Department of Surgery, UOC Clinica di Chirurgia Senologica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genova, Genova, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Granek L, Nakash O. Oncology Healthcare Professionals’ Mental Health during the COVID-19 Pandemic. Curr Oncol 2022; 29:4054-4067. [PMID: 35735432 PMCID: PMC9222050 DOI: 10.3390/curroncol29060323] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
The paper begins by reviewing the literature on oncology healthcare professionals’ (HCP) mental health. We summarize and present the current data on HCP mental health in order to understand the baseline state of oncology HCPs’ mental health status prior to the COVID-19 pandemic. At each juncture, we will discuss the implications of these mental health variables on the personal lives of HCPs, the healthcare system, and patient care. We follow by reviewing the literature on these parameters during the COVID-19 pandemic in order to better understand the impact of COVID-19 on the overall mental health of HCPs working in oncology. By reviewing and summarizing the data before and after the start of the pandemic, we will get a fuller picture of the pre-existing stressors facing oncology HCPs and the added burden caused by pandemic-related stresses. The second part of this review paper will discuss the implications for the oncology workforce and offer recommendations based on the research literature in order to improve the lives of HCPs, and in the process, improve patient care.
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Affiliation(s)
- Leeat Granek
- School of Health Policy and Management and Department of Psychology, Faculty of Health, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
- Correspondence: ; Tel.: +1-416-736-2100
| | - Ora Nakash
- School for Social Work, Smith College, Northampton, MA 01063, USA;
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22
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Beretta GD, Casolino R, Corsi DC, Perrone F, Di Maio M, Cinieri S, Gobber G, Bellani M, Petrini F, Zocchi MT, Traclò F, Zagonel V. Position paper of the Italian Association of Medical Oncology on the impact of COVID-19 on Italian oncology and the path forward: the 2021 Matera Statement. ESMO Open 2022; 7:100538. [PMID: 35921761 PMCID: PMC9222406 DOI: 10.1016/j.esmoop.2022.100538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 11/03/2022] Open
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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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O'Reilly S, Murphy V, Mulroe E, Tucker L, Carragher F, Marron J, Shannon AM, Rogan K, Connolly RM, Hennessy BT, McDermott RS. The SARS-CoV-2 Pandemic and Cancer Trials Ireland: Impact, Resolution and Legacy. Cancers (Basel) 2022; 14:2247. [PMID: 35565375 PMCID: PMC9101172 DOI: 10.3390/cancers14092247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cancer Trials Ireland (CTI) is the national cooperative group in Ireland. The SARS-CoV-2 pandemic led to significant ongoing disruptive change in healthcare from March 2020 to the present day. Its impact and legacy on a national clinical trials organisation was assessed. METHODS A review was conducted of prospectively acquired communications, team logs and time sheets, trial activation, closure and accrual, for the period 2019 to September 2021. An online survey of the impact of the pandemic on clinical investigators and of clinical trials units was performed. A National Cancer Retreat was organised on 21 May 2021 to identify and address pandemic related disruption and develop adaptive strategies. RESULTS In the weeks after the pandemic was declared, remote working was initiated by all central office staff. Nationally, clinical trial accrual fell by 54% compared to the same period in 2019, radiotherapy trial accrual by 90%, and translational studies by 36%. Staff reassignment of research nurse staff occurred in 60% of units, trial monitoring was reduced in 42%, and trial initiations fell by 67%. Extreme fluctuations in monitoring hours were noted paralleling lockdown measures. Significant impact on all clinical trials units was noted including staff reassignments, reduced access to diagnostic imaging and reduced institutional supports. Remote clinic visits and remote monitoring was widely adopted. The National Cancer Retreat identified flexibility in trial conduct, staff recruitment and retention, the need for harmonisation of processes, and research staff support in the context of remote working as priorities. CONCLUSION The pandemic has had a significant ongoing negative impact on cancer clinical trial activity in Ireland. Adaptive strategies including trial flexibility, expanded telehealth and remote monitoring, harmonisation of processes and staff support have been identified as priorities to ameliorate this impact, and develop a more sustainable clinical trial ecosystem.
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Affiliation(s)
- Seamus O'Reilly
- Cancer Trials Ireland, D02 VN51 Dublin, Ireland
- Department of Medical Oncology, Cork University Hospital and Cancer Research @ UCC University College Cork, T12 DCA4 Cork, Ireland
| | | | | | - Lisa Tucker
- Cancer Trials Ireland, D02 VN51 Dublin, Ireland
| | | | | | | | - Ken Rogan
- Cancer Trials Ireland, D02 VN51 Dublin, Ireland
| | - Roisin M Connolly
- Department of Medical Oncology, Cork University Hospital and Cancer Research @ UCC University College Cork, T12 DCA4 Cork, Ireland
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Mano MS, Morgan G. Telehealth, Social Media, Patient Empowerment, and Physician Burnout: Seeking Middle Ground. Am Soc Clin Oncol Educ Book 2022; 42:1-10. [PMID: 35561300 DOI: 10.1200/edbk_100030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The digital revolution is an ongoing process that has nevertheless profoundly affected century-old medical practice. Digitalization has many facets, ranging from telehealth to social media and even new instant communication devices, each of which affect both patients' and physicians' realities. Although the benefits of developments such as telehealth and novel applications of social media to medicine are more easily perceived by all stakeholders, they still have their own hurdles and risks, such as coldness and impersonal treatment in telehealth, and misinformation on social media. The widespread digitalization of health records has greatly facilitated patient access to health information, becoming a major patient empowerment tool; however, some forms of unrestricted access, such as to test results-in particular, prior to consultations-have unclear benefits to patients with cancer and have also become a hurdle for care teams. In addition, the advent of instant messaging, which is revolutionizing personal communication in many cultures, is gradually affecting patient-physician communication and, combined with unrestricted patient access to test results, is creating new challenges for physicians. How these transformations are affecting patients themselves and physicians' well-being and mental health are matters addressed in this text. Last, to address potential biases in an article written by two oncologists, and in line with this year's ASCO presidential theme of including a diversity of voices, we decided to give voice to patients with cancer by collecting the opinions of high-profile patient advocates about the controversial topics addressed in this text.
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Affiliation(s)
- Max S Mano
- Grupo Oncoclínicas, São Paulo, Brazil
- Academy of Leadership Sciences Switzerland, Zurich, Switzerland
| | - Gilberto Morgan
- Skåne University Hospital, Department of Clinical Oncology, Lund, Sweden
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