Work related stress among gynecologic oncologists

Systematic review of the relationship between burn-out and spiritual health in doctors

OBJECTIVE

To investigate the relationship between burn-out and spiritual health among medical doctors.

DESIGN

Systematic literature review and narrative synthesis of cross-sectional studies.

SETTING

Any setting, worldwide.

DATA SOURCES

Five databases were searched from inception to March 2022, including Medline, Embase, PsycINFO, Scopus and Web of Science.

ELIGIBILITY CRITERIA

Any study design that involved medical doctors (and other healthcare staff if assessed alongside medical doctors), that measured (in any way) both burn-out (or similar) and spiritual health (or similar) medical doctors.

DATA EXTRACTION AND SYNTHESIS

All records were double screened. Data extraction was performed by one reviewer and a proportion (10%) checked by a second reviewer. Quality was assessed using the Appraisal of Cross-sectional Studies tool. Due to the heterogeneity of the included studies, a narrative review was undertaken without a meta-analysis.

RESULTS

Searches yielded 1049 studies. 40 studies met eligibility criteria and were included in this review. Low reported levels of spirituality were associated with high burn-out scores and vice versa. Religion was not significantly associated with lower levels of burn-out. Few studies reported statistically significant findings, few used validated spiritual scores and most were vulnerable to sampling bias.

CONCLUSIONS

Published research suggests that burn-out is linked to spiritual health in medical doctors but not to religion. Robust research is needed to confirm these findings and develop effective interventions.

PROSPERO REGISTRATION NUMBER

CRD42020200145.

The paradox: guilt as an antidote to helplessness among oncologists

PURPOSE

Oncologists are exposed to suffering, loss, and death, and as a result may experience guilt. The study examined two competing hypotheses regarding the relation between locus of control (LOC) and guilt among oncologists and the mediating role of helplessness.

METHOD

Eighty-three oncologists answered a demographic questionnaire; the Levenson's "Internal, Powerful Others, and Chance" scale; the Guilt Inventory; and the Learned Helplessness Scale.

RESULTS

Oncologists reported moderate levels of guilt, high levels of internal LOC, and low levels of external LOC and helplessness. The results indicate a significant negative relationship between internal LOC and guilt and a significant positive relationship between external LOC (powerful others) and guilt, both mediated by helplessness. It seems that oncologists with external LOC feel helplessness and this metamorphoses into guilt, due to its potentially protective role against feelings of helplessness.

CONCLUSIONS

Oncologists are at risk for guilt. Whereas an internal LOC plays an important role as a resilience factor in terms of helplessness, an external LOC is a risk factor for helplessness and guilt. A paradoxical association between guilt and helplessness was found. The implication of which is that guilt may be produced to avoid helplessness; in other words, guilt, however painful, might be preferable to feeling helpless. Interventions focusing on oncologists' coping with uncontrolled situations in their daily work, decreasing their sense of helplessness and guilt, should be implanted.

Oncologists' Locus of Control, Compassion Fatigue, Compassion Satisfaction, and the Mediating Role of Helplessness

The oncology setting may give rise to significant feelings of helplessness among oncologists via patients' inevitable deaths or suffering. The current study examines whether and how oncologists' sense of control (locus of control; LOC) influences their compassion fatigue and satisfaction. Methods: Seventy-three oncologists completed the following questionnaires: the Professional Quality of Life scale; Levenson's Internal, Powerful Others, and Chance scale; the Guilt Inventory, State Guilt subscale; and the Learned Helplessness scale. Results: Oncologists reported high levels of secondary traumatic stress and burnout and moderate levels of compassion satisfaction. A positive association between oncologists' external LOC and compassion fatigue, and a negative association between oncologists' internal LOC and compassion fatigue, were found. Helplessness, but not guilt, had a mediating role in these associations. Internal LOC was also positively associated with compassion satisfaction. Conclusions: The current study highlights oncologists as a population at risk of experiencing compassion fatigue and emphasizes oncologists' locus of control as a predisposition that plays a role in the development of this phenomenon. Additionally, the cognitive as well as the emotional aspects of control were found to be important factors associated with compassion fatigue.

Addressing Physician Burnout and Ensuring High-Quality Care of the Physician Workforce

Burnout in health care is a public health crisis. Burnout is a triad of emotional exhaustion, depersonalization, and feelings of reduced personal accomplishment. More than half of practicing physicians and trainees experience burnout, and the rates are increasing. This review highlights the current prevalence of burnout among U.S. physicians, especially obstetrician-gynecologists. We review personal and systemic risk factors for burnout, consequences of burnout, and proven interventions, especially at the systems level, to treat and prevent burnout.

Workplace-related stress among oncologists: Egyptian single-centered observational study

Background

The oncologists are facing more challenges than ever before in their work with cancer patients. The aim of the study is to assess the level of work-related stress among oncology clinicians and to compare it with non-oncologists. Thirty oncologists working at clinical oncology department at Menoufia University hospitals, Egypt, were compared to an equal number of non-oncologists matched for the same gender and work duration. After consent, all the participants were interviewed using a structured questionnaire to collect background information and the workplace stress scale (WSS) was used to ascertain their stress level.

Results

The percentage distribution of different grades of WSS among the two groups did not show any significant difference (P = 0.84). Gender had no significant association to the mean score of WSS (P > 0.05). All the juniors (residents) in this study with work duration ≤ 3 years had significantly higher levels of WSS than seniors (> 3 years), P < 0.001. Among oncologists or non-oncologists, juniors showed significantly higher levels of WSS than seniors (P = 0.003 and < 0.001 respectively). However, junior oncologists had no significant difference than junior non-oncologists and seniors in both groups did not show any significant difference regarding the mean score of WSS.

Conclusion

All the workers within the two groups had experienced work-related stress. However, there was no statistically significant difference among them regarding the different grades of work place stress scale.

Burnout, Depression, Career Satisfaction, and Work-Life Integration by Physician Race/Ethnicity

IMPORTANCE

Previous research suggests that the prevalence of occupational burnout varies by demographic characteristics, such as sex and age, but the association between physician race/ethnicity and occupational burnout is less well understood.

OBJECTIVE

To investigate possible differences in occupational burnout, depressive symptoms, career satisfaction, and work-life integration by race/ethnicity in a sample of US physicians.

DESIGN, SETTING, AND PARTICIPANTS

In this cross-sectional study, data for this secondary analysis of 4424 physicians were originally collected from a cross-sectional survey of US physicians between October 12, 2017, and March 15, 2018. The dates of analysis were March 8, 2019, to May 21, 2020. Multivariable logistic regression, including statistical adjustment for physician demographic and clinical practice characteristics, was performed to examine the association between physician race/ethnicity and occupational burnout, depressive symptoms, career satisfaction, and work-life integration.

EXPOSURES

Physician demographic and clinical practice characteristics included race/ethnicity, sex, age, clinical specialty, hours worked per week, primary practice setting, and relationship status.

MAIN OUTCOMES AND MEASURES

Physicians with a high score on the emotional exhaustion or depersonalization subscale of the Maslach Burnout Inventory were classified as having burnout. Depressive symptoms were measured using the Primary Care Evaluation of Mental Disorders instrument. Physicians who marked "strongly agree" or "agree" in response to the survey items "I would choose to become a physician again" and "My work schedule leaves me enough time for my personal/family life" were considered to be satisfied with their career and work-life integration, respectively.

RESULTS

Data were available for 4424 physicians (mean [SD] age, 52.46 [12.03] years; 61.5% [2722 of 4424] male). Most physicians (78.7% [3480 of 4424]) were non-Hispanic White. Non-Hispanic Asian, Hispanic/Latinx, and non-Hispanic Black physicians comprised 12.3% (542 of 4424), 6.3% (278 of 4424), and 2.8% (124 of 4424) of the sample, respectively. Burnout was observed in 44.7% (1540 of 3447) of non-Hispanic White physicians, 41.7% (225 of 540) of non-Hispanic Asian physicians, 38.5% (47 of 122) of non-Hispanic Black physicians, and 37.4% (104 of 278) of Hispanic/Latinx physicians. The adjusted odds of burnout were lower in non-Hispanic Asian physicians (odds ratio [OR], 0.77; 95% CI, 0.61-0.96), Hispanic/Latinx physicians (OR, 0.63; 95% CI, 0.47-0.86), and non-Hispanic Black physicians (OR, 0.49; 95% CI, 0.30-0.79) compared with non-Hispanic White physicians. Non-Hispanic Black physicians were more likely to report satisfaction with work-life integration compared with non-Hispanic White physicians (OR, 1.69; 95% CI, 1.05-2.73). No differences in depressive symptoms or career satisfaction were observed by race/ethnicity.

CONCLUSIONS AND RELEVANCE

Physicians in minority racial/ethnic groups were less likely to report burnout compared with non-Hispanic White physicians. Future research is necessary to confirm these results, investigate factors contributing to increased rates of burnout among non-Hispanic White physicians, and assess factors underlying the observed patterns in measures of physician wellness by race/ethnicity.

Advanced communication: A critical component of high quality gynecologic cancer care: A Society of Gynecologic Oncology evidence based review and guide

Effective communication between gynecologic oncology providers and patients is vital to patient-centered care. Skilled communication improves the patient's knowledge retention, builds trust in providers, enhances shared decision-making, and alleviates anxiety of both patients and caregivers. Effective communication is also associated with reduced provider burnout due to improved comfort from possessing the skills to handle emotionally charged situations. Therefore, training in serious illness communication skills is critically important to gynecologic oncology practice and benefits patients, providers, and the healthcare system. Like surgical skills, communication skills can be learned and improved upon, particularly by making use of communication skills courses and other resources. While the purpose of each conversation will vary based on the medical setting, most communication roadmaps incorporate four basic components: 1) Assess patient knowledge and understanding, 2) inform patient in accordance with her communication preferences, 3) recognize and respond to emotion 4) elicit patient values, and create a plan that aligns with those values. Improved patient outcomes associated with addressing patient emotions underscore a critical need to recognize and address emotional cues during difficult conversations. We present strategies for delivering serious news, and for discussing prognosis and goals of care. In each strategy, we highlight skills for recognizing and responding to patient and family emotional cues.

Burnout and associated factors among members of the Society of Gynecologic Oncology

OBJECTIVE

Burnout is specific to the work domain and in physicians is indicative of emotional exhaustion, depersonalization in relationships with coworkers and detachment from patients, and a sense of inadequacy or low personal accomplishment. The purpose of this study was to determine the burnout rate among gynecologic oncologists and evaluate other personal, professional, and psychosocial factors associated with this condition.

STUDY DESIGN

This study used a cross-sectional design. Current members of the Society of Gynecologic Oncology were sent an anonymous email survey including 76 items measuring burnout, psychosocial distress, career satisfaction, and quality of life.

RESULTS

A total of 1086 members were invited, 436 (40.1%) responded, and 369 (84.6%) of those completed the survey. Of physicians, 30% scored high for emotional exhaustion, 10% high for depersonalization, and 11% low for personal accomplishment. Overall, 32% of physicians scored above clinical cutoffs indicating burnout. In all, 33% screened positive for depression, 13% endorsed a history of suicidal ideation, 15% screened positive for alcohol abuse, and 34% reported impaired quality of life. Nonetheless, 70% reported high levels of personal accomplishment, and results suggested most were satisfied with their careers, as 89% would enter medicine again and 61% would encourage their child to enter medicine. Respondents with high burnout scores were less likely to report they would become a physician again (P = .002) or encourage a child to enter medicine (P < .001), and more likely to screen positive for depression (P < .001), alcohol abuse (P = .006), history of suicidal ideation (P < .001), and impaired quality of life (P < .001).

CONCLUSION

Burnout is a significant problem associated with psychosocial distress and lower levels of career satisfaction in gynecologic oncologists. Burnout in obstetrics-gynecology and gynecologic oncology is of particular concern as young age and female gender are often identified as risk factors for this significant problem. Interventions targeted at improving quality of life, treatment of depression, or alcohol abuse may have an impact on burnout. However, significant barriers may exist as 44.5% of respondents in this study reported that they would be reluctant to seek medical care for depression, substance use, or other mental health issues due to concerns about their medical license.

The "BUONGIORNO" project: burnout syndrome among young Italian radiation oncologists

Few data exist about the prevalence of burnout syndrome among young radiation oncologists. A national survey to assess its prevalence among junior members (under 40 yrs of age) of the Italian Society of Radiation Oncology was conducted. One hundred and twelve young radiation oncologists completed the questionnaire: the prevalence of burnout syndrome was 35%, and it was related to the presence of different personal, organizational, and work-related aspects, with an impact also on the private life (p<.005). Burnout syndrome is relatively common among young Italian radiation oncologists, and specific educational tools to help improve the management of workload and stress are needed.