Well-being among Italian medical oncologists: an exploratory study

The joint effect of attachment orientations and empathy on compassion fatigue and compassion satisfaction among oncologists

OBJECTIVE

Compassion fatigue, which consists of burnout and secondary traumatic stress, and compassion satisfaction are conceptualized as the negative and positive emotional reactions of working in the helping professions. In this study we examined the joint effect of oncologists' attachment orientations and empathy on their compassion fatigue and satisfaction.

METHODS

Seventy-three oncologists completed a demographic questionnaire, the shortened version of the Experiences in Close Relationships scale, the Interpersonal Reactivity Index, and the Professional Quality of Life questionnaire.

RESULTS

A cluster analysis based on empathy and attachment orientations yielded three meaningful clusters that seem to reflect the three attachment orientations: secure, anxious and avoidant. The oncologists in the three clusters differed in their compassion fatigue levels (i.e. both burnout and secondary traumatic stress) and in their compassion satisfaction levels. Secure attachment (i.e. low scores on both anxious attachment and avoidant attachment) along with high levels of the cognitive component of empathy (perspective-taking) resulted in lower levels of compassion fatigue and higher levels of compassion satisfaction than did insecure attachment.

CONCLUSIONS

The study emphasizes the importance of oncologists' attachment orientations and appropriate distance/closeness to their patients in protecting them from compassion fatigue and helping them experience compassion satisfaction.

Experiences of health professionals treating women diagnosed with cancer during pregnancy and proposals for service improvement

Objective

To examine the experiences, needs, and perceptions of health professionals(HPs) treating women diagnosed with cancer during pregnancy(gestational cancer, GC).

Methods

Interviews were undertaken with Australian HPs who had treated women diagnosed with GC over the previous five years. HPs were recruited via social media, and professional and community networks. Questions focussed upon HPs’ confidence caring for these women, whether current guidelines/training met their needs, psychological impacts of care provision, and service gaps. Interview data were analysed thematically.

Results

Twenty-seven HPs were interviewed; most were oncology HPs(22/27) with experience caring for women with gestational breast cancer and 13 had a breast-specific clinical focus (e.g. breast surgeon). Many were currently treating women with GC(48%) or had in the last 6–12 months(29.6%). Four themes were identified: A clinically complex case, Managing multi-disciplinary care, Centralised resources for health professionals, and Liaison, information and shared experiences for women. HPs found this population personally challenging to treat. They reported initial uncertainty regarding treatment due to infrequent exposure to GC, limited resources/information, and the need to collaborate with services with which they did not usually engage. Solutions offered include centralised resources, clinical liaison/care coordinators, and connecting women with GC with peer support.

Conclusions

HPs perceived women with GC as a vulnerable, complex population and experienced challenges providing comprehensive care; particularly when treatment was delivered at geographically separated hospitals. Systemic changes are needed to optimise comprehensive care for these women. Their insights can guide the development of more integrated cancer and obstetric care, and better 10.13039/100004314HP support.

•

Women with cancer diagnosed in pregnancy require complex, coordinated, multidisciplinary care.

•

Clinicians consider these women vulnerable with needs that are hard to meet using standard care.

•

Systemic changes like co-locating services and integrating supportive care are needed.

•

Access to centralised, coordinated, up-to-date evidence-based guidelines is required.

•

Formalised ways to connect women with cancer in pregnancy with peer support would help.

Hospital Physician Engagement: A Scoping Review

BACKGROUND

Literature on health system transformation highlights the importance of physician engagement, suggesting that it is a critical factor for lowering costs while improving efficiency, quality of care, patient safety, physician satisfaction and retention. "Engagement" in health care is often defined as a positive, fulfilling work-related state of mind, which is characterized by vigor, dedication and absorption. The aim of this scoping review is to identify factors associated with, and tools used to measure physician engagement.

METHODS

MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and gray literature were searched. Supplementary articles were obtained by searching article references. All quantitative and qualitative study designs were eligible that described factors associated with, and tools used to measure, hospital physician engagement. Quantitative and qualitative analyses were conducted. Groupings and clustering were conducted to determine dominant groups or cluster of characteristics. Conceptual mapping was then conducted to identify patterns.

RESULTS

A total of 15 studies fulfilled the eligibility criteria. All were published between 2012 and 2017. Studies were predominantly conducted in Germany (n=8). Factors associated with physician engagement were synthesized into individual characteristics (n=7), work environment characteristics (n=7), and work outcomes (n=5). The Utrecht Work Engagement Scale was the most commonly used tool (n=14).

CONCLUSIONS

This scoping review provides a strong evidence-based platform to further advance knowledge in the area of physician engagement. The identification of environmental factors assists hospital administrative leaders in understanding how they might intervene to affect engagement, while the identification of individual characteristics enable identification of vulnerable physicians, permitting identification of the most pertinent targeted areas for focus.

"My choice": breast cancer patients recollect doctors fertility preservation recommendations

PURPOSE

The increasing rates of early-onset breast cancer (BC) and of woman survival render fertility preservation (FP) a pressing issue. We probe women's experiences of FP counseling and decision making, aiming to identify emergent counseling patterns.

METHODS

Semi-structured interviews were conducted with 16 women, who had been diagnosed with BC at the ages of 24-38, 1 to 5 years prior to the interview. BC survivors were recruited through posts in online fora, consented to participate, and were invited to tell their FP stories. The transcribed interviews were analyzed thematically, using the phenomenological paradigm.

FINDINGS

Doctors' FP recommendations belong into three categories: (a) direct clinical rationale-grounding recommendations in the woman's clinical condition by direct reference to tumor characteristics and prognosis, (b) indirect clinical rationale-reference to the woman's clinical condition by outlining a pressing time-frame, and (c) sociodemographic rationale-focus on the woman's family status. Women's responses revealed primarily detachment and compliance alongside initiative and proactivism.

CONCLUSION AND IMPLICATIONS FOR CANCER SURVIVORS

Beyond its contribution to women's future ability to conceive, FP may constitute an arena of personal autonomy and a coping resource for young BC patients. Raising awareness to this significance may sensitize healthcare providers to the role that FP may play in the moment of cancer diagnosis in adding, alongside sickness and prognosis, a focus on family future planning. As such, FP may affect women's quality of life and even survival.