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Jiang Y, Huang YL, Watral A, Blocker RC, Rushlow DR. Predicting Provider Workload Using Predicted Patient Risk Score and Social Determinants of Health in Primary Care Setting. Appl Clin Inform 2024; 15:511-527. [PMID: 38960376 PMCID: PMC11221991 DOI: 10.1055/s-0044-1787647] [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: 12/20/2023] [Accepted: 05/07/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Provider burnout due to workload is a significant concern in primary care settings. Workload for primary care providers encompasses both scheduled visit care and non-visit care interactions. These interactions are highly influenced by patients' health conditions or acuity, which can be measured by the Adjusted Clinical Group (ACG) score. However, new patients typically have minimal health information beyond social determinants of health (SDOH) to determine ACG score. OBJECTIVES This study aims to assess new patient workload by first predicting the ACG score using SDOH, age, and gender and then using this information to estimate the number of appointments (scheduled visit care) and non-visit care interactions. METHODS Two years of appointment data were collected for patients who had initial appointment requests in the first year and had the ACG score, appointment, and non-visit care counts in the subsequent year. State-of-art machine learning algorithms were employed to predict ACG scores and compared with current baseline estimation. Linear regression models were then used to predict appointments and non-visit care interactions, integrating demographic data, SDOH, and predicted ACG scores. RESULTS The machine learning methods showed promising results in predicting ACG scores. Besides the decision tree, all other methods performed at least 9% better in accuracy than the baseline approach which had an accuracy of 78%. Incorporating SDOH and predicted ACG scores also significantly improved the prediction for both appointments and non-visit care interactions. The R 2 values increased by 95.2 and 93.8%, respectively. Furthermore, age, smoking tobacco, family history, gender, usage of injection birth control, and ACG were significant factors for determining appointments. SDOH factors such as tobacco usage, physical exercise, education level, and group activities were strongly correlated with non-visit care interactions. CONCLUSION The study highlights the importance of SDOH and predicted ACG scores in predicting provider workload in primary care settings.
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Affiliation(s)
- Yiqun Jiang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States
| | - Yu-Li Huang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States
| | - Alexandra Watral
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States
| | - Renaldo C. Blocker
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States
| | - David R. Rushlow
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, United States
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2
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de Jesus A, Pitacho L, Moreira A. Burnout and Suicidal Behaviours in Health Professionals in Portugal: The Moderating Effect of Self-Esteem. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4325. [PMID: 36901334 PMCID: PMC10002387 DOI: 10.3390/ijerph20054325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
The main objective of this study was to investigate the effect of burnout on suicidal behaviours and the mediating effect of self-esteem in this relationship. A total of 1172 healthcare professionals working in Portugal's private and public sector organisations participated in this study. The results indicate a high level of burnout among these professionals and that exhaustion (β = 0.16; p < 0.001) and disengagement (β = 0.24; p < 0.001) positively and significantly affect suicidal behaviours. In turn, self-esteem has a significant and negative effect (β = -0.51; p < 0.001) on suicidal behaviours. Self-esteem moderates the relationship between disengagement and suicidal behaviours (B = -0.12; p < 0.001) and the relationship between exhaustion and suicidal behaviours (B = -0.11; p < 0.001), representing an essential variable for future lines of research, namely on the role of self-esteem in preventing burnout and suicidal behaviours in professionals from other professional areas.
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Affiliation(s)
- Alexandra de Jesus
- Department of Psychology and Sports, Instituto Superior Manuel Teixeira Gomes, 8500-590 Portimão, Portugal
| | - Liliana Pitacho
- Department of Psychology and Sports, Instituto Superior Manuel Teixeira Gomes, 8500-590 Portimão, Portugal
- Escola Superior Ciências Empresariais, Instituto Politécnico de Setúbal, Campus do IPS—Estefanilha, 2910-761 Setúbal, Portugal
- Centro de Investigação em Ciências Empresariais (CICE-IPS), 2914-503 Setúbal, Portugal
| | - Ana Moreira
- Department of Psychology and Sports, Instituto Superior Manuel Teixeira Gomes, 8500-590 Portimão, Portugal
- School of Psychology, ISPA—Instituto Universitário, Rua do Jardim do Tabaco 34, 1149-041 Lisboa, Portugal
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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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4
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Kirca N, Adibelli D, Toptas T, Turan T. The relationship between spiritual well-being, hope and depression in gynecologic oncology patients. Health Care Women Int 2022; 45:301-322. [PMID: 35072585 DOI: 10.1080/07399332.2021.1995387] [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: 11/05/2020] [Accepted: 10/15/2021] [Indexed: 10/19/2022]
Abstract
The authors' aim in this study was to determine the relationship between spiritual well-being, hope and depression in gynecologic oncology patients. This is a descriptive and correlational study. The patients received a total of 41.59 ± 12.11 points from the Spiritual Well-Being Scale, 5.57 ± 4.19 points from the Beck Hopelessness Scale, and 14.92 ± 11.61 points from the Beck Depression Scale. Gynecologic oncology patients had high spiritual well-being levels and low hopelessness and depression levels, and their hopelessness and depression levels decreased and hope levels increased as their spiritual well-being levels increased.
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Affiliation(s)
- Nurcan Kirca
- Faculty of Nursing, Obstetrics and Gynecology Nursing Department, Akdeniz University, Antalya, Turkey
| | - Derya Adibelli
- Public Health Nursing Department, University Faculty of Health Sciences, Antalya, Turkey
| | - Tayfun Toptas
- Department of Gynecologic Oncology, University of Health Sciences Antalya Research and Training Hospital, Antalya, Turkey
| | - Tulay Turan
- Department of Obstetrics and Gynecology, Ministry of Health Korkuteli Public Hospital, Antalya, Turkey
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5
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Chazan G, Jupp J, Bauters T, Duncan N, Weddle KJ, Nomura H, O'Connor S, Chan A, Alkhudair N, Alshamrani M, Buie LW, Chambers P, Chieh TW, DeRemer DL, Duvivier F, Katabalo D, McFarlane T, Mckavanagh D, Mensah K, Martinez EM, Rowan G, Sae-Teaw M, Tadesse TA, Weru I, Alexander M. Impact of coronavirus of 2019 on the delivery of pharmacy services to patients with cancer: An international survey of oncology pharmacy practitioners. J Oncol Pharm Pract 2021; 28:1832-1847. [PMID: 34693814 DOI: 10.1177/10781552211048892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The coronavirus of 2019 pandemic has necessitated vast and rapid changes in the way oncology pharmacy services are delivered around the world. METHODS/AIMS An international survey of oncology pharmacists and technicians was conducted via the International Society of Oncology Pharmacy Practitioners and collaborating global pharmacy organisations to determine the impact that the coronavirus of 2019 has had on pharmacy service delivery, pharmacy practitioners and oncology practice. RESULTS The survey received 862 responses from 40 different countries from September to October 2020. The majority of respondents were pharmacists (n = 841, 97.6%), with 24% involved in the direct care of patients with the coronavirus of 2019. Of the survey participants, 55% increased their time working remotely, with remote activities including dispensing, patient assessment/follow-up and attending multi-disciplinary rounds. Respondents reported a 72% increase in the use of technology to perform remote patient interaction activities and that participation in educational meetings and quality improvement projects was reduced by 68% and 44%, respectively. Workforce impacts included altered working hours (50%), cancelled leave (48%) and forced leave/furloughing (30%). During the pandemic, respondents reported reduced access to intensive care (19%) and anti-cancer (15%) medications. In addition, 39% of respondents reported reduced access to personal protective equipment, including N95 masks for chemotherapy compounding. Almost half of respondents (49%) reported that cancer treatments were delayed or intervals were altered for patients being treated with curative intent. A third of practitioners (30%) believed that patient outcomes would be adversely impacted by changes to pharmacy services. Sixty-five percent of respondents reported impacts on their mental health, with 12% utilising support services. CONCLUSION The coronavirus of 2019 pandemic has altered the way oncology pharmacy services are delivered. These results demonstrate the adaptability of the oncology pharmacy profession and highlight the importance of formal evaluation of the varied practice models to determine the evidence-based practices that enhance pharmacy services and, thus, should be reinstated as soon as practical and reasonable.
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Affiliation(s)
- Grace Chazan
- Sir Peter MacCallum Department of Oncology, 60078University of Melbourne, Australia.,Department of Medical Oncology, 3085Peter MacCallum Cancer Centre, Australia
| | - Jennifer Jupp
- Pharmacy Services, 3146Alberta Health Services, Canada
| | - Tiene Bauters
- Pharmacy Department, 60200Ghent University Hospital, Belgium
| | - Nick Duncan
- Pharmacy Department, 156807Queen Elizabeth Hospital, UK
| | | | - Hisanaga Nomura
- Department of Data Science/Pharmacy, 444492National Cancer Center Hospital East, Japan
| | - Shaun O'Connor
- Pharmacy Department, St Vincent's Hospital, Australia.,Commissioning and System Improvement Division, 1457Department of Health Victoria, Australia
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, 8788University of California, USA
| | - Nora Alkhudair
- Department of Clinical Pharmacy, College of Pharmacy, 37850King Saud University, Saudi Arabia
| | - Majed Alshamrani
- Pharmaceutical Care Services, 47798Ministry of National Guard Health Affairs, Saudi Arabia
| | - Larry W Buie
- Pharmacy Department, 5803Memorial Sloan Kettering Cancer Center, USA
| | - Pinkie Chambers
- 4919University College London Hospital NHS Trust & University College London School of Pharmacy, UK
| | - Tan Wen Chieh
- Pharmacy Department, 69844University Malaya Medical Centre, Malaysia
| | - David L DeRemer
- Department of Pharmacotherapy and Translational Research, 15505University of Florida College of Pharmacy, USA
| | | | - Deogratias Katabalo
- 227206Bugando Medical Center, Tanzania.,150778Catholic University of Health and Allied Sciences, School of pharmacy, Department of Pharmacy Practice and Therapeutics, Tanzania
| | | | - Daniel Mckavanagh
- Office of the Chief Clinical Information Officer, Clinical Excellence Queensland, 1288Queensland Health, Australia
| | - Kofi Mensah
- Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, 98763Kwame Nkrumah University of Science and Technology, Ghana.,Discipline of Pharmaceutical Sciences, College of Health Sciences, 56394University of KwaZulu-Natal, South Africa.,Pharmacy Practice Department, Faculty of Pharmacy and Pharmaceutical Sciences, 98763Kwame Nkrumah University of Science and Technology, Ghana
| | | | - Gail Rowan
- Pharmacy Department, 3085Peter MacCallum Cancer Centre, Australia
| | - Manit Sae-Teaw
- Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Thailand
| | - Tamrat Assefa Tadesse
- School of Pharmacy, College of Health Sciences, 37602Addis Ababa University, Ethiopia
| | - Irene Weru
- Pharmacy Division, 285569Kenyatta National Hospital, Kenya
| | - Marliese Alexander
- Sir Peter MacCallum Department of Oncology, 60078University of Melbourne, Australia.,Pharmacy Department, 3085Peter MacCallum Cancer Centre, Australia
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Alabi RO, Hietanen P, Elmusrati M, Youssef O, Almangush A, Mäkitie AA. Mitigating Burnout in an Oncological Unit: A Scoping Review. Front Public Health 2021; 9:677915. [PMID: 34660505 PMCID: PMC8517258 DOI: 10.3389/fpubh.2021.677915] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: The purpose of this study was to provide a scoping review on how to address and mitigate burnout in the profession of clinical oncology. Also, it examines how artificial intelligence (AI) can mitigate burnout in oncology. Methods: We searched Ovid Medline, PubMed, Scopus, and Web of Science, for articles that examine how to address burnout in oncology. Results: A total of 17 studies were found to examine how burnout in oncology can be mitigated. These interventions were either targeted at individuals (oncologists) or organizations where the oncologists work. The organizational interventions include educational (psychosocial and mindfulness-based course), art therapies and entertainment, team-based training, group meetings, motivational package and reward, effective leadership and policy change, and staff support. The individual interventions include equipping the oncologists with adequate training that include-communication skills, well-being and stress management, burnout education, financial independence, relaxation, self-efficacy, resilience, hobby adoption, and work-life balance for the oncologists. Similarly, AI is thought to be poised to offer the potential to mitigate burnout in oncology by enhancing the productivity and performance of the oncologists, reduce the workload and provide job satisfaction, and foster teamwork between the caregivers of patients with cancer. Discussion: Burnout is common among oncologists and can be elicited from different types of situations encountered in the process of caring for patients with cancer. Therefore, for these interventions to achieve the touted benefits, combinatorial strategies that combine other interventions may be viable for mitigating burnout in oncology. With the potential of AI to mitigate burnout, it is important for healthcare providers to facilitate its use in daily clinical practices. Conclusion: These combinatorial interventions can ensure job satisfaction, a supportive working environment, job retention for oncologists, and improved patient care. These interventions could be integrated systematically into routine cancer care for a positive impact on quality care, patient satisfaction, the overall success of the oncological ward, and the health organizations at large.
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Affiliation(s)
- Rasheed Omobolaji Alabi
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Industrial Digitalization, School of Technology and Innovations, University of Vaasa, Vaasa, Finland
| | | | - Mohammed Elmusrati
- Department of Industrial Digitalization, School of Technology and Innovations, University of Vaasa, Vaasa, Finland
| | - Omar Youssef
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Alhadi Almangush
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Pathology, University of Helsinki, Helsinki, Finland.,University of Turku, Institute of Biomedicine, Pathology, Turku, Finland
| | - Antti A Mäkitie
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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7
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Routine Oncology Treatment and Its Human Deficits. Recent Results Cancer Res 2021. [PMID: 34019172 DOI: 10.1007/978-3-030-63749-1_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Working with cancer patients is a highly demanding task. Both, caring for physical, social and spiritual needs of cancer patients as well as an overwhelming bureaucratisation, and technologisation challenge oncologists in a way that may cause mental and physical exhaustion, often-paradoxically-despite high job and specialty satisfaction. This article (i) summarises research findings with a special focus on oncologists' burnout (including factors associated with the phenomffenon), job satisfaction and physical health; (ii) describes potential consequences of burnout and distress, e.g., shortcomings in the physician-patient interaction in oncological treatment settings, financial implications on the health-care system, etc.; and (iii) reviews published data for interventions that may prevent or alleviate oncologists' burnout on an organisational and/or individual level.
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8
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Feldman DB, O'Rourke MA, Bakitas MA, Krouse RS, Deininger HE, Hudson MF, Corn BW. Hope, Burnout, and Life Satisfaction: An Intriguing Trinity Among Investigators of the SWOG Cancer Research Network. JCO Oncol Pract 2021; 17:e908-e916. [PMID: 33900801 DOI: 10.1200/op.20.00990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although hope has been explored in patients, few studies have investigated hopefulness in health care professionals. We surveyed oncology professionals within the SWOG Cancer Research Network, exploring relationships among personal hopefulness, social support, work stress, burnout, and life satisfaction. We hypothesized that hope would mediate the relationships between these other variables and life satisfaction. METHODS SWOG members were randomly selected for an online survey containing measures of hope, social support, work stress, burnout, and satisfaction with life. Of 1,000 invitees, 226 responded. RESULTS We tested a multiple mediational model using Hayes' bootstrapping approach (ie, PROCESS v3.4). As hypothesized, hope partially mediated the relationships between burnout and life satisfaction as well as between social support and life satisfaction. In particular, hopefulness was associated with lower burnout (-0.23; P = .005), greater social support (0.23; P = .005), and greater life satisfaction (0.50; P < .001). Work stress was associated with greater burnout (0.57; P < .001) but was not associated with general life satisfaction. Finally, social support was associated with lower burnout (-0.16; P = .005) and greater life satisfaction (0.24; P < .001). CONCLUSION Our results suggest that hope may mitigate the effects of burnout. The combination of hope and social support may prove helpful for reducing burnout and improving life satisfaction. Single-session hope-enhancement interventions incorporating both hope and social support have previously been shown to increase hope and well-being in non-health care professionals. Such interventions for health care providers warrant further study.
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Ling EJ, Shanafelt TD, Singer SJ. Understanding memorably negative provider care delivery experiences: Why patient experiences matter for providers. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 9:100544. [PMID: 33894667 DOI: 10.1016/j.hjdsi.2021.100544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/29/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Negative experiences contribute to provider dissatisfaction and burnout. Prior research suggests that negative experiences have greater impact on individuals than positive experiences. METHODS Interviews were conducted with surgical and oncology care providers (107 MDs, 253 non-MDs) working in 10 geographically diverse, academic and community hospitals across the U.S. Using a thematic network approach, we identified core themes describing drivers of memorably negative experiences. We applied logistic regression with adjustments for multiple comparisons to evaluate the relationship between demographic characteristics and types of experiences. RESULTS We identified 13 themes from 360 experiences and from these, developed a framework describing how work culture, environment, individual factors, and patient experiences lead to memorably, negative provider experiences. Providers most frequently described negative work environment experiences (158/360) and poor communication experiences with patients and other care professionals (151/360). Across themes, one third of respondents attributed memorably negative experiences to patient experiences (119/360). Midwest providers described patient centeredness more than other providers (OR = 3.9, p < 0.001). Providers from the Northeast, MDs compared to non-MDs, and providers with 15+ years of work experience identified negative insurance-related experiences more frequently (OR = 0.2, P = 0.007; OR = 2.9, P = 0.002 OR = 4.2, P < 0.001). CONCLUSIONS We offer a framework for understanding negative experiences among providers. Our study suggests that across a broad set of causes, improving patient experiences could substantially improve the negative, memorable experiences of providers. IMPLICATIONS Addressing negative patient experiences may have the double benefit of improving patient care and reducing provider burnout. LEVEL OF EVIDENCE Level III.
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10
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Hlubocky FJ, Symington BE, McFarland DC, Gallagher CM, Dragnev KH, Burke JM, Lee RT, El-Jawahri A, Popp B, Rosenberg AR, Thompson MA, Dizon DS, Srivastava P, Patel MI, Kamal AH, Daugherty CK, Back AL, Dokucu ME, Shanafelt TD. Impact of the COVID-19 Pandemic on Oncologist Burnout, Emotional Well-Being, and Moral Distress: Considerations for the Cancer Organization's Response for Readiness, Mitigation, and Resilience. JCO Oncol Pract 2021; 17:365-374. [PMID: 33555934 DOI: 10.1200/op.20.00937] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fay J Hlubocky
- University of Chicago Medicine, Maclean Center for Clinical Medical Ethics, Chicago, IL
| | | | - Daniel C McFarland
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry, New York, NY
| | - Colleen M Gallagher
- MD Anderson Cancer Center, Section of Integrated Ethics in Cancer Care, Houston, TX
| | | | | | - Richard T Lee
- Case Comprehensive Cancer Center, Department of Medicine, Division of Hematology/Oncology, School of Medicine, Cleveland OH
| | - Areej El-Jawahri
- Massachusetts General Hospital, Cancer Center, Harvard Medical School, Boston MA
| | - Beth Popp
- Ichan School of Medicine, Geriatrics and Palliative Medicine, Mount Sinai, New York, NY
| | - Abby R Rosenberg
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine; Seattle WA; Seattle Children's Research Institute, Seattle, WA
| | | | - Don S Dizon
- Lifespan Cancer Institute, Rhode Island Hospital, Brown University Providence, RI
| | | | - Manali I Patel
- Stanford University, VA Palo Alto Health Care System, Palo Alto, CA
| | - Arif H Kamal
- Duke University, Duke Cancer Institute, Population Health Sciences, Durham, NC
| | - Christopher K Daugherty
- University of Chicago Medicine, Department of Medicine, Section Hematology/Oncology, Maclean Center for Clinical Medical Ethics, Chicago, IL Chicago, IL
| | - Anthony L Back
- University of Washington, Department of Medicine/Oncology, Seattle, WA
| | - Mehmet E Dokucu
- Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL
| | - Tait D Shanafelt
- Stanford University, Department of Medicine, Med/Hematology, Chief Wellness Officer, Palo Alto, CA
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11
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Nadel AL, Barbach N, Fish JD. How I approach peer support in pediatric hematology/oncology. Pediatr Blood Cancer 2020; 67:e28297. [PMID: 32524737 DOI: 10.1002/pbc.28297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 11/10/2022]
Abstract
Peer support has begun to gain traction as a mechanism for improving well-being in medicine. In this paper, we share our experience building, training, and piloting a peer support team based on a "critical incident stress management" model. The HOPES team (Helping Our Peers Endure Stress) is dedicated to, and composed entirely of, members of our division of pediatric hematology/oncology. Peer support will not solve all the well-being problems afflicting medicine. It is, however, a very good place to start.
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Affiliation(s)
- Amy L Nadel
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, East Garden City, New York.,Division of Pediatric Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, Northwell Health, New York City, New York
| | - Nancy Barbach
- Division of Pediatric Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, Northwell Health, New York City, New York.,Department of Social Work, Cohen Children's Medical Center, Northwell Health, New York City, New York
| | - Jonathan D Fish
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, East Garden City, New York.,Division of Pediatric Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, Northwell Health, New York City, New York
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12
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Jiang DM, Berlin A, Moody L, Kumar R, Hannon B, Krzyzanowska MK, Dhani N, Cole H, Elliott M, Sridhar SS. Transitioning to a New Normal in the Post-COVID Era. Curr Oncol Rep 2020; 22:73. [PMID: 32566960 PMCID: PMC7306409 DOI: 10.1007/s11912-020-00956-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Di M Jiang
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 6M9, Canada
| | - Alejandro Berlin
- Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Lesley Moody
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rajat Kumar
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 6M9, Canada
| | - Breffni Hannon
- Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 6M9, Canada
| | - Neesha Dhani
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 6M9, Canada
| | - Heather Cole
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Mary Elliott
- Department of Psychiatry, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Srikala S Sridhar
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 6M9, Canada.
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13
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Leones LMB, Berba CMP, Chua AV, Sandoval-Tan J. Caring for the carers: safeguarding oncologists' mental health in the time of COVID-19. Ecancermedicalscience 2020; 14:1057. [PMID: 32582372 PMCID: PMC7302887 DOI: 10.3332/ecancer.2020.1057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Indexed: 12/31/2022] Open
Abstract
Taking care of patients with chronic, terminal diseases presents unique challenges to the mental health of medical oncologists. The current coronavirus disease 2019 (COVID-19) pandemic has exacerbated these mental health risks brought about by isolation and exhaustion. Delegated to be a national COVID-19 referral centre, the University of the Philippines—Philippine General Hospital faced many challenges, including the increased workload in a perilous and anxiety-inducing national crisis which placed the entire healthcare team in an unprecedented situation. To adapt to these challenges, the Division of Medical Oncology employed the following measures to safeguard the mental health of its faculty and fellows: 1) use of psychological support materials; 2) initiation of a psychological intervention programme and 3) establishment of peer support programmes. Caring for the carers through evidence-based interventions ensures the delivery of quality care to our cancer patients despite the challenges during these trying times.
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Affiliation(s)
| | | | | | - Jennifer Sandoval-Tan
- Division of Medical Oncology, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines.,http://orcid.org/0000-0002-7927-2441.,http://orcid.org/0000-0002-0664-4304.,http://orcid.org/0000-0002-0895-8139
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14
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Patient and Family Caregiver Considerations When Selecting Early Breast Cancer Treatment: Implications for Clinical Pathway Development. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 13:683-697. [DOI: 10.1007/s40271-020-00426-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Richardson DR, Tan X, Winzelberg G, Rosenstein DL, Collichio FA. Development of an Art of Oncology Curriculum to Mitigate Burnout and Foster Solidarity Among Hematology/Oncology Fellows. JCO Oncol Pract 2020; 16:e384-e394. [PMID: 32101489 DOI: 10.1200/jop.19.00529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 04/03/2024] Open
Abstract
PURPOSE Oncologists and fellows in hematology/oncology (HO) training programs report high levels of burnout. The Accreditation Council for Graduate Medical Education requires accredited programs to have a mechanism to foster well-being among fellows. METHODS Through an iterative process involving a multidisciplinary committee, we created a 3-year longitudinal Art of Oncology (AOO) curriculum intended to address burnout and foster solidary among HO fellows. Sessions used narratives to promote the formation of a shared mental model through discussion of the mutual experience of caring for patients with cancer. We tested the feasibility, acceptability, and initial effectiveness of implementing the curriculum into traditional didactic lectures as a pilot intervention from 2018 to 2019. Eight sessions were completed. RESULTS Sixteen fellows participated. Most were married (63%) and planned on pursuing careers in academic medicine (75%). The sample was racially and ethnically diverse (31% minority representation). Thirty-eight percent of fellows reported burnout symptoms. AOO sessions had higher attendance than didactic lectures (P = .04). Of 14 fellows who completed all follow-up assessments (87.5% response rate), 93% (13 of 14 fellows) felt the sessions were very or somewhat helpful and that sessions improved solidarity. Preparedness in managing work-life balance significantly improved (paired t test, mean difference, 0.53; P = .04). Measured levels of burnout did not significantly improve from baseline (mean difference, -0.133; P = .67). Work-life balance was associated with burnout on multivariable analysis (coefficient, 0.40; P = .03). CONCLUSION The implementation of a dedicated AOO curriculum is feasible and viewed as helpful by HO fellows. Larger studies are needed to assess the efficacy of this curricular intervention.
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Affiliation(s)
- Daniel R Richardson
- UNC Lineberger Comprehensive Cancer Center, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Xianming Tan
- UNC Lineberger Comprehensive Cancer Center, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
- UNC Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gary Winzelberg
- UNC School of Medicine, UNC Palliative Care Program, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Donald L Rosenstein
- UNC School of Medicine, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Frances A Collichio
- UNC Lineberger Comprehensive Cancer Center, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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16
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Gajra A, Bapat B, Jeune-Smith Y, Nabhan C, Klink AJ, Liassou D, Mehta S, Feinberg B. Frequency and Causes of Burnout in US Community Oncologists in the Era of Electronic Health Records. JCO Oncol Pract 2020; 16:e357-e365. [DOI: 10.1200/jop.19.00542] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND: Physician burnout, characterized by exhaustion of physical or emotional strength, cynicism, and lack of achievement, has become a worsening phenomenon in medicine, contributing to higher health care costs and patient/physician dissatisfaction. How burnout has affected hematologists and oncologists is not well studied. METHODS: US community oncologists/hematologists were queried via a Web-based survey from September-November 2018. Physicians were asked about frequency of burnout symptoms, drivers of work-related stress, and their perceptions on management of workload. RESULTS: Among the 163 physicians surveyed, 46% felt a substantial amount of stress at work. Most physicians felt emotionally (85%) and physically (87%) exhausted. A majority of physicians felt lethargic (67%), ineffective (64%), and/or detached (63%). In a typical workweek, 93% needed time beyond time allocated to clinical care to complete work responsibilities. Electronic health record (EHR) responsibilities caused moderate to excessive stress at work for 67% of physicians; 79% of physicians worked on EHRs outside of clinic hours. Other sources of excessive stress were changing reimbursement models (33%), interactions with payers (31%), and increasing patient and caregiver demands (31%). A third of physicians have considered retiring early or changing their career path to cope. To combat burnout, physicians’ practices have used advanced practice providers, invested in information technology, and/or hired additional administrative staff. However, the majority of physicians stated they had optimal or good control over their workload. CONCLUSION: Most oncologists experience burnout symptoms and require additional time beyond that allocated to clinical care to complete their workload. The discordance between oncologists’ admission of stress and exhaustion while claiming good control over those same burdens warrants exploration in future research.
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Affiliation(s)
- Ajeet Gajra
- Cardinal Health Specialty Solutions, Dublin, OH
| | - Bela Bapat
- Cardinal Health Specialty Solutions, Dublin, OH
| | | | | | | | | | - Sonam Mehta
- Cardinal Health Specialty Solutions, Dublin, OH
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Hlubocky FJ, Spence R, McGinnis M, Taylor L, Kamal AH. Burnout and Moral Distress in Oncology: Taking a Deliberate Ethical Step Forward to Optimize Oncologist Well-Being. JCO Oncol Pract 2020; 16:185-186. [PMID: 32134705 DOI: 10.1200/op.20.00030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fay J Hlubocky
- Department of Medicine, Section of Hematology/Oncology, MacLean Center for Clinical Medical Ethics, Cancer Research Center, Supportive Oncology Program, The University of Chicago Medicine, Chicago, IL
| | - Rebecca Spence
- American Society of Clinical Oncology, Ethics Committee, Alexandria, VA
| | - Molly McGinnis
- American Society of Clinical Oncology, Ethics Committee, Alexandria, VA
| | - Lynne Taylor
- Departments of Neurology and Neurologic Surgery, University of Washington, and Seattle Cancer Care Alliance, Seattle, WA
| | - Arif H Kamal
- Duke Cancer Institute and Duke Fuqua School of Business, Durham, NC
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