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Youssef G, Acquaye-Mallory A, Vera E, Chheda MG, Dunn GP, Moliterno J, O'Brien BJ, Venere M, Yust-Katz S, Lee EQ, Armstrong TS. Burnout and career satisfaction in young neuro-oncology investigators: Results of the Society for Neuro-Oncology Young Investigator Survey. Neurooncol Pract 2024; 11:494-506. [PMID: 39006527 PMCID: PMC11241357 DOI: 10.1093/nop/npae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
Background Burnout is a syndrome characterized by emotional exhaustion, depersonalization, and a reduced sense of accomplishment, which commonly arises from chronic workplace stress in the medical field. Given the higher risk of burnout in younger age groups reported in some studies, the Society for Neuro-Oncology (SNO) Young Investigator (YI) and Wellness Committees combined efforts to examine burnout in the SNO YI membership to better understand and address their needs. Methods We distributed an anonymous online survey to SNO members in 2019. Only those meeting the definition of a YI were asked to complete the survey. The survey consisted of questions about personal and professional characteristics as well as the validated Maslach Burnout Inventory-Human Services Survey (MBI-HSS) questionnaire. Statistical analyses included descriptive statistics, univariate and multivariate analyses, and incorporation of previously defined burnout profiles. Results Data were analyzed for 173 participants who self-identified as YI. Measures of burnout showed that YI members scored higher on emotional exhaustion and depersonalization compared to normative population but similar to those in a prior SNO general membership survey. With respect to burnout profiles, 30% of YI respondents classified as overextended and 15% as burnout. Organizational challenges were the most common contributors to stress. Conclusions Similar to results from a previous survey completed by general SNO membership, the prevalence of burnout among neuro-oncology clinical and research YI is high, and is mainly characterized by overextension, warranting interventions at institutional and organizational levels.
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Affiliation(s)
- Gilbert Youssef
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Alvina Acquaye-Mallory
- Neuro-Oncology Branch, Center for Cancer Research, The National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, The National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Milan G Chheda
- Division of Oncology, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Gavin P Dunn
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Moliterno
- Yale School of Medicine, Chenevert Family Brain Tumor Center, Yale Cancer Center and Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Barbara J O'Brien
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Monica Venere
- Department of Radiation Oncology, James Cancer Hospital and Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Tzagournis Medical Research Facility, Columbus, Ohio, USA
| | - Shlomit Yust-Katz
- Neuro-Oncology Unit, Davidoff Cancer Center at Rabin Medical Center and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eudocia Q Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, The National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Oware J, Iddrisu M, Konlan KD, Dzansi G. Challenges and support systems of nurses caring for women with advanced cervical cancer in Accra, Ghana. BMC Palliat Care 2024; 23:174. [PMID: 39010028 PMCID: PMC11250963 DOI: 10.1186/s12904-024-01507-2] [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: 05/13/2024] [Accepted: 07/09/2024] [Indexed: 07/17/2024] Open
Abstract
INTRODUCTION Cervical cancer is one of the causes of female deaths worldwide. Cervical cancer incidence is rising with almost three thousand (2797) women in Ghana being diagnosed with the condition each year, with almost two thousand (1,699) of them dying from its complications Nurses caring for cervical cancer patients are exposed to emotional and psychological distress due to late presentation, the burden of care, patients' suffering and the alarming number of deaths associated with it. Improving positive patient outcomes require identifying the challenges and support systems available to nursing staff so as to harness these support systems for improving care outcomes. AIM This study explored the challenges and support systems of nurses caring for women with advanced cervical cancer in Accra, Ghana. METHOD In this study, we adopted an exploratory qualitative design. The study was conducted among eleven (11) nurses and nine (9) midwives engaged at the national referral hospital in Ghana who were providing care for patients with advanced cervical cancer for over a year who were purposively sampled. The data was collected using in-depth interviews with a pre-tested semi-structure interview guide from the twenty participants. We recorded the interviews using an audio-tape. The audio files were transcribed verbatim and thematic analysis was undertaken with the aid of Nvivo 10.0. RESULTS The challenges when rendering nursing care faced by participants of this study were exposure to frequent deaths, inadequate resources, and workload. Most participants lamented that they received absolutely no support from their workplace, hence their only form of support was from their family and friends. They also added that most of them were general nurses and midwives with no special training in oncology nursing or palliative nursing. CONCLUSION Nurses and midwives experience resource, knowledge and skill challenges when caring for patients with advanced cervical cancer. However, the nurses and midwives had emotional attachment to their jobs and their patients and were not distracted by their bad experiences. We recommend improving resource allocation for cervical cancer care through the National Health Insurance Authority (NHIA), Ghana and increased training of nurses in oncology and palliative nursing by the Ministry of Health, Ghana to improve knowledge and skills of the nurses and midwives caring for women with advanced cervical cancer to improve their quality of care. Further, hospitals must make it a priority to have more nurses and midwives trained in oncology and end of life care to improve the knowledge and skills of nurses and midwives caring for advanced cervical cancer patients. Also, these findings should trigger policy-level discussions at the Ministry of Health, Ghana on the training of specialized nurses and midwives in cancer and end of life care to help Ghana meet the sustainable development goal targets related to health.
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Affiliation(s)
- Jennifer Oware
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Legon, Greater Accra Region, Ghana
| | - Merri Iddrisu
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Legon, Greater Accra Region, Ghana
| | - Kennedy Dodam Konlan
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Legon, Greater Accra Region, Ghana.
| | - Gladys Dzansi
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Legon, Greater Accra Region, Ghana
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Attieh S, Kilpatrick K, Chênevert D, Pomey MP, Loiselle CG. Measuring Team Functioning During the COVID-19 Pandemic: Perspectives of Cancer Care Team Members. J Multidiscip Healthc 2024; 17:2623-2633. [PMID: 38828266 PMCID: PMC11141571 DOI: 10.2147/jmdh.s448985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/24/2024] [Indexed: 06/05/2024] Open
Abstract
Background In a public health crisis such as COVID-19, cancer teams face significant challenges including acute work disruptions, rapid shifts in clinical practice, and burnout. Within this context, it is crucial to explore team functioning from the perspectives of multiple stakeholders. Objective This quantitative pilot study aimed to 1) measure perceptions of multi-stakeholders on key indicators of team functioning (Team Effectiveness, TE, and Team Relational Coordination, TRC) during COVID-19 and its transition, and 2) document whether patient perceptions of TE/TRC are significantly associated with their cancer care experiences. Methods A descriptive design with repeated measures was used. Through convenience sampling, participants were recruited from two outpatient cancer clinics at a large university-affiliated hospital, in Montréal, Qc, Canada. Sixty-six participants (ie, 13 healthcare professionals, 40 patients, 6 informal caregivers, and 7 volunteers) completed e-measures at T1 (years 2021-2022) and n = 44 at T2 (year 2023). Results At T1, participants reported high perceptions of Team Effectiveness (scale 1 to 6) M = 4.47; SD = 0.7 (Mdn = 4.54; IQR: 4.06-5) and Relational Coordination (scale 1 to 5) M = 3.77; SD = 0.77 (Mdn = 3.81; IQR: 3.12-4.38) with no significant differences in perceptions across the four groups. At T2, no significant changes in TE/TRC perceptions were found. At both time points, patient perceptions of TE/TRC were significantly correlated with positive cancer care experiences (Spearman rank correlation rs ranging from 0.69 and 0.83; p < 0.01). Conclusion To our knowledge, this is the first study documenting perceptions of cancer team functioning amidst the pandemic as reported by multiple stakeholders. Significant relationships between patient perceptions of TE/TRC and their cancer care experiences underscore the importance of including patients' views in team functioning processes. Future work should rely on larger sample sizes to further explore key elements of optimal team functioning.
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Affiliation(s)
- Samar Attieh
- Department of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Denis Chênevert
- Department of Human Resources Management, HEC Montréal, Montréal, QC, Canada
| | - Marie-Pascale Pomey
- Research Centre of the University of Montreal Hospital Centre, Montréal, QC, Canada
- Centre d’excellence sur le partenariat avec les patients et le public, Montréal, QC, Canada
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montréal, Montréal, QC, Canada
| | - Carmen G Loiselle
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
- Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
- Segal Cancer Center, Jewish General Hospital, Montréal, Canada
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Peppercorn J. For Those About to MOC, We Salute You. JCO Oncol Pract 2024; 20:591-593. [PMID: 38657193 DOI: 10.1200/op.24.00282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024] Open
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Haverfield MC, Carrillo Y, Itliong JN, Ahmed A, Nash A, Singer A, Lorenz KA. Cultivating Relationship-Centered Care: Patient, Caregiver, and Provider Communication Preferences for and Experiences with Prognostic Conversations. HEALTH COMMUNICATION 2024; 39:1256-1267. [PMID: 37165555 DOI: 10.1080/10410236.2023.2210383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Prognostic conversations present many challenges for patients, caregivers, and providers alike. Most research examining the context of prognostic conversations have used a more siloed approach to gather the range of perspectives of those involved, typically through the lens of patient-centered care. However, the mutual influence evident in prognostic conversations suggests a relationship-centered care model may be useful in cancer communication research. Similarities and differences in preferences for and experiences with prognostic conversations among oncology patients, caregivers, and providers (N = 32) were explored. Identified themes were then mapped to the principles of the relationship-centered care framework to extend our understanding of prognostic conversations and contribute to a new direction in the application of relationship-centered care. Findings suggest fewer similarities than differences, point to important discrepancies among participant perspectives, and reinforce the utility of relationship-centered care in identifying communication practices that enhance the prognostic conversation experience.
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Affiliation(s)
| | | | | | - Anum Ahmed
- Communication Studies, San José State University
| | - Amia Nash
- School of Public Health, University of California
| | - Adam Singer
- School of Medicine, University of California Los Angeles
| | - Karl A Lorenz
- VA Palo Alto Health Care System, Center for Innovation to Implementation
- Department of Primary Care and Population Health, Stanford University School of Medicine
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Pacheco-Barcia V, Custodio-Cabello S, Carrasco-Valero F, Palka-Kotlowska M, Mariño-Mendez A, Carmona-Bayonas A, Gallego J, Martín AJM, Jimenez-Fonseca P, Cabezon-Gutierrez L. Systemic Inflammation Response Index and weight loss as prognostic factors in metastatic pancreatic cancer: A concept study from the PANTHEIA-SEOM trial. World J Gastrointest Oncol 2024; 16:386-397. [PMID: 38425396 PMCID: PMC10900150 DOI: 10.4251/wjgo.v16.i2.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/14/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND The prognostic value of the Systemic Inflammation Response Index (SIRI) in advanced pancreatic cancer is recognized, but its correlation with patients´ nutritional status and outcomes remains unexplored. AIM To study the prognostic significance of SIRI and weight loss in metastatic pancreatic cancer. METHODS The PANTHEIA-Spanish Society of Medical Oncology (SEOM) study is a multicentric (16 Spanish hospitals), observational, longitudinal, non-interventional initiative, promoted by the SEOM Real World-Evidence work group. This pilot study sought to analyze the association between weight loss and inflammatory status as defined by SIRI. The cohort stems from a proof-of-concept pilot study conducted at one of the coordinating centers. Patients with pathologically confirmed metastatic pancreatic adenocarcinoma, treated from January 2020 to January 2023, were included. The index was calculated using the product of neutrophil and monocyte counts, divided by lymphocyte counts, obtained within 15 days before initiation chemotherapy. This study evaluated associations between overall survival (OS), SIRI and weight loss. RESULTS A total of 50 patients were included. 66% of these patients were male and the median age was 66 years. Metastasis sites: 36% liver, 12% peritoneal carcinomatosis, 10% lung, and 42% multiple locations. Regarding the first line palliative chemotherapy treatments: 50% received gemcitabine plus nab-paclitaxel; 28%, modified fluorouracil, leucovorin, irinotecan and oxaliplatin, and 16% were administered gemcitabine. 42% had a weight loss > 5% in the three months (mo) preceding diagnosis. 21 patients with a SIRI ≥ 2.3 × 103/L exhibited a trend towards a lower median OS compared to those with a SIRI < 2.3 × 103/L (4 vs 18 mo; P < 0.000). Among 21 patients with > 5% weight loss before diagnosis, the median OS was 6 mo, in contrast to 19 mo for those who did not experience such weight loss (P = 0.003). Patients with a weight loss > 5% showed higher SIRI levels. This difference was statistically significant (P < 0.000). For patients with a SIRI < 2.3 × 103/L, those who did not lose > 5% of their weight had an OS of 20 mo, compared to 11 mo for those who did (P < 0.001). No association was found between carbohydrate antigen 19-9 levels ≥ 1000 U/mL and weight loss. CONCLUSION A higher SIRI was correlated with decreased survival rates in patients with metastatic pancreatic cancer and associated with weight loss. An elevated SIRI is suggested as a predictor of survival, emphasizing the need for prospective validation in the upcoming PANTHEIA-SEOM study.
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Affiliation(s)
- Vilma Pacheco-Barcia
- Department of Medical Oncology, Hospital Universitario de Torrejon, Madrid 28850, Spain
| | - Sara Custodio-Cabello
- Department of Medical Oncology, Hospital Universitario de Torrejon, Madrid 28850, Spain
| | - Fatima Carrasco-Valero
- Department of Internal Medicine, Hospital Universitario de Torrejon, Madrid 28850, Spain
| | - Magda Palka-Kotlowska
- Department of Medical Oncology, Hospital Universitario de Torrejon, Madrid 28850, Spain
| | - Axel Mariño-Mendez
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo 33011, Spain
| | - Alberto Carmona-Bayonas
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, University of Murcia, Murcia 30001, Spain
| | - Javier Gallego
- Department of Medical Oncology, Hospital General Universitario de Elche, Elche 03202, Spain
| | - A J Muñoz Martín
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Universidad Complutense Madrid, Madrid 28007, Spain
| | - Paula Jimenez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo 33011, Spain
| | - Luis Cabezon-Gutierrez
- Department of Medical Oncology, Hospital Universitario de Torrejon, Madrid 28850, Spain
- Universidad Francisco de Vitoria, Madrid 28223, Spain
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Peters R, Rogge A, Dunst J, Freitag-Wolf S, Schmalz C. Moral Distress in Radiation Oncology: Insights From Residents in Germany. Adv Radiat Oncol 2024; 9:101378. [PMID: 38405316 PMCID: PMC10885585 DOI: 10.1016/j.adro.2023.101378] [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] [Received: 05/15/2023] [Accepted: 09/12/2023] [Indexed: 02/27/2024] Open
Abstract
Purpose Being challenged by circumstances that force one to act in discordance with one's moral compass can lead to moral distress. The phenomenon has been widely investigated among nurses. This study was designed to shed some light on the situation of resident physicians in radiation oncology. Methods and Materials To gain insight into moral distress among residents in radiation oncology, a web-based questionnaire was developed and distributed throughout Germany. Participants were asked to evaluate possible burdensome situations and different options for relief. To outline the main issues of moral distress, an exploratory factor analysis was conducted. Relief options were examined by frequencies. Results The factor analysis yielded lack of time, contradiction between patient request and indication, nonmedical interests, and decisions between curative treatment and best supportive care as main issues for the 84 participants. Support from supervisors and senior physicians, as well as exchanges with resident colleagues were indicated as forms of relief. Professional support, such as ethics consultations, structured conversation groups (Balint), or psychological case supervisions, were rated as less helpful, although most participants reported a lack of experience with these. Conclusions The results are in accordance with existing assumptions that moral distress among physicians is mainly due to uncertainty. Regarding radiation oncology residents in particular, moral distress seems to be related to uncertainty in decisions and conflicts about treatment options. Although senior physicians and supervisors present important role models in dealing with moral distress, professional services such as ethics consultations offer an opportunity for relief that can still be expanded.
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Affiliation(s)
- Ricarda Peters
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Annette Rogge
- Paracelsus Nordseeklinik Helgoland, Helgoland, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sandra Freitag-Wolf
- Institut für Medizinische Informatik und Statistik, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Claudia Schmalz
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Krause R, Gwyther L, Olivier J. The influence of context on the implementation of integrated palliative care in an academic teaching hospital in South Africa. Palliat Care Soc Pract 2024; 18:26323524231219510. [PMID: 38196405 PMCID: PMC10775728 DOI: 10.1177/26323524231219510] [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: 07/01/2023] [Accepted: 11/22/2023] [Indexed: 01/11/2024] Open
Abstract
Background Palliative care (PC) has been integrated to a limited extent in the South African healthcare system. Contextual factors may be a pivotal influence in this integration. Objectives This study aims to explore contextual factors that are possibly influencing the integration or lack thereof in an academic teaching hospital (ATH). Design A mixed-method study was conducted in a large ATH in South Africa. Methods The mixed methods were conducted in parallel and then merged. Findings were integrated to describe the contextual factors influencing PC integration, to develop a timeline of implementation and assess the probable influence of context on the integration process. The mixed-methods phases included a narrative review of published literature related to health systems, integration of health interventions and PC in teaching hospital settings; followed by interviews, documentary and routine data analyses. Semi-structured interviews with purposively sampled participants provided the qualitative data. Primary national, provincial and organizational documents expanded the contextual phenomena and corroborated findings. Routine hospital admission and mortality data was statistically analysed to expand further and corroborate findings. All qualitative data was thematically analysed using deductive coding, drawing from the aspects of the contextual dimensions of integration. Results Enabling contextual factors for local PC integration were global and local advocacy, demonstrated need, PC being a human right, as well as the personal experiences of hospital staff. Impeding factors were numerous misconceptions, PC not valued as a healthcare priority, as well as limitations in functional elements necessary for PC integration: national and regional political support, leadership at all levels and sustainable financing. Conclusion The normative and functional contextual aspects interplay at macro, meso and micro levels positively and negatively. How stakeholders understand and value PC directly and indirectly impacts on PC integration. Strategic interventions such as mandatory education are required to ensure PC integration. The health system is dynamic, and understanding the context in which the health system functions is core to the integration of PC. This may assist in developing integration strategies to address PC integration and the transferability of these strategies.
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Affiliation(s)
- Rene Krause
- Division of Interdisciplinary Palliative Care and Medicine, University of Cape Town, Room 2.28, Falmouth Building, Observatory, Western Cape 7935, South Africa
| | - Liz Gwyther
- Division of Interdisciplinary Palliative Care and Medicine, University of Cape Town, Observatory, Western Cape, South Africa
| | - Jill Olivier
- Department of Public Health, University of Cape Town, Rondebosch, Western Cape, South Africa
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Petruzzelli D, Vignetti M, Trasarti S, Sportoletti P, Torre SD, Cairoli R, Leone FPC, Pompilio G, Gullì M, Hajdukova EB, Integlia D. Exploring the administrative burden faced by hematologists: a comprehensive study in Italy. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2024; 11:161-168. [PMID: 38979549 PMCID: PMC11228512 DOI: 10.33393/grhta.2024.3042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/12/2024] [Indexed: 07/10/2024] Open
Abstract
Background Administrative burdens have been identified as a major issue impacting patient care, professional practice, and the overall efficiency of healthcare systems. The aim of this study is to assess the administrative burden faced by Italian hematologists. Methods A cross-sectional survey that included both closed-ended quantitative questions and open-ended free text answer options was administered to 1,570 hematologists working with malignancies and members of Italian GIMEMA Foundation - Franco Mandelli ONLUS and the Italian Linfomi Foundation (FIL). The survey was conducted online from May 24 to June 30, 2023. Descriptive statistics were computed for the quantitative data to clearly summarize the responses and descriptive analysis of free text responses was carried out. Results Surveyed hematologists spend an average of 47.07% of their time on administrative tasks, with 63.22% (n = 110) of respondents reporting spending at least half of their time on these activities. More than half (57.47%, n = 100) reported that "Patient care" is the medical task most affected by a lack of time. Additionally, 55.17% (n = 96) reported experiencing burnout in the past 6 months, with filling out "Forms" being identified as the top contributing administrative task by 27.59% (n = 48) of respondents, followed by "Scheduling" (24.71%, n = 43) and "Managing IT system failures" (21.84%, n = 38). Nearly half of the surveyed hematologists (45.40%, n = = 79) identified patient care as the top priority requiring more time. Conclusions The study confirms that the administrative workload of hematologists has a significant impact on patient care, communication, and burnout risk, reducing the time available for patient care, leading to exhaustion and concern about clinical errors.
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Affiliation(s)
| | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA) - Franco Mandelli ONLUS, Rome - Italy
| | - Stefania Trasarti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome - Italy
| | - Paolo Sportoletti
- Department of Medicine and Surgery, Institute of Hematology, Centro di Ricerca Emato-Oncologica (CREO), University of Perugia, Perugia - Italy
| | - Silvia Della Torre
- "La Lampada di Aladino ETS", Bari - Italy
- Oncology Unit, ASST Rhodense, Rho - Italy
| | - Roberto Cairoli
- Department of Hematology and Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan - Italy
| | | | - Giuseppe Pompilio
- Health Economics, Outcome Research and Market Access, ISHEO - Integrated Strategies for Health Enhancing Outcomes, Rome - Italy
| | - Marco Gullì
- ISHEO - Integrated Strategies for Health Enhancing Outcomes, Rome - Italy
| | - Eva Brown Hajdukova
- Patient-Reported Outcomes Research (PROQOL), Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, Paris - France
| | - Davide Integlia
- ISHEO - Integrated Strategies for Health Enhancing Outcomes, Rome - Italy
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Manookian A, Nadali J, Ghiyasvandian S, Weaver K, Haghani S, Divani A. Spiritual care competence, moral distress and job satisfaction among Iranian oncology nurses. Int J Palliat Nurs 2023; 29:487-497. [PMID: 37862158 DOI: 10.12968/ijpn.2023.29.10.487] [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] [Indexed: 10/22/2023]
Abstract
BACKGROUND Nurses have a crucial role in identifying spiritual needs and providing spiritual care to patients living with cancer. AIM This study evaluated Iranian oncology nurses' spiritual care competence and its relationship with job satisfaction and moral distress. METHOD This cross-sectional study was conducted on 280 Iranian oncology nurses in 2020 using four questionnaires: demographic questionnaires, the Spiritual Care Competence Questionnaire (SCCQ), the Minnesota Job Satisfaction Questionnaire (MSQ) and the nurses' Moral Distress Questionnaire (MDS-R). FINDINGS The mean scores indicated a medium to high Spiritual Care Competence (SCC), mild to moderate moral distress and high job satisfaction. There was a positive correlation between SCC and external job satisfaction (r=184, p<0.05) and a negative correlation between SCC and moral distress (r=-0.356, p<0.05). CONCLUSIONS SCC diminishes with decreasing external job satisfaction and increasing moral distress. To improve the SCC of nurses working with patients living with cancer, it is recommended that nursing managers and policymakers revise the organisational policies to tackle the obstacles and consider the related factors to provide an ethical climate, implement quality spiritual care and increase job satisfaction.
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Affiliation(s)
- Arpi Manookian
- Associate Professor of Nursing, USERN CARE (TUMS) Office, School of Nursing and Midwifery, Tehran University of Medical Sciences, Iran
| | - Javad Nadali
- Clinical Instructor of Nursing, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Iran
| | - Shahrzad Ghiyasvandian
- Professor of Nursing, Medical-Surgical Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Iran
| | - Kathryn Weaver
- Honorary Research Professor, Faculty of Nursing, University of New Brunswick, Fredericton, Canada
| | - Shima Haghani
- Biostatistical Supervisor, Biostatistics Department, Iran University of Medical Sciences, Iran
| | - Anahita Divani
- Oncology Nurse Practitioner, Cancer Institute of Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran
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Mathews N, Alodan K, Kuehne N, Widger K, Locke M, Fung K, Gandhi S, McLean J, Hossain A, Alexander S. Prevalence and Risk Factors for Moral Distress in Pediatric Oncology Health Care Professionals. JCO Oncol Pract 2023; 19:917-924. [PMID: 37625100 DOI: 10.1200/op.23.00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/31/2023] [Accepted: 07/13/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE Moral distress (MoD) is prevalent among health care professionals (HCPs) in oncology and is associated with burnout. The objectives of this study were to quantify MoD among pediatric oncology healthcare professionals (HCPs) at a Canadian quaternary care hospital, identify root causes, and evaluate change over time. METHODS Eligible pediatric oncology HCPs were identified, and consenting participants completed the Measure of Moral Distress-Healthcare Professionals (MMD-HP) and MoD Thermometer (MDT) at baseline, followed by biweekly MDTs over 12 weeks. RESULTS A total of 139 HCPs participated. The mean MMD-HP score was 123 ± 57.0, range 9-288. Demographic risk factors identified for elevated MMD-HP scores were female sex (female 127.1 and male 83.6, P = .01) and nursing role (nurse 136.3 and most responsible physician 85.3, P = .02). Higher MMD-HP scores were found in HCPs who were currently considering resigning because of MoD compared with those who were not (169.9 v 115.4, P < .001). Situations involving administration of treatment to children with poor prognosis cancers that was perceived to be overly aggressive were ranked as the greatest environmental contributor to MoD. Baseline and mean MDT scores over time strongly correlated with MMD-HP scores (P < .0001 and P = .0003, respectively), with mean MDT scores showing no significant fluctuation over the 12-week period. CONCLUSION MoD was common among pediatric oncology HCPs. Risk factors for elevated levels of MoD included both demographic and environmental factors. Implementation of systems to improve team communication and decision making, especially in the care of patients with poor prognosis cancers, may affect HCP MoD.
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Affiliation(s)
- Natalie Mathews
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pathology and Molecular Medicine, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Khalid Alodan
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Nathan Kuehne
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kimberley Widger
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Maria Locke
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Karen Fung
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Sheila Gandhi
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer McLean
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Alomgir Hossain
- Clinical Research Services, Hospital for Sick Children, Toronto, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Sarah Alexander
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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12
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Foster MW, McKellar L, Fleet JA, Sweet L. Moral distress in midwifery practice: A Delphi study. Women Birth 2023; 36:e544-e555. [PMID: 37164777 DOI: 10.1016/j.wombi.2023.04.005] [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: 02/23/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Moral distress is a psychological concept that describes the harm associated with actions or inactions that oppose an individuals' moral beliefs. Moral distress is linked to moral compromise in the workplace that may negatively impact mental wellbeing. Current tools available to assess moral distress are not specific for the Australian health care system or midwifery practice. AIM The aim of this study was to develop a list of situational and outcome statements associated with moral compromise and levels of moral distress in midwifery to inform the development of a tool to measure levels of moral distress in midwives. METHODS This e-Delphi study was the third stage of a sequential exploratory mixed-methods study. Using an online strategy, three iterative rounds of e-Delphi were collected and analysed for consensus on situations leading to moral distress and the associated psychological outcomes. FINDINGS Twenty participants contributed across the three rounds. Consensus was met in 40 morally compromising situation statements. The highest level of consensus related to excessive workloads and the associated negative impact of this on women and families. Consensus on outcomes following exposure to morally distressing situations led to the development of a continuum scale from moral frustration to moral injury. DISCUSSION/CONCLUSION This is the first study to use a consensus method to establish different levels of moral compromise, frustration, distress, and injury in midwifery practice. The findings of this study contribute to a growing body of literature that supports the concept of moral distress occurring across a continuum.
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Affiliation(s)
- Mrs Wendy Foster
- Clinical and Health Sciences, University of South Australia, Australia; Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA 5000, Australia.
| | - Lois McKellar
- Clinical and Health Sciences, University of South Australia, Australia; School of Health and Social Care, Edinburgh Napier University, Scotland, UK
| | - Julie-Anne Fleet
- Clinical and Health Sciences, University of South Australia, Australia; Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA 5000, Australia
| | - Linda Sweet
- School of Health and Social Care, Edinburgh Napier University, Scotland, UK; School of Nursing and Midwifery, Deakin University and Western Health Partnership, Australia
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13
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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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14
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Patel MI, Hinyard L, Hlubocky FJ, Merrill JK, Smith KT, Kamaraju S, Carrizosa D, Kalwar T, Fashoyin-Aje L, Gomez SL, Jeames S, Florez N, Kircher SM, Tap WD. Assessing the Needs of Those Who Serve the Underserved: A Qualitative Study among US Oncology Clinicians. Cancers (Basel) 2023; 15:3311. [PMID: 37444421 PMCID: PMC10341104 DOI: 10.3390/cancers15133311] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/01/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The American Society of Clinical Oncology established the 'Supporting Providers Serving the Underserved' (SUS) Task Force with a goal to develop recommendations to support cancer clinicians who deliver care for populations at risk for cancer disparities. As a first step, the Task Force explored barriers and facilitators to equitable cancer care delivery. METHODS Clinicians across the United States who deliver care predominantly for low-income and racially and ethnically minoritized populations were identified based on lists generated by the Task Force and the Health Equity Committee. Through purposive sampling based on geographical location, clinicians were invited to participate in 30-60 min semi-structured interviews to explore experiences, barriers, and facilitators in their delivery of cancer care. Interviews were recorded, transcribed, imported into qualitative data management software, and analyzed using thematic analysis. RESULTS Thematic analysis revealed three major themes regarding barriers (lack of executive leadership recognition of resources; patient-related socio-economic needs; clinician burnout) and two major themes regarding facilitators (provider commitment, experiential training). CONCLUSIONS Findings reveal modifiable barriers and potential solutions to facilitate equitable cancer care delivery for populations at risk for cancer disparities.
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Affiliation(s)
- Manali I. Patel
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Medical Services, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Leslie Hinyard
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO 63104, USA;
| | - Fay J. Hlubocky
- Department of Medicine, University of Chicago School of Medicine, Chicago, IL 60637, USA;
| | - Janette K. Merrill
- American Society of Clinical Oncology, Alexandria, VA 22314, USA; (J.K.M.); (K.T.S.)
| | - Kimberly T. Smith
- American Society of Clinical Oncology, Alexandria, VA 22314, USA; (J.K.M.); (K.T.S.)
| | - Sailaja Kamaraju
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | | | - Tricia Kalwar
- Medical Services, Veterans Administration, Miami Healthcare System, Miami, FL 33125, USA;
| | | | - Scarlett L. Gomez
- Department of Epidemiology, University of California—San Francisco School of Medicine, San Francisco, CA 93701, USA
| | - Sanford Jeames
- Department of Social and Behavioral Sciences, Huston Tillotson University College of Arts and Sciences, Austin, TX 78702, USA;
| | - Narjust Florez
- Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA;
| | - Sheetal M. Kircher
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA;
| | - William D. Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
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15
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Kichenadasse G, Koczwara B, Karapetis CS. Re: Workforce challenges across Victorian medical oncology services: review consultations and workload. Intern Med J 2023; 53:1093. [PMID: 37349274 DOI: 10.1111/imj.16112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/19/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Ganessan Kichenadasse
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Bogda Koczwara
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Christos S Karapetis
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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16
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Bramati PS, Swan A, Urbauer DL, Rozman De Moraes A, Bruera E. Evaluation of a Daily Nine-Item "Handbook for Self-Care at Work" for Palliative Care Clinicians. J Palliat Med 2023; 26:622-626. [PMID: 36318801 PMCID: PMC10325800 DOI: 10.1089/jpm.2022.0347] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
Abstract
Context: A daily nine-item "Handbook for Self-Care at Work" was created to increase the well-being and satisfaction of the staff at the department of palliative care of a tertiary oncological center in the United States. Objectives: To evaluate the perceived usefulness of and adherence to the Handbook. Design, Setting and Participants: An anonymous survey was conducted among the palliative care staff asking for the frequency of utilization and the perception of usefulness of the Handbook. Additional data collected included demographics, satisfaction with professional life, frequency of burnout, and frequency of callousness toward people. We also compared the use and perception of the Handbook before and during the COVID-19 pandemic. Results: Of 52 palliative care clinicians, 39 (75%) completed the survey. Most participants were women and were <49 years. Most respondents (59%) found the Handbook useful or very useful. Offer help, ask for help, and hydration were perceived as the most useful items. The items most frequently achieved were movement, hydration, and eat light. The least useful perceived item was nap time, which was rarely achieved. During the COVID-19 pandemic, 32 (82%) respondents found the Handbook to be as/somewhat more/much more useful, and 29 (75%) were able to adhere to the items as/somewhat more/much more often than before. Conclusion: Most respondents found the Handbook useful and were able to accomplish the items most of the days. During the COVID-19 pandemic, the staff felt that the Handbook was more useful.
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Affiliation(s)
- Patricia S. Bramati
- Department of Palliative Care, Rehabilitation, Integrative Medicine, and The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy Swan
- Department of Palliative Care, Rehabilitation, Integrative Medicine, and The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diana L. Urbauer
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aline Rozman De Moraes
- Department of Palliative Care, Rehabilitation, Integrative Medicine, and The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, Integrative Medicine, and The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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17
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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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18
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Oxley S, Kalra A, Sideris M, Itzkowitz N, Evans O, Atakpa EC, Brentnall AR, Dworschak N, Gaba F, Gabe R, Sundar S, Wood N, Nicum S, Taylor A, Dobbs S, McCluggage WG, Nordin A, Legood R, Kehoe S, Ghaem-Maghami S, Manchanda R. Impact of Multiple COVID-19 Waves on Gynaecological Cancer Services in the UK. Cancers (Basel) 2023; 15:cancers15041273. [PMID: 36831615 PMCID: PMC9953843 DOI: 10.3390/cancers15041273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND This study aimed to assess the impact of multiple COVID-19 waves on UK gynaecological-oncology services. METHODS An online survey was distributed to all UK-British-Gynaecological-Cancer-Society members during three COVID-19 waves from 2020 to2022. RESULTS In total, 51 hospitals (including 32 cancer centres) responded to Survey 1, 42 hospitals (29 centres) to Survey 2, and 39 hospitals (30 centres) to Survey 3. During the first wave, urgent referrals reportedly fell by a median of 50% (IQR = 25-70%). In total, 49% hospitals reported reduced staffing, and the greatest was noted for trainee doctors, by a median of 40%. Theatre capacity was reduced by a median of 40%. A median of 30% of planned operations was postponed. Multidisciplinary meetings were completely virtual in 39% and mixed in 65% of the total. A median of 75% of outpatient consultations were remote. By the second wave, fewer hospitals reported staffing reductions, and there was a return to pre-pandemic urgent referrals and multidisciplinary workloads. Theatre capacity was reduced by a median of 10%, with 5% of operations postponed. The third wave demonstrated worsening staff reductions similar to Wave 1, primarily from sickness. Pre-pandemic levels of urgent referrals/workload continued, with little reduction in surgical capacity. CONCLUSION COVID-19 led to a significant disruption of gynaecological-cancer care across the UK, including reduced staffing, urgent referrals, theatre capacity, and working practice changes. Whilst disruption eased and referrals/workloads returned to normal, significant staff shortages remained in 2022, highlighting persistent capacity constraints.
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Affiliation(s)
- Samuel Oxley
- Wolfson Institute of Population Health, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - Ashwin Kalra
- Wolfson Institute of Population Health, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - Michail Sideris
- Wolfson Institute of Population Health, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - Nicole Itzkowitz
- Wolfson Institute of Population Health, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Olivia Evans
- Wolfson Institute of Population Health, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - Emma Christine Atakpa
- Wolfson Institute of Population Health, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Adam R. Brentnall
- Wolfson Institute of Population Health, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Nina Dworschak
- Wolfson Institute of Population Health, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Faiza Gaba
- Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Rhian Gabe
- Wolfson Institute of Population Health, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Sudha Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Nick Wood
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
| | - Shibani Nicum
- Institute of Cancer Research, University College London, London WC1E 6DD, UK
| | | | - Stephen Dobbs
- Belfast City Hospital, Belfast Health and Social Care Trust, Belfast BT9 7AB, UK
| | - W. Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast BT12 6BA, UK
| | - Andy Nordin
- East Kent Gynaecological Oncology Centre, Queen Elizabeth the Queen Mother Hospital, Margate CT9 4AN, UK
| | - Rosa Legood
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Sean Kehoe
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Sadaf Ghaem-Maghami
- Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, UK
| | - Ranjit Manchanda
- Wolfson Institute of Population Health, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, Faculty of Population Health Sciences, University College London, London WC1V 6LJ, UK
- Department of Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India
- Correspondence:
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19
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Liu R, Weldon CB, Linehan E, Gordon N, Abbe T, Hennings M, James H, Katzel J, Ng C, Tomita M, Velotta JB, Ossowski S, Sakoda LC, Sprague SL, Dowling A, Beringer K, Ravelo A, Yu E, Trosman JR. Fostering a High-Functioning Team in Cancer Care Using the 4R Oncology Model: Assessment in a Large Health System and a Blueprint for Other Institutions. JCO Oncol Pract 2023; 19:e125-e137. [PMID: 36178937 PMCID: PMC10166419 DOI: 10.1200/op.22.00287] [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: 04/27/2022] [Accepted: 07/20/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Delivering cancer care by high-functioning multidisciplinary teams promises to address care fragmentation, which threatens care quality, affects patient outcomes, and strains the oncology workforce. We assessed whether the 4R Oncology model for team-based interdependent care delivery and patient self-management affected team functioning in a large community-based health system. METHODS 4R was deployed at four locations in breast and lung cancers and assessed along four characteristics of high-functioning teams: recognition as a team internally and externally; commitment to an explicit shared goal; enablement of interdependent work to achieve the goal; and engagement in regular reflection to adapt objectives and processes. RESULTS We formed an internally and externally recognized team of 24 specialties committed to a shared goal of delivering multidisciplinary care at the optimal time and sequence from a patient-centric viewpoint. The team conducted 40 optimizations of interdependent care (22 for breast, seven for lung, and 11 for both cancers) at four points in the care continuum and established an ongoing teamwork adaptation process. Half of the optimizations entailed low effort, while 30% required high level of effort; 78% resulted in improved process efficiency. CONCLUSION 4R facilitated development of a large high-functioning team and enabled 40 optimizations of interdependent care along the cancer care continuum in a feasible way. 4R may be an effective approach for fostering high-functioning teams, which could contribute to improving viability of the oncology workforce. Our intervention and taxonomy of results serve as a blueprint for other institutions motivated to strengthen teamwork to improve patient-centered care.
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Affiliation(s)
- Raymond Liu
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Christine B. Weldon
- Center for Business Models in Healthcare, Glencoe, IL
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Elizabeth Linehan
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
| | - Nancy Gordon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Thea Abbe
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
| | - Marti Hennings
- Department of Hematology Oncology, The Permanente Medical Group, Modesto, CA
| | - Henie James
- Department of Hematology Oncology, The Permanente Medical Group, Oakland, CA
| | - Jed Katzel
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
| | - Chun Ng
- Department of Hematology Oncology, The Permanente Medical Group, Modesto, CA
| | - Megumi Tomita
- Department of Hematology Oncology, The Permanente Medical Group, Modesto, CA
| | - Jeffrey B. Velotta
- Department of Hematology Oncology, The Permanente Medical Group, Oakland, CA
| | - Stephanie Ossowski
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
| | - Lori C. Sakoda
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Anna Dowling
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
| | - Kimberly Beringer
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
| | | | - Elaine Yu
- Genentech, Inc, South San Francisco, CA
| | - Julia R. Trosman
- Center for Business Models in Healthcare, Glencoe, IL
- Feinberg School of Medicine, Northwestern University, Chicago, IL
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Saatcioglu F, Cirit B, Koprucu Suzer G. The Promise of Well-Being Interventions to Mitigate Physician Burnout During the COVID-19 Pandemic and Beyond. JCO Oncol Pract 2022; 18:808-814. [PMID: 36162039 DOI: 10.1200/op.22.00108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The high degree of burnout in physicians, including oncologists, is detrimental to physicians themselves, their families, patients, health care organizations, and the health care systems as a whole. This dire situation has significantly worsened during the COVID-19 pandemic. It is well established that both organizational and individual measures are urgently needed to mitigate the negative consequences of physician burnout. Here, we review the research that has begun to indicate potential evidence-based individual approaches to promote physician well-being. We give an overview of these emerging programs and their importance, provide an example from our own experience, and enumerate considerations for future research. We also discuss the need for developing new approaches that are evidence-based and the best ways in which they can be incorporated in the health care setting. When judiciously combined with organizational approaches, preferentially as an integral part of them, individual wellness programs for physicians are poised to contribute significantly toward the much needed relief from physician burnout.
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Affiliation(s)
| | - Burcu Cirit
- University of Health Sciences, Ataturk Chest Diseases Education and Research Hospital, Ankara, Turkey
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21
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Peppercorn J. Don't Stop Believing. JCO Oncol Pract 2022; 18:683-684. [DOI: 10.1200/op.22.00561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Quek CWN, Ong RRS, Wong RSM, Chan SWK, Chok AKL, Shen GS, Teo AYT, Panda A, Burla N, Wong YA, Chee RCH, Loh CYL, Lee KW, Tan GHN, Leong REJ, Koh NSY, Ong YT, Chin AMC, Chiam M, Lim C, Zhou XJ, Ong SYK, Ong EK, Krishna LKR. Systematic scoping review on moral distress among physicians. BMJ Open 2022; 12:e064029. [PMID: 36691160 PMCID: PMC9442489 DOI: 10.1136/bmjopen-2022-064029] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/15/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Concepts of moral distress (MD) among physicians have evolved and extend beyond the notion of psychological distress caused by being in a situation in which one is constrained from acting on what one knows to be right. With many accounts involving complex personal, professional, legal, ethical and moral issues, we propose a review of current understanding of MD among physicians. METHODS A systematic evidence-based approach guided systematic scoping review is proposed to map the current concepts of MD among physicians published in PubMed, Embase, PsycINFO, Web of Science, SCOPUS, ERIC and Google Scholar databases. Concurrent and independent thematic and direct content analysis (split approach) was conducted on included articles to enhance the reliability and transparency of the process. The themes and categories identified were combined using the jigsaw perspective to create domains that form the framework of the discussion that follows. RESULTS A total of 30 156 abstracts were identified, 2473 full-text articles were reviewed and 128 articles were included. The five domains identified were as follows: (1) current concepts, (2) risk factors, (3) impact, (4) tools and (5) interventions. CONCLUSIONS Initial reviews suggest that MD involves conflicts within a physician's personal beliefs, values and principles (personal constructs) caused by personal, ethical, moral, contextual, professional and sociocultural factors. How these experiences are processed and reflected on and then integrated into the physician's personal constructs impacts their self-concepts of personhood and identity and can result in MD. The ring theory of personhood facilitates an appreciation of how new experiences create dissonance and resonance within personal constructs. These insights allow the forwarding of a new broader concept of MD and a personalised approach to assessing and treating MD. While further studies are required to test these findings, they offer a personalised means of supporting a physician's MD and preventing burn-out.
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Affiliation(s)
- Chrystie Wan Ning Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ryan Rui Song Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ruth Si Man Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Sarah Wye Kit Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Amanda Kay-Lyn Chok
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Grace Shen Shen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Andrea York Tiang Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Aiswarya Panda
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Neha Burla
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yu An Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ryan Choon Hoe Chee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Caitlin Yuen Ling Loh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Kun Woo Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Gabrielle Hui Ning Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ryan Emmanuel Jian Leong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Natalie Song Yi Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | | | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Singapore
| | - Xuelian Jamie Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Simon Yew Kuang Ong
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
- Centre of Biomedical Ethics, National University of Singapore, Singapore
- The Palliative Care Centre for Excellence in Research and Education, Singapore
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Braun M, Naor L, Hasson-Ohayon I, Goldzweig G. Oncologists’ Locus of Control, Compassion Fatigue, Compassion Satisfaction, and the Mediating Role of Helplessness. Curr Oncol 2022; 29:1634-1644. [PMID: 35323337 PMCID: PMC8947102 DOI: 10.3390/curroncol29030137] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/18/2022] [Accepted: 03/01/2022] [Indexed: 01/22/2023] Open
Abstract
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.
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Affiliation(s)
- Michal Braun
- Oncology Breast Unit, Sharett Institute of Oncology, Hadassah Medical Center, Jerusalem 9574401, Israel
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Yaffo 6818211, Israel; (L.N.); (G.G.)
- Correspondence:
| | - Lee Naor
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Yaffo 6818211, Israel; (L.N.); (G.G.)
| | | | - Gil Goldzweig
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Yaffo 6818211, Israel; (L.N.); (G.G.)
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24
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Maintaining and Advancing Quality Cancer Care During a Global Pandemic. Cancer J 2022; 28:134-137. [PMID: 35333499 PMCID: PMC9158732 DOI: 10.1097/ppo.0000000000000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
The care of patients with cancer occurs in a fast-moving, high-pressure, and high-stakes ecosystem. Early in 2020, that complex ecosystem was further complicated by the advent of the COVID-19 pandemic. We address actions taken by care providers and systems during the initial phases of the pandemic, and how those actions preserved lifesaving and life-sustaining cancer care despite severely constrained resources. We outline cancer care principles and guidelines that were developed, shared, and adopted by cancer care organizations across the country. Care delivery concerns that arose during the pandemic, including equipment and personnel shortages, moral distress for care providers, and exacerbation of health care inequities are addressed. Process and operations changes taken by payers to serve their clients are described. Lessons learned are highlighted, along with a call to action that we learn from the experience, broaden our cancer care delivery mission, and commit to structural changes that will permanently improve the capacity of cancer care teams.
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Abstract
Moral distress has been well reviewed in the literature with established deleterious side effects for all healthcare professionals, including nurses, physicians, and others. Yet, little is known about the quality and effectiveness of interventions directed to address moral distress. The aim of this integrative review is to analyze published intervention studies to determine their efficacy and applicability across hospital settings. Of the initial 1373 articles discovered in October 2020, 18 were appraised as relevant, with 1 study added by hand search and 2 after a repeated search was completed in January and then in May of 2021, for a total of 22 reviewed articles. This review revealed data mostly from nurses, with some studies making efforts to include other healthcare professions who have experienced moral distress. Education-based interventions showed the most success, though many reported limited power and few revealed statistically lowered moral distress post intervention. This may point to the difficulty in adequately addressing moral distress in real time without adequate support systems. Ultimately, these studies suggest potential frameworks which, when bolstered by organization-wide support, may aid in moral distress interventions making a measurable impact.
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26
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Epstein RM, Marshall F, Sanders M, Krasner MS. Effect of an Intensive Mindful Practice Workshop on Patient-Centered Compassionate Care, Clinician Well-Being, Work Engagement, and Teamwork. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:19-27. [PMID: 34459443 DOI: 10.1097/ceh.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Mindfulness-based interventions for health professionals have been linked to improvements in burnout, well-being, empathy, communication, patient-centered care, and patient safety, but the optimal formats and intensity of training have been difficult to determine because of the paucity of studies and the heterogeneity of programs. A 4-days residential "Mindful Practice" workshop for physicians and medical educators featuring contemplative practices, personal narratives, and appreciative dialogs about challenging experiences may hold promise in improving participants' well-being while also improving compassionate care, job satisfaction, work engagement, and teamwork. METHODS We collected baseline and 2-month follow-up data during four workshops conducted in 2018 to 2019 at conference centers in the United States and Europe. Primary outcomes were burnout, work-related distress, job satisfaction, work engagement, patient-centered compassionate care, and teamwork. RESULTS Eighty-five of 120 participants (71%) completed both surveys (mean age was 49.3 and 68.2% female). There were improvements (P < .01) in two of three burnout components (emotional exhaustion and depersonalization), work-related distress, job satisfaction, patient-centered compassionate care, work engagement and meaning, teamwork, well-being, positive emotion, mindfulness, somatic symptoms, and spirituality. Effect sizes (standardized mean difference of change) ranged from 0.25 to 0.61. With Bonferroni adjustments (P < .0031), teamwork, general well-being, and mindfulness became nonsignificant. DISCUSSION An intensive, multiday, mindfulness-based workshop for physicians had clinically significant positive effects on clinician well-being, quality of interpersonal care and work satisfaction, and meaning and engagement, all important indicators of improved health and sustainability of the health care workforce. Future iterations of the program should increase the focus on teamwork.
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Affiliation(s)
- Ronald M Epstein
- Mr. Epstein: Professor of Family Medicine, Oncology and Medicine (Palliative Care), and American Cancer Society's Clinical Research Professor, Codirector, Center for Communication and Disparities Research, Departments of Family Medicine and Medicine and the Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY. Mr. Marshall: Professor, Department of Neurology, Division of Geriatric Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY. Mr. Sanders: Senior Instructor, Department of Family Medicine, Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, NY. Mr. Krasner: Professor of Clinical Medicine and Clinical Family Medicine, Departments Medicine and Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
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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: 10] [Impact Index Per Article: 3.3] [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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Zimmaro LA, Moss A, Reibel DK, Handorf EA, Reese JB, Fang CY. A Telephone-Adapted Mindfulness-Based Stress Reduction Program: Preliminary Effects among Healthcare Employees. Behav Sci (Basel) 2021; 11:139. [PMID: 34677232 PMCID: PMC8533574 DOI: 10.3390/bs11100139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022] Open
Abstract
Healthcare employees often experience high stress and may benefit from accessible psychosocial interventions. In this pilot study, we explored preliminary feasibility, acceptability, and psychological effects of a telephone-based adaption of mindfulness-based stress reduction (MBSR) for healthcare employees. Eleven participants (M age = 49.9; 27.3% ethnic/racial minority) were enrolled in an eight-session group-based MBSR program adapted for telephone delivery. Feasibility was assessed using rates of program attrition and session completion; acceptability was explored qualitatively via participants' responses to an open-ended item about their program experience. Participants also completed pre-and post-program assessments on psychosocial outcomes (distress (overall distress, depression, anxiety, somatization), mindfulness, and self-compassion). We characterized mean change scores, 95% confidence intervals, and effect sizes to explore preliminary program effects. With regard to preliminary feasibility, one participant dropped out prior to the intervention; of the remaining 10 participants, 90% completed at least half (≥4) of the sessions; 70% completed at least three-quarters (≥6 sessions). Feedback reflected positive experiences and included suggestions for program delivery. Participants reported reductions in distress post-program (M difference range = -5.0 to -9.4), showing medium to large effect sizes (d range = 0.68 to 1.11). Mindfulness scores increased from pre- to post-intervention (M difference range = 1.0 to 10.4), with small-to-medium effects (d range = 0.18 to 0.55). Almost all aspects of self-compassion remained stable over time, with the exception of common humanity, which increased post-program (M difference = 2.9, CI 95% 0.5 to 5.4, d = 0.91). Preliminary findings from our small pilot trial suggest that telephone-based adaptations of MBSR may be a useful mode of delivery for healthcare employees; however, larger studies are needed to provide further evidence of feasibility, acceptability, and program effects.
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Affiliation(s)
- Lauren A. Zimmaro
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (L.A.Z.); (E.A.H.); (J.B.R.)
| | - Aleeze Moss
- Myrna Brind Center for Mindfulness, Marcus Institute of Integrative Health—Jefferson Health, Department of Integrative Medicine and Nutritional Sciences, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.M.); (D.K.R.)
| | - Diane K. Reibel
- Myrna Brind Center for Mindfulness, Marcus Institute of Integrative Health—Jefferson Health, Department of Integrative Medicine and Nutritional Sciences, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.M.); (D.K.R.)
| | - Elizabeth A. Handorf
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (L.A.Z.); (E.A.H.); (J.B.R.)
| | - Jennifer B. Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (L.A.Z.); (E.A.H.); (J.B.R.)
| | - Carolyn Y. Fang
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (L.A.Z.); (E.A.H.); (J.B.R.)
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Moral Distress Among Interdisciplinary Critical Care Team Members at a Comprehensive Cancer Center. Dimens Crit Care Nurs 2021; 40:301-307. [PMID: 34398568 DOI: 10.1097/dcc.0000000000000490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Moral distress (MD) has been linked to health care professional burnout, intent to leave, and decreased quality of care. OBJECTIVES The aim of this study was to describe the perceptions of MD among critical care interdisciplinary team members and assess the association of MD with team member characteristics. METHODS A descriptive cross-sectional design was used with interdisciplinary team members in an intensive care unit setting at an NCI-designated Comprehensive Cancer Center in the southeastern United States. The Measure of Moral Distress for Healthcare Professionals was provided to registered nurses, oncology technicians, providers, respiratory therapists, and ancillary team members (social workers, pharmacists, dietitians). RESULTS A total of 67 team members completed the survey. Mean responses for 3 items were higher than 8 (halfway point of scale): "Follow family's insistence to continue aggressive treatment even though I believe it is not in the best interest of patient" (mean [SD], 11.4 [4.8]); "Continue to provide aggressive treatment for a patient most likely to die regardless of this treatment when no one will make a decision to withdraw it" (mean [SD], 10.5 [5.3]); and "Witness providers giving 'false hope' to patient/family" (mean [SD], 9.0 [5.3]). Higher responses on the "Continuing to provide aggressive treatment" item was associated with having "considered leaving due to MD" (P = .027) and "considering leaving now due to MD" (P = .016). Higher total scores were related to having left or considered leaving a job (P = .04). When examining education level, registered nurses with a master's degree (n = 5) exhibited the most MD (P = .04). CONCLUSION This study suggests that the Measure of Moral Distress for Healthcare Professionals is useful in identifying areas for focused efforts at reducing MD for interdisciplinary teams.
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Advancing Measurement of the Sources and Consequences of Burnout in a Comprehensive Cancer Center: A Structural Equation Modeling Analysis. Am J Med Qual 2021; 37:95-102. [PMID: 34310378 DOI: 10.1097/01.jmq.0000743676.35805.c0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Burnout is endemic among oncology clinicians and impacts quality of care. In order to develop institutional strategies to address burnout, psychometrically sensitive measurement within local cancer organizations is necessary to identify embedded causes of burnout and resulting effects. The authors administered the Mini-Z burnout survey to clinicians and staff (n = 160) at a National Cancer Institute-designated comprehensive cancer center. Structural equation modeling was used to examine workplace stressors that predicted burnout, and the pathway between burnout and 2 meaningful quality outcomes was tested: (1) lack of compassion and (2) thoughts of leaving one's job or specialty. Females and advanced practice practitioners had the highest prevalence of burnout. The structural equation model achieved excellent model fit, and indicated that workplace atmosphere, control over workload, values alignment, time for documentation, and team efficiency underlie burnout in this sample. The pathways from burnout to lack of compassion and to thoughts of leaving one's job were significant.
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Guan T, Nelson K, Otis-Green S, Rayton M, Schapmire T, Wiener L, Zebrack B. Moral Distress Among Oncology Social Workers. JCO Oncol Pract 2021; 17:e947-e957. [PMID: 34252313 DOI: 10.1200/op.21.00276] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Literature on moral distress among oncology social workers (OSWs) is sparse. The aim of the current study was to examine the prevalence of moral distress and its domains of influence, and to identify demographic and work-related characteristics associated with moral distress among OSWs. METHODS Data came from the Oncology Social Work Competencies, Opportunities, Roles, and Expertise survey, conducted from August to September 2020 (during the COVID-19 global pandemic). Data collected included demographic information (eg, age, sex, and race) and work-related characteristics (eg, job position, organization type, work setting, employment status, salary, years in the profession, and OSW-C certification). Moral distress was measured using the Measure of Moral Distress for Healthcare Professionals. Tests of association, including multivariate linear regression, were conducted to achieve the research aims. RESULTS Total moral distress scores on the Measure of Moral Distress for Healthcare Professionals (range 0-432) for 745 OSWs ranged from 1 to 273, with an average score of 74.0. The three highest indicators of moral distress were observed in the patient or family experience domain. Higher levels of moral distress were associated with younger age, being a direct service provider, provision of inpatient cancer care, and more years in the profession. CONCLUSION OSWs are experiencing moral distress. Institutional investments in professional education and support of OSWs are needed to mitigate and possibly prevent moral distress experienced by cancer care providers and thus ensure the delivery of quality psychosocial care for patients with cancer and their families.
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Affiliation(s)
- Ting Guan
- University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, NC
| | | | | | | | - Tara Schapmire
- University of Louisville School of Medicine, Louisville, KY
| | - Lori Wiener
- National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD
| | - Brad Zebrack
- University of Michigan School of Social Work, Ann Arbor, MI
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Hlubocky FJ, Back AL, Shanafelt TD, Gallagher CM, Burke JM, Kamal AH, Paice JA, Page RD, Spence R, McGinnis M, McFarland DC, Srivastava P. Occupational and Personal Consequences of the COVID-19 Pandemic on US Oncologist Burnout and Well-Being: A Study From the ASCO Clinician Well-Being Task Force. JCO Oncol Pract 2021; 17:e427-e438. [PMID: 34152789 DOI: 10.1200/op.21.00147] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic is an unprecedented global crisis profoundly affecting oncology care delivery. PURPOSE This study will describe the occupational and personal consequences of the COVID-19 pandemic on oncologist well-being and patient care. MATERIALS AND METHODS Four virtual focus groups were conducted with US ASCO member oncologists (September-November 2020). Inquiry and subsequent discussions centered on self-reported accounts of professional and personal COVID-19 experiences affecting well-being, and oncologist recommendations for well-being interventions that the cancer organization and professional societies (ASCO) might implement were explored. Qualitative interviews were analyzed using Framework Analysis. RESULTS Twenty-five oncologists were interviewed: median age 44 years (range: 35-69 years), 52% female, 52% racial or ethnic minority, 76% medical oncologists, 64% married, and an average of 51.5 patients seen per week (range: 20-120). Five thematic consequences emerged: (1) impact of pre-COVID-19 burnout, (2) occupational or professional limitations and adaptations, (3) personal implications, (4) concern for the future of cancer care and the workforce, and (5) recommendations for physician well-being interventions. Underlying oncologist burnout exacerbated stressors associated with disruptions in care, education, research, financial practice health, and telemedicine. Many feared delays in cancer screening, diagnosis, and treatment. Oncologists noted personal and familial stressors related to COVID-19 exposure fears and loss of social support. Many participants strongly considered working part-time or taking early retirement. Yet, opportunities arose to facilitate personal growth and rise above pandemic adversity, fostering greater resilience. Recommendations for organizational well-being interventions included psychologic or peer support resources, flexible time-off, and ASCO and state oncology societies involvement to develop care guidelines, well-being resources, and mental health advocacy. CONCLUSION Our study suggests that the COVID-19 pandemic has adversely affected oncologist burnout, fulfillment, practice health, cancer care, and workforce. It illuminates where professional organizations could play a significant role in oncologist well-being.
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Affiliation(s)
- Fay J Hlubocky
- Section Hematology/Oncology, Department of Medicine, Maclean Center for Clinical Medical Ethics, University of Chicago Medicine, Chicago, IL
| | - Anthony L Back
- Department of Medicine/Oncology, University of Washington, Seattle, WA
| | - Tait D Shanafelt
- VA Palo Alto Health Care System, Stanford University, Palo Alto, CA
| | - Colleen M Gallagher
- Section of Integrated Ethics in Cancer Care, The University of Texas MD Anderson Cancer Center, Houston, TX.,Research Scholar, UNESCO Chair for Bioethics and Human Rights
| | | | - Arif H Kamal
- Population Health Sciences, Duke Cancer Institute, Duke University, Durham, NC
| | - Judith A Paice
- Division Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ray D Page
- The Center for Cancer and Blood Disorders, Fort Worth, TX
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Hlubocky FJ, Shanafelt TD, Back AL, Paice JA, Tetzlaff ED, Friese CR, Kamal AH, McFarland DC, Lyckholm L, Gallagher CM, Chatwal M, Saltzman J, Dudzinski D, Burke JM, James TA, Page RD, Boyle DA, Gonzalez MM, Srivastava P. Creating a Blueprint of Well-Being in Oncology: An Approach for Addressing Burnout From ASCO's Clinician Well-Being Taskforce. Am Soc Clin Oncol Educ Book 2021; 41:e339-e353. [PMID: 34061565 DOI: 10.1200/edbk_320873] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Optimizing the well-being of the oncology clinician has never been more important. Well-being is a critical priority for the cancer organization because burnout adversely impacts the quality of care, patient satisfaction, the workforce, and overall practice success. To date, 45% of U.S. ASCO member medical oncologists report experiencing burnout symptoms of emotional exhaustion and depersonalization. As the COVID-19 pandemic remains widespread with periods of outbreaks, recovery, and response with substantial personal and professional consequences for the clinician, it is imperative that the oncologist, team, and organization gain direct access to resources addressing burnout. In response, the Clinician Well-Being Task Force was created to improve the quality, safety, and value of cancer care by enhancing oncology clinician well-being and practice sustainability. Well-being is an integrative concept that characterizes quality of life and encompasses an individual's work- and personal health-related environmental, organizational, and psychosocial factors. These resources can be useful for the cancer organization to develop a well-being blueprint: a detailed start plan with recognized strategies and interventions targeting all oncology stakeholders to support a culture of community in oncology.
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Affiliation(s)
- Fay J Hlubocky
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medicine, Chicago, IL
| | | | - Anthony L Back
- Seattle Cancer Care, University of Washington, Seattle, WA
| | - Judith A Paice
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Eric D Tetzlaff
- Department of Hematology Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | | | | | - Laurie Lyckholm
- Division of Hematology Oncology, University of Iowa, Iowa City, IA
| | | | | | - Joel Saltzman
- Lake Health, University Hospitals, Seidman Cancer Center, Mentor, OH
| | | | | | - Ted A James
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - Ray D Page
- The Center for Cancer and Blood Disorders, Fort Worth, TX
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DeBoer RJ, Mutoniwase E, Nguyen C, Ho A, Umutesi G, Nkusi E, Sebahungu F, Van Loon K, Shulman LN, Shyirambere C. Moral Distress and Resilience Associated with Cancer Care Priority Setting in a Resource-Limited Context. Oncologist 2021; 26:e1189-e1196. [PMID: 33969927 PMCID: PMC8265342 DOI: 10.1002/onco.13818] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/05/2021] [Indexed: 12/24/2022] Open
Abstract
Background Moral distress and burnout are highly prevalent among oncology clinicians. Research is needed to better understand how resource constraints and systemic inequalities contribute to moral distress in order to develop effective mitigation strategies. Oncology providers in low‐ and middle‐income countries are well positioned to provide insight into the moral experience of cancer care priority setting and expertise to guide solutions. Methods Semistructured interviews were conducted with a purposive sample of 22 oncology physicians, nurses, program leaders, and clinical advisors at a cancer center in Rwanda. Interviews were recorded, transcribed verbatim, and analyzed using the framework method. Results Participants identified sources of moral distress at three levels of engagement with resource prioritization: witnessing program‐level resource constraints drive cancer disparities, implementing priority setting decisions into care of individual patients, and communicating with patients directly about resource prioritization implications. They recommended individual and organizational‐level interventions to foster resilience, such as communication skills training and mental health support for clinicians, interdisciplinary team building, fair procedures for priority setting, and collective advocacy for resource expansion and equity. Conclusion This study adds to the current literature an in‐depth examination of the impact of resource constraints and inequities on clinicians in a low‐resource setting. Effective interventions are urgently needed to address moral distress, reduce clinician burnout, and promote well‐being among a critical but strained oncology workforce. Collective advocacy is concomitantly needed to address the structural forces that constrain resources unevenly and perpetuate disparities in cancer care and outcomes. Implications for Practice For many oncology clinicians worldwide, resource limitations constrain routine clinical practice and necessitate decisions about prioritizing cancer care. To the authors’ knowledge, this study is the first in‐depth analysis of how resource constraints and priority setting lead to moral distress among oncology clinicians in a low‐resource setting. Effective individual and organizational interventions and collective advocacy for equity in cancer care are urgently needed to address moral distress and reduce clinician burnout among a strained global oncology workforce. Lessons from low‐resource settings can be gleaned as high‐income countries face growing needs to prioritize oncology resources. Oncology providers in low‐ and middle‐income countries face resource priority setting decisions on a routine basis. This article describes the moral experience and recommendations of oncology clinicians, advisors, and program leaders engaged in clinical priority setting at a cancer center in Rwanda.
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Affiliation(s)
- Rebecca J DeBoer
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | | | - Cam Nguyen
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | - Anita Ho
- Program in Bioethics, University of California, San Francisco, California, USA.,University of British Columbia, Vancouver, Canada
| | - Grace Umutesi
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | - Eugene Nkusi
- Republic of Rwanda Ministry of Health, Kigali, Rwanda
| | | | - Katherine Van Loon
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Lawrence N Shulman
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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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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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: 43] [Impact Index Per Article: 14.3] [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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Prevalence of burnout among healthcare professionals at the Serbian National Cancer Center. Int Arch Occup Environ Health 2021; 94:669-677. [PMID: 33387030 DOI: 10.1007/s00420-020-01621-7] [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: 05/26/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the level of burnout and identify who is at highest risk among healthcare professionals (HCPs) working at the largest referent national institution. METHODS A cross-sectional survey was conducted at the Institute of Oncology and Radiology of Serbia from May 2019 to July 2019, evaluating the level of burnout, depression, fatigue, socio-demographic, behavioral and professional characteristics, and quality of life among healthcare professionals. Of the 576 distributed questionnaires among physicians, nurses/technicians and healthcare coworkers, 432 participants returned their questionnaires (75%). All instruments used in our study had been validated and cross-culturally adapted to Serbian language. RESULTS The overall prevalence of burnout was 42.4%, with the greatest proportion of burned out in emotional exhaustion domain (66.9%). The multivariable-adjusted model analysis showed that nurses/technicians had a 1.41 times greater chance of experiencing burnout, compared to physicians (OR = 1.41, 95% CI 1.16-7.10), and that with each year of work experience, the chance of burnout increased by about 2% (OR = 1.02, 95% CI 1.00-1.92). Furthermore, it was shown that, with each point in the PHQ-9 score for depression, probability of burnout increased by 14% (OR = 1.14, 95% CI 1.07-1.94). Finally, after controlling all these potential confounders, the Mental Composite Score of SF-36 score showed an independent prognostic value in exploring the burnout presence among HCPs (OR = 1.17, 95% CI 1.03-2.47). CONCLUSION Our research showed a significant level of burnout among healthcare professionals working in oncology, especially among nurses/technicians. The development of effective interventions at both individual and organizational level toward specific risk groups is needed.
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Pennell NA, Dillmon M, Levit LA, Moushey EA, Alva AS, Blau S, Cannon TL, Dickson NR, Diehn M, Gonen M, Gonzalez MM, Hensold JO, Hinyard LJ, King T, Lindsey SC, Magnuson A, Marron J, McAneny BL, McDonnell TM, Mileham KF, Nasso SF, Nowakowski GS, Oettel KR, Patel MI, Patt DA, Perlmutter J, Pickard TA, Rodriguez G, Rosenberg AR, Russo B, Szczepanek C, Smith CB, Srivastava P, Teplinsky E, Thota R, Traina TA, Zon R, Bourbeau B, Bruinooge SS, Foster S, Grubbs S, Hagerty K, Hurley P, Kamin D, Phillips J, Schenkel C, Schilsky RL, Burris HA. American Society of Clinical Oncology Road to Recovery Report: Learning From the COVID-19 Experience to Improve Clinical Research and Cancer Care. J Clin Oncol 2020; 39:155-169. [PMID: 33290128 DOI: 10.1200/jco.20.02953] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This report presents the American Society of Clinical Oncology's (ASCO's) evaluation of the adaptations in care delivery, research operations, and regulatory oversight made in response to the coronavirus pandemic and presents recommendations for moving forward as the pandemic recedes. ASCO organized its recommendations for clinical research around five goals to ensure lessons learned from the COVID-19 experience are used to craft a more equitable, accessible, and efficient clinical research system that protects patient safety, ensures scientific integrity, and maintains data quality. The specific goals are: (1) ensure that clinical research is accessible, affordable, and equitable; (2) design more pragmatic and efficient clinical trials; (3) minimize administrative and regulatory burdens on research sites; (4) recruit, retain, and support a well-trained clinical research workforce; and (5) promote appropriate oversight and review of clinical trial conduct and results. Similarly, ASCO also organized its recommendations regarding cancer care delivery around five goals: (1) promote and protect equitable access to high-quality cancer care; (2) support safe delivery of high-quality cancer care; (3) advance policies to ensure oncology providers have sufficient resources to provide high-quality patient care; (4) recognize and address threats to clinician, provider, and patient well-being; and (5) improve patient access to high-quality cancer care via telemedicine. ASCO will work at all levels to advance the recommendations made in this report.
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Affiliation(s)
| | | | - Laura A Levit
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | - Sibel Blau
- Northwest Medical Specialties, Seattle, WA
| | | | | | | | - Mithat Gonen
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | - Tari King
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Todd A Pickard
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Barry Russo
- The Center for Cancer and Blood Disorders, Fort Worth, TX
| | | | | | | | | | | | | | - Robin Zon
- Michiana Hematology Oncology, Niles, MI
| | | | | | | | | | | | | | - Deborah Kamin
- American Society of Clinical Oncology, Alexandria, VA
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Thomaier L, Teoh D, Jewett P, Beckwith H, Parsons H, Yuan J, Blaes AH, Lou E, Hui JYC, Vogel RI. Emotional health concerns of oncology physicians in the United States: Fallout during the COVID-19 pandemic. PLoS One 2020; 15:e0242767. [PMID: 33232377 PMCID: PMC7685431 DOI: 10.1371/journal.pone.0242767] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Cancer care is significantly impacted by the Coronavirus Disease 2019 (COVID-19) pandemic. Our objective was to evaluate the early effects of the pandemic on the emotional well-being of oncology providers across the United States and explore factors associated with anxiety and depression symptoms. MATERIALS AND METHODS A cross-sectional survey was administered to United States cancer-care physicians recruited over a two-week period (3/27/2020-4/10/2020) using snowball-convenience sampling through social media. Symptoms of anxiety and depression were measured using the Patient Health Questionnaire (PHQ-4). RESULTS Of 486 participants, 374 (77.0%) completed the PHQ-4: median age was 43 years; 63.2% female; all oncologic specialties were represented. The rates of anxiety and depression symptoms were 62.0% and 23.5%, respectively. Demographic factors associated with anxiety included female sex, younger age, and less time in clinical practice. Perception of inadequate personal protective equipment (68.6% vs. 57.4%, p = 0.03) and practicing in a state with more COVID-19 cases (65.8% vs. 51.1%, p = 0.01) were associated with anxiety symptoms. Factors significantly associated with both anxiety and depression included the degree to which COVID-19 has interfered with the ability to provide treatment to cancer patients and concern that patients will not receive the level of care needed for non-COVID-19 illness (all p-values <0.01). CONCLUSION The perceived degree of interference with clinical practice along with personal concerns about COVID-19 were significantly associated with both anxiety and depression among oncology physicians in the United States during the COVID-19 pandemic. Our findings highlight factors associated with and sources of psychological distress to be addressed to protect the well-being of oncology physicians.
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Affiliation(s)
- Lauren Thomaier
- Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Deanna Teoh
- Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Patricia Jewett
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, United States of America
| | - Heather Beckwith
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, United States of America
| | - Helen Parsons
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, United States of America
| | - Jianling Yuan
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Anne H. Blaes
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, United States of America
| | - Emil Lou
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, United States of America
| | - Jane Yuet Ching Hui
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States of America
| | - Rachel I. Vogel
- Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
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Rosenberg AR, Barton K, Junkins C, Scott S, Bradford MC, Steineck A, Lau N, Comiskey L, Yi-Frazier JP. Creating a Resilient Research Program-Lessons Learned From a Palliative Care Research Laboratory. J Pain Symptom Manage 2020; 60:857-865. [PMID: 32621950 PMCID: PMC7328580 DOI: 10.1016/j.jpainsymman.2020.06.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 12/03/2022]
Abstract
Conducting palliative care research can be personally and professionally challenging. Although limitations in funding and training opportunities are well described, a less recognized barrier to successful palliative care research is creating a sustainable and resilient team. In this special report, we describe the experience and lessons learned in a single palliative care research laboratory. In the first few years of the program, 75% of staff quit, citing burnout and the emotional tolls of their work. To address our sustainability, we translated resilience theory to practice. First, we identified and operationalized shared mission and values. Next, we conducted a resilience resource needs assessment for both individual team members and the larger team as a whole and created a workshop-based curriculum to address unmet personal and professional support needs. Finally, we changed our leadership approach to foster psychological safety and shared mission. Since then, no team member has left, and the program has thrived. As the demand for rigorous palliative care research grows, we hope this report will provide perspective and ideas to other established and emerging palliative care research programs.
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Affiliation(s)
- Abby R Rosenberg
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, Washington, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.
| | - Krysta Barton
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Courtney Junkins
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Samantha Scott
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA; Department of Psychology, University of Denver, Denver, Colorado, USA
| | - Miranda C Bradford
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA; Children's Core for Biomedical Statistics, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Angela Steineck
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, Washington, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Nancy Lau
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, Washington, USA; Department of Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Liam Comiskey
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
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Thomaier L, Teoh D, Jewett P, Beckwith H, Parsons H, Yuan J, Blaes AH, Lou E, Hui JYC, Vogel RI. Emotional health concerns of oncology physicians in the United States: fallout during the COVID-19 pandemic. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 32587986 DOI: 10.1101/2020.06.11.20128702] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Cancer care is significantly impacted by the Coronavirus Disease 2019 (COVID-19) pandemic. Our objective was to evaluate the effect of the pandemic on the emotional well-being of oncology providers across the United States and explore factors associated with anxiety and depression symptoms. METHODS AND MATERIALS A cross-sectional survey was administered to United States cancer-care physicians recruited over a two-week period (3/27/2020-4/10/2020) using snowball-convenience sampling through social media. Symptoms of anxiety and depression were measured using the Patient Health Questionnaire (PHQ-4). RESULTS Of 486 participants, 374 (77.0%) completed the PHQ-4: mean age 45.7 +/- 9.6 years; 63.2% female; all oncologic specialties were represented. The rates of anxiety and depression symptoms were 62.0% and 23.5%, respectively. Demographic factors associated with anxiety included female sex, younger age, and less time in clinical practice. Perception of inadequate PPE (68.6% vs. 57.4%, p=0.03) and practicing in a state with more COVID-19 cases (65.8% vs. 51.1%, p=0.01) were associated with anxiety symptoms. Factors significantly associated with both anxiety and depression included: degree to which COVID-19 has interfered with the ability to provide treatment to cancer patients and concern that patients will not receive the level of care needed for non-COVID-19 illness (all p-values <0.01). CONCLUSION The prevalence of anxiety and depression symptoms among oncology physicians in the United States during the COVID-19 pandemic is high. Our findings highlight factors associated with and sources of psychological distress to be addressed to protect the well-being of oncology physicians.
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Shanafelt TD, Kamal AH, Hlubocky FJ. Promoting Oncologist Well-Being to Foster Delivery of Ethical, High-Quality Cancer Care: Priorities for 2020 and Beyond. JCO Oncol Pract 2020; 16:188-190. [DOI: 10.1200/op.20.00069] [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)
| | - Arif H. Kamal
- Duke Cancer Institute and Duke Fuqua School of Business, Durham, NC
| | - Fay J. Hlubocky
- The University of Chicago Medicine, Department of Medicine, Section of Hematology/Oncology, MacLean Center for Clinical Medical Ethics, Cancer Research Center, Supportive Oncology Program, Chicago, IL,
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