Combating Compassion Fatigue and Burnout in Cancer Care

Linda Emanuel, MD, PhD; Frank D. Ferris, MD, FAAPHM; Charles F. von Gunten, MD, PhD; Jaime H. Von Roenn, MD

Disclosures

June 06, 2011

In This Article

How Common Are Burnout and Compassion Fatigue?

Several review articles have examined the literature related to compassion fatigue, caregiver stress, and burnout in health professionals caring for patients with cancer. The evidence suggests that prevalence rates for burnout, psychosocial distress, and compassion fatigue are high among oncology physicians and nurses, oncology social workers, hospice nurses, palliative care physicians, and allied health professionals working with cancer patients. Findings are similar in several countries, including Great Britain, Canada, and the United States.[7,8,9]

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In a large study of stress among oncologists, 56% of subscribers to the Journal of Clinical Oncology reported experiencing burnout in their professional lives.[10]Burnout was measured using an investigator-constructed questionnaire, as opposed to the Maslach Burnout Inventory, which is typically used to measure burnout.[11]When asked to define the specific nature of their burnout, 56% of respondents mentioned frustration or a sense of failure; 34% cited depression; 20% said disinterest in practice; and 18% blamed boredom. Almost 50% believed that burnout was inherent to the practice of oncology. Institution- or university-based oncologists on salary reported a lower incidence of burnout (47%) than those in private adult oncology practice (63%).

Still other studies by Graham and Ramirez have found prevalence rates on 3 dimensions of burnout from 13% to 38%, with an estimated prevalence of psychiatric diagnoses among oncologists of 28%.[12]

Another study of 395 head and neck surgeons, also using an investigator-constructed questionnaire, found that 34% of respondents reported feeling burned out, 27% indicated frustration with disease, 67% indicated frustration with government, and 58% indicated frustration with the economics of medical practice.[13]

In the United Kingdom, the percentage of clinicians reporting high levels of exhaustion on the Maslach Burnout Inventory was similar to that of the normative sample (31% vs 33%, respectively).[14,15]Among both the cancer clinicians and the normative sample, 33% reported a sense of low personal accomplishment. Significantly fewer of the UK cancer clinicians reported high levels of depersonalization compared with the US sample (23% vs 33%, respectively). In general, North Americans reported higher levels of burnout than did Europeans.[1]

In a study by Cancer Care Ontario, the comparable figure for physician exhaustion was 53.3%; for allied health professionals, 37.1%; and for support staff, 30.5%. Almost half (49%) of physicians reported having low feelings of personal accomplishment, as did 54% of allied health professionals and 31.4% of support staff.[16]The feelings of depersonalization in the Canadian group were similar to those of the UK sample, with 22.1% of physicians (vs 4.3% of allied health personnel and 5.5% of support staff) reporting feelings of depersonalization. These figures may be unique to Ontario, or may indicate an increase in stress in oncology partly as a result of ever-increasing workloads and limited resources.

A study of oncologists, housestaff, and oncology nurses from Memorial-Sloan Kettering Cancer Center reported that housestaff experienced the most burnout, emotional exhaustion, feeling of emotional distance from patients, and a poorer sense of personal accomplishment.[17] Nurses reported more physical symptoms than housestaff or oncologists; however, they were less emotionally distant from patients.

Potter and coworkers[19] investigated the prevalence of compassion fatigue and burnout among oncology nurses, using the Professional Quality of Life Revised, version IV (ProQOL R-IV) scale, a commonly used instrument for measuring the positive and negative effects of working with people who have experienced extremely stressful events [20]. It consists of 3 subscales, measuring compassion satisfaction, compassion fatigue, and burnout. Among the 153 respondents (mostly registered nurses [RNs]), staff working on inpatient nursing units had the highest percentage of high-risk compassion satisfaction scores. High-risk scores for compassion fatigue were equal among inpatient and outpatient staff (37% and 35% respectively); but 44% of inpatient staff (vs 33% of outpatient staff, a non-significant difference) were at high risk for burnout. Other studies of oncology nurses found between 37% and 47% reporting high emotional exhaustion, 11%-47% reporting high depersonalization, and 20%-55% experiencing low personal accomplishment.

Simon[21] examined the prevalence of secondary traumatic stress among oncology social workers, and found that they experienced compassion fatigue and burnout, which was inversely related to compassion satisfaction and that empathy was compromised by compassion fatigue.

Some studies[22,23,24] seem to indicate that hospice and palliative care physicians and nurses fare better than their oncology associates when it comes to compassion fatigue and burnout, whereas other studies dispute this. In studying hospice nurses, Abendroth and Flannery[25] found 80% to be at moderate to high risk for compassion fatigue.

Taken together, these studies illustrate that healthcare providers caring for persons with cancer (physicians, nurses, social workers, and others), experience significant rates of compassion fatigue and burnout.

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