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

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In This Article

Models of Burnout

Recent research has focused on the degree of match or mismatch between the individual and 6 domains of the job environment.[1]The greater the gap or mismatch between the person and the environment, the greater the likelihood of burnout. The greater the match or fit, the greater the likelihood of engagement with work. Mismatches arise when the process of establishing a psychological contract leaves critical issues unresolved, or when the working relationship becomes unacceptable to the individual. Mismatches lead to burnout.

The following 6 areas of work life come together in a framework that encompasses the major organizational antecedents of burnout:

  1. Workload

  2. Community

  3. Control

  4. Fairness

  5. Reward

  6. Values

Burnout arises from chronic imbalances between a person's expectations or needs and work life in some or all of these areas. Preliminary evidence suggests that the area of "values" may play a central mediating role for the other areas. Alternatively, people may vary in the extent to which each of the 6 areas is important to them. Some people place a higher weight on rewards than on values; others may be prepared to tolerate a mismatch with respect to workload if they receive praise, and good pay, and have good relationships with colleagues.

Job Engagement and Burnout

Some studies have looked at sources of satisfaction among oncologists. These include dealing well with patients and relatives, having professional status and esteem, deriving intellectual satisfaction, and having adequate resources to perform one’s role.[14,38]

Job engagement is conceptualized as being the opposite of burnout. Job engagement represents the individual's relationship with work, and encompasses energy, involvement, and efficacy. It involves a sustainable workload, feelings of choice and control, appropriate recognition and reward, a supportive work community, fairness and justice, and meaningful and valued work. Engagement is also characterized by high levels of activation and pleasure.[1]Engagement is a persistent, positive-affective-motivational state of fulfillment in employees that is characterized by vigor, dedication, and absorption.[1]

Burnout and Depression

In contrast to depression, which tends to pervade every domain of a person's life, burnout is a problem that is specific to the work context. However, individuals who are prone to depression (as indicated by higher scores of neuroticism) are more vulnerable to burnout.[1]

Burnout and depression can be differentiated.[39]A reduced sense of superiority and a perceived loss of status are more characteristic of depressed individuals than individuals who are burned out. It seems that burned-out individuals are still "in the battle" for obtaining status and consider themselves potential winners, whereas depressed individuals have "given up."[39]

Coping With Job Stress

A number of lifestyle management techniques may help reduce one's vulnerability to burnout.[31]In the study comparing physicians in The Netherlands and the United States, physicians' perceived control over their work conferred substantial benefit in minimizing stress and increasing satisfaction in both countries, and home support had remarkable benefits on stress reduction in the United States.[29]In both countries, work control was correlated with job stress and satisfaction, whereas work-home interference was associated with work hours, children, stress, dissatisfaction, and burnout.

Victimization and Trauma

In addition to the elements of burnout, compassion fatigue also involves elements of vicarious victimization or secondary trauma that are more akin to post-traumatic stress symptomatology, including fear, avoidance, intrusive thoughts, and sleep disturbances.[6]

Signs and Symptoms of Burnout

To prevent or address burnout early, monitor yourself for signs and symptoms of burnout (Table 1).

Table 1. Signs and Symptoms of Burnout

Boredom
Lower quality of care
Depression
Fatigue
Frustration
Gastrointestinal disturbances
Headaches
Insomnia
Staff turnover
Low morale
Physical/emotional exhaustion
Weight loss
Impaired job performance (decreased empathy, increased absenteeism)
Deterioration of physician-patient relationships
Less satisfaction, desire to reduce time spent seeing patients, greater likelihood
of ordering tests or procedures, greater interest in early retirement
Inability to leave work (working longer and longer hours), absenteeism, less job
satisfaction, lower sense of personal accomplishment

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