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


June 06, 2011

In This Article

Management of Burnout and Compassion Fatigue

A paucity of evidence-based interventions has been shown to be effective for either the prevention or the treatment of compassion fatigue or burnout in healthcare providers caring for persons with cancer. Preliminary investigations and anecdotal and empirical reports offer suggestions such as communication skills training, stress management workshops, self-care behavior coaching, individual counseling, mentoring programs, staff retreats, and sabbaticals.

One program that has been studied and found to be effective is the Accelerated Recovery Program (ARP), a 5-session copyrighted protocol developed to address the symptoms of compassion fatigue and burnout in caregivers.[41] A Certified Compassion Fatigue Specialist Training for ARP was developed, and found to be effective in reducing symptoms of compassion fatigue in participants who attended the train-the-trainer sessions.[42]

Another approach that has shown promise in small observational and a few controlled clinical trials is mindfulness-based stress reduction (MBSR). It combines mindfulness, meditation, and yoga in a structured 8-week program, and has been demonstrated to reduce stress, increase coping, and improve empathy in health professionals who complete the program. [43]Of interest, investigators studying individuals who have undergone MBSR training have identified, on whole brain analysis, increases in gray matter density in several areas of the brain, including the posterior cingulate cortex, the temporo-parietal junction, and the cerebellum, when compared with pre-intervention and controls.[44]

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Prevention and early detection are thought to be the best approaches to minimize the risk for serious consequences from burnout and compassion fatigue. A variety of lifestyle management techniques may help healthcare providers maintain balance in their lives and reduce the risk for burnout (Table 2).

Table 2. Lifestyle Management Techniques

Monitoring for and recognizing symptoms early
Maintaining good nutrition
Maintaining spiritual life; meditating; spending time in nature
Grieving losses effectively
Reducing overtime work
Exercising: aerobics, yoga, qi gong, tai chi
Maintaining energy: Reiki, healing touch, therapeutic touch
Maintaining a sense of humor
Seeking consultation if symptoms are severe
Discussing work-related stresses with others who share the same problems;
visiting counterparts in other institutions; looking for new solutions to problems

Meier and colleagues[45] recently proposed an approach to physician awareness that involves identifying and working with emotions that can affect patient care. Although originally proposed with the physician in mind, the approach has applicability to other healthcare professionals. The approach involves looking at healthcare professional, situational, and patient risk factors that can influence provider emotions and patient care.[45]The steps include:

  1. Identify the factors that predispose to emotions that might affect patient care.

  2. Monitor for signs (behavioral) and symptoms (feelings) of emotions.

  3. Name and accept the emotion.

  4. Identify possible sources of the emotion.

  5. Respond constructively to the emotion.

  6. Step back from the situation to gain perspective.

  7. Identify behaviors resulting from the feeling.

  8. Consider implications and consequences of behaviors.

  9. Think through alternative outcomes for patients according to different behaviors.

  10. Consult a trusted professional colleague.

More research needs to be done on organizational changes to reduce burnout. Hierarchical organizations that overemphasize standardization and efficiency, combined with increasing expectations of perfection (by patients, corporations, and colleagues) may promote burnout and reduce the quality of professional practice.[46]The underlying theme in burnout and work engagement is that group and management processes have to promote more open futures in which employees are better able to deploy their gifts in meaningful ways and grow as human beings.

It may be essential to measure the moral climate, assess the culture of each workplace, and evaluate spiritual concerns of staff. The latter might include clarification and strengthening of meaning and purpose conducive to both personal vitality and that of the organization.

Interventions that combine changes in managerial practice with educational interventions, on the basis of the 6 areas of work life, may reduce burnout.[1]People may be able to tolerate heavier workloads if they value the work and feel they are doing something important, or if they feel well-rewarded for their efforts. Interventions can target values and rewards. A study by Fallowfield and coworkers[47] showed that improvements in communication skills of oncologists leads to more personally and professionally rewarding consultations, which can have a significant impact on clinical care and the well-being of both patients and physicians.


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