PURPOSE: Provider well-being has become the fourth pillar of the quadruple aim for providing quality care. Exacerbated by the global COVID-19 pandemic, provider well-being has become a critical issue for health care systems worldwide. We describe the prevalence and key system-level drivers of burnout in oncologists in Ontario, Canada. METHODS: This is a cross-sectional survey study conducted in November-December 2019 of practicing cancer care physicians (surgical, medical, radiation, gynecologic oncology, and hematology) in Ontario, Canada. Ontario is Canada's largest province (with a population of 14.5 million), and has a single-payer publicly funded cancer system. The primary outcome was burnout experience assessed through the Maslach Burnout Inventory. RESULTS: A total of 418 physicians completed the questionnaire (response rate was 44% among confirmed oncologists). Seventy-three percent (n = 264 of 362) of oncologists had symptoms of burnout (high emotional exhaustion and/or depersonalization scores). Significant drivers of burnout identified in multivariable regression modeling included working in a hectic or chaotic atmosphere (odds ratio [OR] = 15.5; 95% CI, 3.4 to 71.5; P < .001), feeling unappreciated on the job (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), reporting poor or marginal control over workload (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), and not being comfortable talking to peers about workplace stress (OR = 3.0; 95% CI, 1.1 to 7.9; P < .001). Older age (≥ 56 years) was associated with lower odds of burnout (OR = 0.16; 95% CI, 0.1 to 0.4; P < .001). CONCLUSION: Nearly three quarters of participants met predefined standardized criteria for burnout. This number is striking, given the known impact of burnout on provider mental health, patient safety, and quality of care, and suggests Oncologists in Ontario may be a vulnerable group that warrants attention. Health care changes being driven by the COVID-19 pandemic provide an opportunity to rebuild new systems that address drivers of burnout. Creating richer peer-to-peer and leadership engagement opportunities among early- to mid-career individuals may be a worthwhile organizational strategy.
Introduction The use of surveillance CT imaging in patients with DLBCL in remission is neither effective to detect recurrence nor cost-effective. The ASH Choosing Wisely (CW) campaign, in particular, emphasizes the lack of benefit in imaging beyond 2-years of completion of therapy. We sought to describe the practice of surveillance imaging and predictors of this practice. Methods We used population-based health system administrative databases from Ontario, Canada. We studied a cohort of all adult patients ≥18 with diffuse large B-cell lymphoma who received R-CHOP therapy for curative intent between January 1, 2004 to June 30, 2011. Based on the CW campaign, we defined an index date of 2-years after the last dose of R-CHOP as the time-frame beyond which surveillance CT imaging would be inappropriate. The cumulative incidence of receiving CT scans within 3 years after the index date (i.e. from 2- to 5-years beyond the end of treatment) represented the primary outcome of interest (established within the Ontario Health Insurance Program database). To ensure that only surveillance scans in asymptomatic patients were captured, patients were censored 6 months prior to development of recurrent disease or a new cancer diagnosis, further chemotherapy/radiation, or if they died (censored at time of death). Predictor characteristics included baseline comorbidities (John Hopkins weighted Aggregated Diagnosis Groups (ADG) comorbidity score) and income quintile (linkage of the patient postal code to Statistics Canada Census data on average household income by postal code). Results The cohort consisted of 2,838 patients treated with R-CHOP during the study period. Median age at time of first R-CHOP dosing was 63 years (IQR 52-72) and the median number of cycles received was 6 (IQR 6-8). The cumulative incidence of receiving CT imaging from the index date (2-years from end of treatment) to 3-years beyond the end of treatment was 40.1% (95% CI 38.3%-41.9%). The cumulative incidence of imaging from the index date to 5-years beyond the end of treatment was 55.6 % (95% CI 53.7%-57.5%). During the follow-up period, patients ≥65 were more likely to receive imaging than those aged <65 (58.2% vs. 53.0%; p<0.01) as were those with more comorbidities (65.4% in ADG group ≥7 vs. 44.3% in ADG group 0-2; p<0.01). Income level (p=0.06) and rurality (p=0.52) did not predict for increased imaging. The cumulative incidence appeared to decrease over the study follow-up period (from 65.5% in 2006 to 47.4% in 2013; p<0.01). For the entire population, the number of CT scans completed was 0.45 per patient-year of follow-up. Conclusion During a time-frame in which surveillance imaging is deemed unnecessary by the CW campaign (2 to 5 years beyond therapy), the practice in a large population remains excessive (>50% cumulative incidence in scanning). Patients who are older and with more comorbidities are more likely to receive scans, and may represent target populations to ensure greater compliance with the CW campaign. This study represents a real-world baseline from which future efforts to reduce surveillance imaging can be benchmarked. Disclosures No relevant conflicts of interest to declare.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.