A Call to Action: Ethics Committee Roundtable Recommendations for Addressing Burnout and Moral Distress in Oncology

Hlubocky, Fay J.; Taylor, Lynne; Marron, Jonathan M.; Spence, Rebecca A.; McGinnis, Molly M.; Brown, Richard F.; McFarland, Daniel C.; Tetzlaff, Eric D; Gallagher, Colleen M.; Rosenberg, Abby R.; Popp, Beth; Dragnev, Konstantin H.; Bosserman, Linda D.; Dudzinski, Denise M.; Smith, Sonali M.; Chatwal, Monica Sheila; Patel, Manali I.; Markham, Merry Jennifer; Levit, Kathryn; Bruera, Éduardo; Epstein, Ronald M.; Brown, Marie T.; Back, Anthony L.; Shanafelt, Tait D.; Kamal, Arif H.

doi:10.1200/jop.19.00806

Cited by 54 publications

(69 citation statements)

References 68 publications

(137 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The prevalence of anxiety-related symptoms we observed among oncology physicians in the United States is alarming. These findings support a recent call to action to address emotional distress among physicians even prior to the pandemic [ 20 ]. It is crucial to protect the mental health of all oncologists in order to preserve their ability to deliver high quality and efficient care to cancer patients at a time of unprecedented uncertainty.…”

Section: Discussionsupporting

confidence: 85%

Emotional health concerns of oncology physicians in the United States: Fallout during the COVID-19 pandemic

et al. 2020

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 85%

Emotional health concerns of oncology physicians in the United States: Fallout during the COVID-19 pandemic

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The prevalence of anxiety-related symptoms we observed among oncology physicians in the United States is alarming. These findings support a recent call to action to address burnout, prior to the pandemic, to protect the mental health of all oncologists in order to preserve their ability to deliver high quality and efficient care to cancer patients at a time of unprecedented uncertainty 16 . Further studies are needed to identify the sources of psychological distress and assess the efficacy of interventions for physicians during and after the COVID-19 pandemic.…”

Section: Discussionsupporting

confidence: 78%

Emotional health concerns of oncology physicians in the United States: fallout during the COVID-19 pandemic

Thomaier

Teoh

Jewett

et al. 2020

Preprint

View full text Add to dashboard Cite

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.

show abstract

“…The literature on addressing burnout in oncology has focused on promoting resilience through individual and organizational level interventions such as burnout education, mindfulness training, and assessment of clinician wellbeing as an quality metric. 3,27 Some suggestions from our participants, such as communication training and teambuilding, are recommended in this literature as well. Our findings contribute additional individual and organizational level strategies that are specific to mitigating moral distress caused by priority setting, yet also demand a more proximal or "upstream" approach to addressing the structural forces that constrain resources and perpetuate disparities.…”

Section: Discussionmentioning

confidence: 99%

“…Moral distress is considered a root cause of clinician burnout [ 3 ]. In a Call to Action from the American Society of Clinical Oncology Ethics Committee, many important factors associated with oncologist burnout were recognized, including moral distress related to ethical challenges in end‐of‐life care [ 4 ]. However, the effects of resource constraints and systemic inequalities have been absent from this discourse.…”

Section: Introductionmentioning

confidence: 99%

Moral Distress and Resilience Associated with Cancer Care Priority Setting in a Resource-Limited Context

et al. 2021

View full text Add to dashboard Cite

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 lowand middle-income countries (LMICs) are well positioned to provide insight into the moral experience of cancer care priority setting and expertise to guide solutions. Methods. Semi-structured 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 indepth 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 our 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. The Oncologist 2021;9999:• •

show abstract

A Call to Action: Ethics Committee Roundtable Recommendations for Addressing Burnout and Moral Distress in Oncology

Cited by 54 publications

References 68 publications

Emotional health concerns of oncology physicians in the United States: Fallout during the COVID-19 pandemic

Emotional health concerns of oncology physicians in the United States: Fallout during the COVID-19 pandemic

Emotional health concerns of oncology physicians in the United States: fallout during the COVID-19 pandemic

Moral Distress and Resilience Associated with Cancer Care Priority Setting in a Resource-Limited Context

Contact Info

Product

Resources

About