Attending to Oncology Team Well-Being

Fay J. Hlubocky, PhD, MA


J Oncol Pract. 2022;18(8):541-542. 

As we, the oncology community, continue in our efforts to provide the optimal care possible for patients with cancer as this relentless COVID-19 pandemic rages on, never has it been more critical to enhance the well-being of, not only the individual oncology clinician, but the entire oncology team. For many of us, it would be entirely impossible to work during this pandemic without our team colleagues. Together, we have faced the challenges with significant disruptions in cancer care including treatment delays and modification.[1,2] Together, we have held challenging communication encounters centered on end-of-life wishes and values with patients and families, including early discussions over the allocation of resources.[2] Together, we have witnessed death through a screen, tablet, or phone as we were unable to hold our patient's hand while they lay dying in the unit. All of this in an environment where telemedicine became a major tool of care necessity further altering the patient-clinician relationship in oncology. And sadly, together, we have encountered occupational stress in the form of intensified burnout and moral distress, with potential for significant negative impacts on psychological well-being in the both the immediate short-term and long-term. We have been there with our oncology team members, oncologists, nursing, pharmacy, physician assistants (PAs), and oncology trainees, witnessing it all, together.

Yet, despite this shared involvement in an unprecedented time of cancer care, little is known about how various team members directly experience burnout. Recently, efforts have centered on the occupational and personal consequences of the COVID-19 pandemic on US oncologist burnout and well-being.[3] Given the recent reports indicating that there will be a shortage of oncologists,[4] which has only been accelerated by the COVID-19 pandemic, it will be important to identify these team member's self-reports of burnout and what factors contribute to this occupational stress within the organization to help sustain and deliver high-quality cancer care. Fortunately, we have an enhanced understanding of this experience as revealed by rigorous empirical research conducted by Tetzlaff et al and Golbach et al in this series of the JCO OP.[5,6] In this meticulously conducted study, Tetzlaff et al conducted a national survey of oncology PAs to describe potential relationships between burnout and the organizational culture in which the PA practiced using well-validated burnout and work life measures. They found that the workplace qualities (workload, reward, and values) were associated with an increased likelihood of burnout. Workload was being the most frequent mismatch in job fit. The authors also encouraged leaders to center on specific workplace factors such as sustainable workloads and consistency in rewards (financial, institutional, and social) to both prevent and address burnout in oncology PAs. Golbach et al similarly conducted a rigorous survey study to determine the prevalence of burnout among hematology-oncology pharmacists from the Hematology/Oncology Pharmacy Association including potential occupational contributors that would be associated with burnout. The investigators found that burnout is highly prevalent among hematology-oncology pharmacists. Burnout was associated with longer work hours, medication errors, and with intentions to leave their positions in the next couple of years, with negative impacts on the work force and patient care. Both studies provide preliminary evidence that the cancer organization may wish to consider as they prioritize oncology clinician well-being initiatives.

Burnout is contagious. When one clinician experiences occupational stress, significant demands are placed on other team members, who are at risk of developing burnout in the future. It has never been more vital to readily identifying approaches designed to create a sustainable culture of well-being and resilience in oncology. Both of these studies identified factors within the organization that contributed to team member well-being and adversely affected both the workforce and patient care and safety. We recently offered practical guidance in developing a blueprint of well-being to oncology leaders meeting the needs of the individual, team, and greater cancer organization.[7] To sustain well-being, the organizational key priorities are to recognize the importance of oncology physician well-being to achieving its mission; provide educational opportunities on burnout; assess burnout frequently in their clinicians, proactively engage organizational leaders and physicians in collaborative action planning; and optimize the clinical practice environment and institutional culture; and provide well-being resources including long-term post-COVID-19 crisis during recovery. For the individual, the cultivation of resilience is the positive response to the current adversity that occupational stress brings and is the key to empowerment to rise above adversity.[8] Restoring vitality, promoting patient engagement, and self-efficacy supports health and aids in coping with the organizational demands we face. The individual can learn to recognize symptoms of irritability, impatience, exasperation, feeling burdened by work; seek out professional advice; develop an action plan; acquire resilience strategies for well-being; fitness/sleep, cognitive behavioral interventions, mindfulness, finding meaning and purpose, and seek connection with peer clinicians. Finally, we can only rebuild a local culture of oncology with the support of leadership to sustain us, to sustain the workforce. Please sustain us and the future of cancer care, the oncology team.