Oncologists require support to overcome stressors, ensure work–life balance

Female oncologists are more likely than male oncologists to report grief responses and burnout, according to a study led by researchers from Israel and Canada.

However, male oncologists report greater vulnerability to grief reactions and emotional distress, even at moderate levels of burnout, results showed.

Leeat Granek

“This is not a topic that has received a great deal of attention in the literature,” Leeat Granek, PhD, a critical health psychologist at Ben-Gurion University of the Negev in Israel, told HemOnc Today. “My research has showed that the way oncologists react to patient death can have an impact on health care professionals’ personal lives, as well as on patient care.”

Granek and colleagues analyzed the effect of grief reactions and burnout on emotional distress among 178 oncologists practicing in Israel and Canada.

Granek spoke with HemOnc Today about the study results and the types of interventions that may be necessary in light of the findings.

Question: What prompted you to conduct this study?

Answer: I have been interested in oncologists’ reactions to patient death for a long time, and have conducted a number of qualitative and quantitative studies on Canadian and Israeli oncologists who treat both children and adults. I was interested to look at a wider sample of oncologists across two cultures to see if there was a relationship between reactions to patient death, emotional distress and burnout. Burnout is a big issue for oncologists and, although there has been a lot of work to date documenting the prevalence rates of burnout among oncologists, it has been harder to identify the factors that might be associated with it. I also was interested to examine whether there would be differences between sexes related to their reactions to patient death, emotional distress and burnout.

Q: Can you summarize the findings?

A: We found interesting differences by sex in this study. The main findings of the study were not actually that female oncologists report more grief responses and burnout than male oncologists, although that is one part of the story. We also examined the association between grief responses and emotional distress as it related to burnout. For male and female oncologists who reported high levels of burnout, we found they reported more grief reactions and more emotional distress. For male oncologists, the relationship between these three variables also was significant, even at moderate levels of burnout.

Q: What is the overall take-home message of the study?

A: The take-home message is that patient death is a regular and expected part of the work of clinical oncology, and that this work can have an emotional toll on oncologists who are already dealing with a number of challenges, such as high patient load, administrative burden and long work hours. Wherever there is an attachment — a meaningful relationship between two people, such as between an oncologist and a patient — there is the potential for experiencing emotional distress when that patient dies. These relationships — and the grief that may result when a patient dies — have not received a lot of acknowledgment among the medical community. Patient death is a regular part of the work, so oncologists should receive training and support to deal with this.

Q: What types of support would benefit oncologists?

A: One thing to consider when thinking about how to help oncologists with this part of their work is to look at the cumulative stressors they face on a day-to-day basis. Our research indicates that oncologists may be able to cope effectively with patient death when they are not feeling burned out by other aspects of their work. Interventions need to look at the whole picture when trying to help oncologists improve their quality of life at work and, in the process, improve quality of care for patients and their families. It is also essential that interventions be gender sensitive. There is accumulating evidence that the cumulative stressors for women in all professions include work–life balance. We cited a meta-analysis of nearly 200 studies that showed that when longer maternity leave is offered and in places that have family friendly policies, women report significantly less burnout. This is good evidence that differences in burnout among men and women are not inherent or biological, but are caused by structural inequalities that affect women differently. Taking our study as a case example, the issue is not that women suffer more from burnout or grief reactions because they are women. A plausible explanation may be that they are experiencing more difficulty with balancing all other stressors in addition to patient deaths.

Q: Were you surprised by any o f your findings?

A: I am always surprised by my findings. Every research project I do starts with a genuine curiosity about the phenomenon I am examining, and I do not take anything for granted when I begin a project. The finding that may surprise others the most is that men reported more vulnerability to grief reactions and emotional distress even at moderate levels of burnout, whereas women reported it only at high levels of burnout. This finding may be surprising to some because there is an expectation that women are more emotional and sensitive than men. It did not surprise me, however, because I know from my qualitative research that male oncologists experience just as much grief, loss and distress when patients they cared about die as female oncologists. The difference is they are less likely to talk about it openly. Men and women have different levels of comfort in expressing emotion, but both are equally affected when patients they care about die. It is possible that men are more vulnerable to the relationship between burnout, emotional distress and reactions to patient death because they have fewer outlets to talk openly about it than female oncologists, who may be more comfortable expressing their emotions.

Q: What type of supportive interventions are in place at most institutions now?

A: Our manuscript includes online supplementary material that lists all of the supportive interventions that are available in most institutions. There is wide variability in what is offered. It can range from support groups and debriefing sessions to hospital-wide memorials. The evidence on the effectiveness of these interventions, though, is variable. Although the vast majority of interventions are not evaluated for effectiveness, those that do check for outcomes do not show a lot of success helping oncologists cope with patient death. We certainly need a lot more research before we can say conclusively what works.

Q: What types of supportive interventions may be necessary in light of your findings?

A: Any intervention must be holistic and deal with all aspects of the oncologist’s work. Interventions that deal only with patient death likely will not be effective for reducing the cumulative stress of working in oncology, which is associated with burnout. Institutional interventions need to take the whole picture into account and understand that burnout or distress over patient death cannot be solved by fixing only one aspect of the work. On a more practical level, institutions should offer an array of supportive interventions that oncologists can choose from. These can include individual sessions with a mental health professional, support groups, onsite gym facilities, sabbaticals or retreats, or allowing for research time to help them get away from clinical practice. One effective way to reduce stigma in accessing these interventions is to ask oncologists to opt out of access to these interventions rather than requiring them to opt in. By making these interventions a regular part of the work structure, there is a higher likelihood that more oncologists will use them. This can improve their quality of life and, thus, the quality of life and care for their patients and their caregivers. – by Jennifer Southall

Reference:

Granek L, et al. Cancer. 2016;doi:10.1002/cncr.30236.

For more information:

Leeat Granek, PhD, can be reached at Ben-Gurion University of the Negev, POB 653, Beer-Sheva, Israel 84105; email: leeatg@gmail.com.

Disclosure: The study was funded by the Israeli Cancer Association. Granek reports no relevant financial disclosures.