The Problem of Professional Stress and Emotional Burnout of Medical Staff in Pediatric Oncology and Hematology

The purpose of this article is to highlight the state of the problem of professional stress and burnout of medical and social professionals working in pediatric oncology/hematology. The authors review the problems and results of researches (reflected in modern international literature), taking into account the specifics of this field of medicine, which significantly determine the prevalence and high level of emotional burnout among specialists. The problems and difficulties of investigating this topic are analyzed. The selected groups of factors leading to burnout are described. A special attention is given to demographic, individual psychological, cultural and organizational factors. Special phenomena are described related to the content of the work of different specialists in pediatric oncology/hematology (moral distress, re-traumatization, compassion fatigue and satisfaction, mourning) and the difference in the level of burnout. The article also analyzes the results of applying various programs and areas of psychosocial assistance for specialists in this difficult field of medicine, including organizational measures, training and development of special skills, group psychological support. Many of them are proved to be highly effective in this difficult area of medicine both for preventing burnout and reducing the already existing level of professional stress.

1. Klipinina N.V. Psikhologicheskie trudnosti i rekomendatsii po professional'noi adaptatsii v rabote palliativnykh meditsinskikh sester [Psychological difficulties and recommendations for professional adaptation in the work of palliative nurses] [Elektronnyi resurs]. Pallium: Palliativnaya i khospisnaya pomoshch' = Pallium: Palliative and hospice care, 2019, no. 4, pp. 19—22. URL: https://www.elibrary.ru/item.asp?id=45816155 (Accessed 28.06.2023). (In Russ.).
2. Matyushkina E.Y., Roy A.P., Rakhmanina A.A., Kholmogorova A.B. Professional'nyi stress i professional'noe vygoranie u meditsinskikh rabotnikov [Occupational stress and burnout among healthcare professionals] [Elektronnyi resurs]. Sovremennaya zarubezhnaya psikhologiya = Journal of Modern Foreign Psychology, 2020. Vol. 9, no. 1, pp. 39—49. DOI:10.17759/jmfp.2020090104 URL: https://psyjournals.ru/journals/jmfp/archive/2020_n1/jmfp_2020_n1_Matyushkina_et_al.pdf (Accessed 28.06.2023). (In Russ.).
3. Weintraub A.S., Sarosi A., Goldberg E., Waldman E.D. A Cross-sectional Analysis of Compassion Fatigue, Burnout, and Compassion Satisfaction in Pediatric Hematology-Oncology Physicians in the United States. Journal of Pediatric Oncology Nursing, 2020. Vol. 42, № 1, pp. e50—e55. DOI:10.1097/MPH.0000000000001548
4. Demerouti E., Bakker A.B., Nachreiner F., Schaufeli B.W. A model of Burnout and life satisfaction amongst nurse. Journal of Advanced Nursing, 2000. Vol. 32, no. 2, pp. 454—464. DOI:10.1046/j.1365-2648.2000.01496.x
5. Algamdi M. Prevalence of oncology nurses' compassion satisfaction and compassion fatigue: Systematic review and meta-analysis. Nursing Open, 2022. Vol. 9, no. 1, pp. 44—56. DOI:10.1002/nop2.1070
6. Lioka E., Moschovi M., Koutelekos I., Baka M., Polychronopoulou S., Petsios K., Dousis E. Assessment of Pediatric Oncology Nurses’ Occupational Stress: A Comparative Study [Elektronnyi resurs]. International Journal of Caring Sciences, 2022. Vol. 15, no. 1, pp. 381—394. URL: http://www.internationaljournalofcaringsciences.org/docs/39.pp_381_394-dousis.pdf (Accessed 28.06.2023).
7. Dunn T., Terao M., Blazin L. et al. Associations of Job Demands and Patient Safety Event Involvement on Burnout among a Multidisciplinary Group of Pediatric Hematology/Oncology Clinicians. Pediatric Blood & Cancer, 2021. Vol. 68, no. 11, article ID e29214, 8 p. DOI:10.1002/pbc.29214
8. Boyle D.A., Bush N.J. Reflections on the Emotional Hazards of Pediatric Oncology Nursing: Four Decades of Perspectives and Potential. Journal of Pediatric Nursing, 2018. Vol. 40, pp. 63—73. DOI:10.1016/j.pedn.2018.03.007
9. Shanafelt T.D., Gradishar W.J., Kosty M. et al. Burnout and career satisfaction among US oncologists. Journal of Clinical Oncology, 2014. Vol. 32(7), pp. 678—686. DOI:10.1200/JCO.2013.51.8480
10. Rushton C.H., Schroeder K., Batcheller J., Donohue P. Burnout and Resilience Among Nurses Practicing in High-Intensity Settings. American Journal of Critical Care, 2015. Vol. 24, no. 5, pp. 412—420. DOI:10.4037/ajcc2015291
11. Abusanad A., Bensalem A., Shash E. et al. Burnout in oncology: Magnitude, risk factors and screening among professionals from Middle East and North Africa (BOMENA study). Psycho‐Oncology, 2021. Vol. 30, no. 5, pp. 736—746. DOI:10.1002/pon.5624
12. Morris S.E., Tarquini S.J., Yusufov M. et al. Burnout in psychosocial oncology clinicians: A systematic review. Palliative and Supportive Care, 2020. Vol. 19, no. 2, pp. 223—234. DOI:10.1017/S147895152000084X
13. Neumann J.L., Mau L.-W., Virani S. et al. Burnout, Moral Distress, Work—Life Balance, and Career Satisfaction among Hematopoietic Cell Transplantation Professionals. Biology of Blood and Marrow Transplantation, 2018. Vol. 24, no. 4, pp. 849—860. DOI:10.1016/j.bbmt.2017.11.015
14. Bonetti L., Tolotti A., Valcarenghi D., Pedrazzani C., Barello S., Ghizzardi G., Graffigna G., Sari D., Bianchi M. Burnout Precursors in Oncology Nurses: A Preliminary Cross-Sectional Study with a Systemic Organizational Analysis. Sustainability, 2019. Vol. 11, no. 5, article ID 1246, 13 p. DOI:10.3390/su11051246
15. De la Fuente-Solana E.I., Pradas-Hernández L., Ramiro-Salmerón A., Suleiman-Martos N., Gómez-Urquiza J.L., Albendín-García L., Cañadas-De la Fuente G.A. Burnout Syndrome in Paediatric Oncology Nurses: A Systematic Review and Meta-Analysis. Healthcare, 2020. Vol. 8(3), article ID 309, 12 p. DOI:10.3390/healthcare8030309
16. Chaves M.O., Ribeiro G.P., Amorim K.A. The role of the nurse in caring for the child with cancer: integration review. Hospice & Palliative Medicine International Journal, 2018. Vol. 2(4), pp. 225‒229. DOI:10.15406/hpmij.2018.02.00096
17. Colvill G. Pediatric intensive care nurses report higher empathy but also higher burnout than other health professionals. Evidence-Based Nursing, 2018. Vol. 21, no. 1, pp. 25. DOI:10.1136/eb-2017-102774
18. Cross L.A. Compassion Fatigue in Palliative Care Nursing. Journal of Hospice & Palliative Nursing, 2019. Vol. 21, no. 1, pp. 21—28. DOI:10.1097/NJH.0000000000000477
19. Davis Sh., Lind B.K., Sorensen C. A Comparison of Burnout Among Oncology Nurses Working in Adult and Pediatric Inpatient and Outpatient Settings. Oncology Nursing Forum, 2013. Vol. 40, no. 4, pp. E303—E311. DOI:10.1188/13.ONF.E303-E311
20. Zhang Y.-Y., Zhang C., Han X.-R., Li W., Wang Y.-L. Determinants of compassion satisfaction, compassion fatigue and burn out in nursing: A correlative meta-analysis. Medicine (Baltimore), 2018. Vol. 97(26), article ID e11086. 7 p. DOI:10.1097/MD.0000000000011086
21. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (fifth edition). Washington: American Psychiatric Association Publishing, 2022. 1120 p. DOI:10.1176/appi.books.9780890425596
22. Moody K., Kramer D., Santizo R.O., Magro L., Wyshogrod D., Ambrosio J., Castillo C., Lieberman R., Stein J. Helping the Helpers: Mindfulness Training for Burnout in Pediatric Oncology—A Pilot Program. Journal of Pediatric Oncology Nursing, 2013. Vol. 30, no. 5, pp. 275—284. DOI:10.1177/1043454213504497
23. World Health Organization. ICD-11. International Classification of Diseases 11th Revision [Elektronnyi resurs]: The global standard for diagnostic health information. 2019. URL: https://icd.who.int/en (Accessed 28.06.2023).
24. Cheli S., Zagonel V., Oliani C., Blasi L., Fioretto L. Is burnout affecting life satisfaction in oncologists? The moderating role of family concerns in an Italian sample. Psycho-Oncology, 2021. Vol. 30, no. 3, pp. 385—391. DOI:10.1002/pon.5589
25. Jarrad R.A., Hammad S. Oncology nurses’ compassion fatigue, burn out and compassion satisfaction. Annals of General Psychiatry, 2020. Vol. 19, article ID 22, 8 p. DOI:10.1186/s12991-020-00272-9
26. Leung J., Rioseco P. Burnout, stress and satisfaction among Australian and New Zealand radiation oncology trainees. Journal of Medical Imaging and Radiation Oncology, 2017. Vol. 61, no. 1, pp. 146—155. DOI:10.1111/1754-9485.12541
27. Mukherjee S., Tennant A., Beresford B. Measuring Burnout in Pediatric Oncology Staff: Should We Be Using the Maslach Burnout Inventory? Journal of Pediatric Oncology Nursing, 2020. Vol. 37, no. 1, pp. 55—64. DOI:10.1177/1043454219873638
28. Nowrouzi B., Llghtfoot N., Larivière M., Carter L., Rukholm E., Schinke R., Belanger-Gardner D. Occupational Stress Management and Burnout Interventions in Nursing and Their Implications for Health Work Environments a Literature Review. Workplace health & safety, 2015. Vol. 63, no. 7, pp. 308—315. DOI:10.1177/2165079915576931
29. Okan A. Burnout Among Medical Oncology Physicians and Related Factors: A Nationwide Survey. Eurasian Journal of Medical Investigation, 2021. Vol. 5, no. 3, pp. 301—308. DOI:10.14744/ejmi.2021.93667
30. Wiener L., Viola A., Koretski J., Perper E.D., Patenaude A.F. Pediatric psycho-oncology care: standards, guidelines, and consensus reports. Psycho-Oncology, 2015. Vol. 24, no. 2, pp. 204—211. DOI:10.1002/pon.3589
31. López-López I.M., Gómez-Urquiza J.L., Cañadas G.R., De la Fuente E.I., Albendín-García L., Cañadas-De la Fuente G.A. Prevalence of burnout in mental health nurses and related factors: A systematic review and meta-analysis. International Journal of Mental Health Nursing, 2019. Vol. 28, no. 5, pp. 1032—1041. DOI:10.1111/inm.12606
32. Pradas-Hernandez L., Ariza T., Gómez-Urquiza J.L., Albendín-García L., De la Fuente E.I., Cañadas-De la Fuente G.A. Prevalence of burnout in paediatric nurses: A systematic review and meta-analysis. PLoS ONE, 2018. Vol. 13, no. 4, article ID e0195039. 14 p. DOI:10.1371/journal.pone.0195039
33. Cañadas‐De la Fuente G.A., Gómez‐Urquiza J.L., Ortega‐Campos E.M., Cañadas G.R., Albendín-García L., De la Fuente‐Solana E.I. Prevalence of burnout syndrome in oncology nursing: A meta‐analytic study. Psycho‐Oncology, 2018. Vol. 27, no. 5, pp. 1426—1433. DOI:10.1002/pon.4632
34. Albendín L., Gómez J.L., Cañadas-de la Fuente G.A., Cañadas G.R., San Luis C., Aguayo R. Prevalencia bayesiana y niveles de burnout en enfermería de urgencias. Una revisión sistemática. Revista Latinoamericana de Psicología, 2016. Vol. 48, no. 2, pp. 137—145. DOI:10.1016/j.rlp.2015.05.004
35. Clough B.A., March S., Chan R.J., Casey L.M., Phillips R., Ireland M. Psychosocial interventions for managing occupational stress and burnout among medical doctors: a systematic review. Journal Systematic Reviews, 2017. Vol. 6, article ID 144, 19 p. DOI:10.1186/s13643-017-0526-3
36. Sekol M.A., Kim S.Ch. Job satisfaction, burnout, and stress among pediatric nurses in various specialty units at an acute care hospital. Journal of Nursing Education and Practice, 2014. Vol. 4, no. 12, pp. 115—124. DOI:10.5430/jnep.v4n12p115
37. International Society of Nursing in Cancer Care. Strengthening the Oncology Nursing Workforce in Low- and Middle-Income Countries to Address the Growing Cancer Burden [Elektronnyi resurs]. Vancuver, BC: ISNCC, 2015. 31 p. URL: https://isncc.org/resources/Documents/White_Paper_Final_Revisions_.pdf (Accessed 28.06.2023).
38. Zadeh S., Gamba N., Hudson C., Wiener L. Taking Care of Care Providers: A Wellness Program for Pediatric Nurses. Journal of Pediatric Oncology Nursing, 2012. Vol. 29, no. 5, pp. 294—299. DOI:10.1177/1043454212451793
39. Yates M., Samuel V. Burnout in oncologists and associated factors: A systematic literature review and meta‐analysis. European Journal of Cancer Care, 2019. Vol. 28, no. 3, article ID e13094, 19 p. DOI:10.1111/ecc.13094