Combating Compassion Fatigue and Burnout in Cancer Care

Linda Emanuel, MD, PhD; Frank D. Ferris, MD, FAAPHM; Charles F. von Gunten, MD, PhD; Jaime H. Von Roenn, MD

June 06, 2011

Editor's Note:

This text has been excerpted and adapted from: Emanuel LL, Ferris FD, von Gunten CF, Von Roenn J, eds. EPEC™-O: Education in Palliative and End-of-life Care for Oncology(Module 15:Cancer Doctors and Burnout), Copyright The EPEC™ Project, Chicago, IL, 2005). The EPEC™-O curriculum was produced by The EPEC™ Project, with major funding provided by the National Cancer Institute, and with supplemental funding provided by the Lance Armstrong Foundation.

Compassion Fatigue and Burnout in Cancer Care

Working as a healthcare provider with patients who have cancer has many rewards, but can also be challenging and stressful. Healthcare providers caring for persons with cancer and their families are at increased risk of developing burnout and compassion fatigue, with potentially devastating consequences not only for themselves, but also for patients and families.

This oncologist is showing evidence of burnout -- anger, exhaustion, and detachment. His coworkers voice concerns.

Burnout

Burnout, a psychological syndrome, is a response to chronic interpersonal stressors on the job.^[1]The concept of burnout was first developed in the 1970s.^[2]

The 3 key dimensions of this response are:

Individual: overwhelming exhaustion; feelings of being overextended and depleted of one's emotional and physical resources;
Interpersonal: cynicism (or depersonalization) and detachment from the job. Cynicism refers to a negative, callous, or excessively detached response to various aspects of the job; and
Self-evaluative: sense of ineffectiveness and lack of accomplishment -- Ineffectiveness refers to feelings of incompetence and a lack of achievement and productivity at work.

Pines suggests, "The root cause of burnout lies in people's need to believe that their lives are meaningful, and that the things they do -- and consequently they themselves -- are important and significant."^[3]Most healthcare professionals who are treated for burnout do not come in saying they are burned out.^[4]Typically, they say, "There's something wrong with me. I don't care anymore. Terrible things happen in front of me, and I feel nothing."

Compassion Fatigue

Compassion fatigue is related to, but distinct from, burnout. Figley describes compassion fatigue as "a state experienced by those helping people in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper."^[5] Compassion fatigue is conceptualized as consisting of 2 parts: 1) symptoms associated with burnout, such as exhaustion, frustration, anger and depression; and 2) secondary traumatic stress, the negative effects of which may include fear, sleep difficulties, intrusive images, or avoidance of reminders of past traumatic experiences.^[6] Healthcare workers are at increased risk for compassion fatigue, especially those involved with highly emotionally charged situations.

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Cite this: Linda Emanuel, Frank D. Ferris, Charles F. von Gunten, et. al. Combating Compassion Fatigue and Burnout in Cancer Care - Medscape - Jun 06, 2011.

Compassion Fatigue and Burnout in Cancer Care
How Common Are Burnout and Compassion Fatigue?
Risk Factors for Burnout and Compassion Fatigue
Models of Burnout
Management of Burnout and Compassion Fatigue
Points to Remember
References

Authors and Disclosures

Author(s)

Linda Emanuel, MD, PhD

Author, researcher, educator, previously practicing clinician; Principal, The EPEC Project; Director, Buehler Center on Aging, Heath and Society (where the EPEC Project and its derivatives are housed), Northwestern University Feinberg School of Medicine, Chicago, Illinois

Disclosure: Linda Emanuel, MD, PhD, has disclosed no relevant financial relationships.

Dr. Emanuel does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the US Food and Drug Administration (FDA) for use in the United States.

Dr. Emanuel does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Frank D. Ferris, MD

Director, International Programs, Institute for Palliative Medicine at San Diego Hospice, San Diego, California; Professor, Department of Family and Preventative Medicine, University of California School of Medicine, San Diego, California; Co-principal, The EPEC Project

Disclosure: Frank D. Ferris, MD, FAAPHM, has disclosed no relevant financial relationships.

Dr. Ferris does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics not approved by the US Food and Drug Administration (FDA) for use in the United States.

Dr. Ferris does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Charles F. von Gunten, MD, PhD

Medical Director, Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, California; Associate Clinical Professor, University of California, San Diego, School of Medicine; Co-principal, The EPEC Project; Past Chairman, The American Board of Hospice and Palliative Medicine

Disclosure: Charles F. von Gunten, MD, PhD, has disclosed no relevant financial relationships.

Dr. von Gunten does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the US Food and Drug Administration (FDA) for use in the United States.

Dr. von Gunten does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Jaime H. Von Roenn, MD

Medical Director, Palliative Care and Home Hospice Program, Northwestern Memorial Hospital, Chicago, Illinois; Professor of Medicine, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Co-Principal, The EPEC Project; Editor, EPEC-O Curriculum; Editor-in-Chief, The Journal of Supportive Oncology

Disclosure: Jamie H. Von Roenn, MD, has disclosed the following relevant financial relationships:
Served as a director, officer, partner, employee, advisor, consultant, or trustee for: GTx; AstraZeneca
Received income in an amount equal to or greater than $250 from: GTx; AstraZeneca

Editor(s)

Cheryl Arenella, MD, MPH

Cancer Education Program Specialist, Contractor, National Cancer Institute, Office of Communications and Education, Office of Education and Special Initiatives, Rockville, Maryland

Disclosure: Cheryl Arenella, MD, MPH, has disclosed no relevant financial relationships.

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Combating Compassion Fatigue and Burnout in Cancer Care

Compassion Fatigue and Burnout in Cancer Care

Burnout

Compassion Fatigue

Tables

References

Authors and Disclosures

Authors and Disclosures

Author(s)

Linda Emanuel, MD, PhD

Frank D. Ferris, MD

Charles F. von Gunten, MD, PhD

Jaime H. Von Roenn, MD

Editor(s)

Cheryl Arenella, MD, MPH

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