Hematopoietic Cell Transplantation Multidisciplinary Care Teams: Burnout, Moral Distress and Career Satisfaction Sanya Virani, MBBS, MPH candidate1,2; Alexandra De Kesel Lofthus, MNM, CHTC1; Deborah A. Boyle RN, MSN, AOCNS, FAAN3; Elaine Z. Stenstrup, MSN, RN, ACNS-BC, AOCNS, BMTCN4; Ellen Denzen, MS1; Jane Dabney, LISW-S, OSW-C5; Kimberly Schmit-Pokorny, RN, MSN, OCN, BMTCN6; Leslie Parran, RN, MS, AOCN, NE-BC, BMTCN7; Lih-Wen Mau, PhD, MPH1; Linda Burns, MD1; Marion Kalbacker, MSW, LCSW8; Miguel-Angel Perales, MD9; Nancy J. Boyle, MSW, LCSW, OSW-C10; Navneet S. Majhail, MD, MS5; Pamela Paplham, DNP, AOCNP, FNP-BC11; Tait D. Shanafelt, MD12; Tippu Khan, PharmD, BCOP13; William A. Wood, MD13; Elizabeth Murphy, RN, EdD1; Joyce L. Neumann PhD, RN, AOCN, BMTCN14 1National Marrow Donor Program/Be The Match ; 2University of Minnesota School of Public Health; 3University of California Irvine Medical Center; 4University of Minnesota Cancer Care; 5The Cleveland Clinic Foundation; 6University of Nebraska Medical Center; 7University of Minnesota Medical Center; 8Duke University Medical Center; 9Memorial Sloan-Kettering Cancer Center; 10Knight Cancer Institute, Oregon Health & Science University; 11Roswell Park Cancer Institute; 12Mayo Clinic; 13University of North Carolina Chapel Hill; 14University of Texas, MD Anderson Cancer Center Background objectives Figure 1. Survey domains STRENGTHS & limitations Burnout Emotional drain Work is energizing or causes stress Empathy for patients Positive influence on others Become more callous or frustrated Contribution to relaxed work atmosphere Sense of accomplishment Compassion Fatigue Difficulty forgiving self & feeling like a failure Difficulty with confrontation Internalizing rather than sharing feelings Not paying enough attention to own needs Negativity/cynicism and trouble receiving positive feedback Insensitivity or impatience with patients and families Moral Distress Feel pressured by administration or payers Give or observe peer giving false hope to a patient or family Disagree with clinical orders/guidelines or family wishes but follow anyway Lack of confidence in own or peers’ competency Observe but do not act on an ethical issue Observe sub-par quality of patient care Career Satisfaction Recognition programs Professional development opportunities Work conditions Administrative responsibilities Emotional gratification Clinical requirements Prestige & reputation of program Hope & promise of patient treatment Resources for clinical care/research Demographics Age & gender Relationship status & number of dependent(s) Years in practice Hours worked per week Frequency of on-call shifts Percent of outpatient/inpatient time Patient population (i.e., adult, pediatric, both) Transplant center volume A needs assessment was conducted through the multi- year System Capacity Initiative1 (SCI) to evaluate the impact of workforce and infrastructure limitations on the utilization of HCT.2 It was shown that recruitment and retention efforts were limited by work-related distress. Although a recent study identified a burnout rate of 44.7% in ~3,000 oncologists3, there has been no comprehensive assessment of the prevalence and etiology of burnout within HCT. A sub-group formed as part of the SCI was representative of the multi-disciplinary care teams. This research team partnered with members of the American Society of Blood and Marrow Transplantation (ASBMT) Education Committee due to common interest and a desire to improve recruitment and retention of the HCT workforce. The study emanates from this team’s deliberation and collaboration. To describe the prevalence of work-related distress in HCT health professionals To examine the association of work-related distress and career satisfaction in HCT health professionals To our knowledge, this will be the first comprehensive study of HCT multidisciplinary care teams examining work- related distress and career satisfaction. Due to the absence of a current census, the precise size of the study population is unknown. The generalizability of the findings is limited to the members of professional societies/associations. Methods A 30-item, cross-sectional, internet survey was conducted in Jan.-Feb. 2015, comprised of two validated instruments (Table 1) and five measurement domains (Figure 1) Table 1. Validated study instruments Implications Results of this study will be made available by May 2015. The findings will add empirical evidence to HCT workforce-related studies. This study will inform the development of best-practice strategies to mitigate work-related distress and ultimately overcome barriers to workforce recruitment and retention. HCT program administrators and medical directors should systematically address work-related distress and allocate resources to develop programs educate and support the multidisciplinary care team in coping with burnout and moral distress. Scale Score Range 1. Maslach Burnout Inventory (MBI) 6 Emotional Exhaustion Depersonalization Personal Accomplishment 0-132 0-54 0-30 0-48 2. Moral Distress Scale-Revised (MDS-R) 7 0-336 Physician, nurse, advanced practice nurse, physician assistant, social worker or pharmacist providing direct care to patients in a U.S. hospital- or clinic-based HCT program Eligible HCT health professionals will be recruited from relevant professional societies/ associations (Table 2) Target sample size is 6,000 Table 2. HCT health professional sample population Multi-causal integral model PERSONAL STRESSORS Multiple role demands Compromised social engagement Inattention to self-care ACKNOWLEDGMENTS The research team would like to acknowledge the support of the professional associations and societies for their support in recruiting participants for this study: ASBMT, AOSW, APHON, APOSW, and ONS. We would also like to thank Todd Rockwood, PhD, University of Minnesota for consultation on survey methodology. Last, we thank the SCI working group members and survey participants for their time and interest in this important topic. Professional Society/Association Discipline Target Sample Size* American Society of Blood and Marrow Transplantation (ASBMT) Pharmacist Physician Physician assistant / Nurse practitioner Nurse 142 1,724 125 152 Association of Oncology Social Work (AOSW) Social worker 160 Association of Pediatric Hematology/Oncology Nurses (APHON) Advanced practice nurse 3,300 Association of Pediatric Oncology Social Workers (APOSW) 300 Oncology Nursing Society (ONS) 3,410 Pharmacy Google Group 245 B U R N O T INPUTS High expectations Compassionate caring High value to work performed Self-efficacy Commitment Equity OUTPUTS Unfulfilled expectations Robotization of behavior Demotivation Stoicism, apathy Lethargy, fatigue References https://network.bethematchclinical.org/about-us/what-we-do/system-capacity-initiative/ Denzen EM et al. Hematopoietic cell transplantation in 2020: summary of year 2 recommendations of the National Marrow Donor Program’s System Capacity Initiative. Biol. Blood Marrow Transplant. 2013;19(1):4-11. Shanafelt T, Dyrbye L. Oncologist burnout: causes, consequences, and responses. J. Clin. Oncol. 2012;30(11):1235-41. Manzano-Garcia G. New Perspectives : Towards an Integration of the concept “ burnout ” and its explanatory models. An Psicol. 2013;29:800-809. Dalmolin GDL et al. Moral distress and burnout syndrome: are there relationships between these phenomena in nursing workers? Rev Lat Am Enfermagem. 2014;22(1):35-42. Maslach C, Jackson S, Leiter MP. Maslach Burnout Inventory Manual. Mind Gard. 2014. Hamric AB, Borchers CT, Epstein EG. Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Prim. Res. 2012;3(2):1-9. MORAL DISTRESS Lack of competence Disrespect for patient autonomy Inadequate working conditions Therapeutic obstinacy WORK STRESSORS Conflict and role ambiguity Work overload High patient acuity Lack of appreciation for a job well done Adapted from: Guadalupe Manzano-García, 2013 & Graziele de Lima Dalmolin, 20144-5 *The sum of target sample size less than 6,000 due to dual memberships