1. 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 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
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):
Manzano-Garcia G. New Perspectives : Towards an Integration of the concept “ burnout ” and its explanatory models. An Psicol. 2013;29:
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
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,
*The sum of target sample size less than 6,000 due to dual memberships