PDF 
Views 
Share
Relation between Burnout and Psychosocial Factors in Health Care Providers and Family Caregivers of Patients with Cancer
CC BY 4.0 · Indian J Med Paediatr Oncol 2024; 45(03): 249-255
DOI: DOI: 10.1055/s-0043-1769490
Abstract
Introduction Burnout has been widely studied among oncology health care providers such as nurses and doctors. However, it is a less explored but highly prevalent factor in family caregivers of patients with cancer.
Objective The study aimed to understand the construct of burnout among health care providers and family caregivers of patients with cancer, through three objectives: (1) to distinguish burnout between health care providers and family caregivers; (2) to predict burnout based on measurable characteristics, namely, perceived stress, psychological morbidity, well-being, problem-focused coping, emotion-focused coping, and avoidant coping; and (3) to find out the levels of burnout (low, medium, and high) in health care providers and family caregivers.
Materials and Methods It is a cross-sectional study conducted among the health care providers and family caregivers of patients with cancer. The measures used in the study were the Professional Quality of Life scale, 12-Item General Health Questionnaire, Perceived Stress Scale, 5-Item World Health Organization Well-Being Index, Brief COPE inventory, and a sociodemographic details form.
Results The study found a statistically significant difference in the mean burnout of health care providers (p = 0.027) and family caregivers. Study variables such as perceived stress and avoidant coping positively predicted burnout, whereas well-being and emotion-focused coping negatively predicted burnout. The study also found that a majority of the participants fell into the category of “medium” level of burnout.
Conclusion While enhancing well-being and employing adaptive coping styles can act as the mitigating factors to burnout, the existence of stress and maladaptive styles of coping can prove counterproductive in dealing with burnout in work environments. This indicates that there is a need for psychosocial interventions to help the medical professionals deal with the burnout.
Note
The manuscript has been read and approved by all the authors, that the requirements for authorship have been met, and that each author believes that the manuscript represents honest work
Authors' Contributions
D.A. conducted the literature search, data acquisition, data analysis, manuscript preparation, and manuscript editing. G.P. was responsible for the concept, design, and manuscript review. C.R.R. handled the statistical analysis.
Publication History
Article published online:
26 June 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
Abstract
Introduction Burnout has been widely studied among oncology health care providers such as nurses and doctors. However, it is a less explored but highly prevalent factor in family caregivers of patients with cancer.
Objective The study aimed to understand the construct of burnout among health care providers and family caregivers of patients with cancer, through three objectives: (1) to distinguish burnout between health care providers and family caregivers; (2) to predict burnout based on measurable characteristics, namely, perceived stress, psychological morbidity, well-being, problem-focused coping, emotion-focused coping, and avoidant coping; and (3) to find out the levels of burnout (low, medium, and high) in health care providers and family caregivers.
Materials and Methods It is a cross-sectional study conducted among the health care providers and family caregivers of patients with cancer. The measures used in the study were the Professional Quality of Life scale, 12-Item General Health Questionnaire, Perceived Stress Scale, 5-Item World Health Organization Well-Being Index, Brief COPE inventory, and a sociodemographic details form.
Results The study found a statistically significant difference in the mean burnout of health care providers (p = 0.027) and family caregivers. Study variables such as perceived stress and avoidant coping positively predicted burnout, whereas well-being and emotion-focused coping negatively predicted burnout. The study also found that a majority of the participants fell into the category of “medium” level of burnout.
Conclusion While enhancing well-being and employing adaptive coping styles can act as the mitigating factors to burnout, the existence of stress and maladaptive styles of coping can prove counterproductive in dealing with burnout in work environments. This indicates that there is a need for psychosocial interventions to help the medical professionals deal with the burnout.
Keywords
burnout - health care providers - family caregivers - oncologyIntroduction
Cancer diagnosis has a catastrophic impact on both the professionals providing the care and the family caregivers. Oncology health care providers have high rates of burnout due to exposure to numerous patient deaths, treatment decisions, planning and carrying out treatments, and dealing with high workloads and time pressure, and they experience stress, burnout, and trauma. Family caregivers, on the other hand, have to deal with the emotional and psychological trauma of the diagnosis, stressors associated with the treatment, adjusting their own lives after the diagnosis, and additional caregiver responsibilities.[1] [2] [3] [4]
Burnout can be defined as “a state of physical, emotional and mental exhaustion caused by long-term involvement in emotionally demanding situations.”[5] The construct has been widely studied over the decades among individuals working in the helping professions. Studies on understanding the effects of burnout on oncology health care providers such as nurses and doctors due to the nature of their jobs have also been common.[6] [7] [8] In the case of family caregivers, the most widely studied concept, to understand the exhausting and negative effects of caregiving, has been the study of caregiver burden. Efforts have been made to understand the extent of burnout solely on family caregivers,[9] and studies comparing the effects of burnout on both oncology health care providers and family caregivers together have been sparse. Present study, to the best of our knowledge, is the first in its field to understand burnout in the formal as well as the informal caregivers of patients with cancer. Thus, this study aims to understand the construct of burnout among health care providers and family caregivers of patients with cancer through the following objectives: (1) to distinguish burnout between health care providers and family caregivers; (2) to predict burnout based on measurable characteristics, namely, perceived stress, psychological morbidity, well-being, problem-focused, emotion-focused, and avoidant coping; and (3) to find out the levels of burnout (low, medium, and high) in health care providers and family caregivers. Based on the study findings obtained, recommendations for the development of necessary interventions for both healthcare providers as well as family caregivers to mitigate burnout will be proposed.
Materials and Method
Study Design and Procedure
A cross-sectional study was carried out at a regional cancer center and a corporate cancer hospital located in India for a period of 1 year. The total sample obtained was 309 participants inclusive of health care providers as well as family caregivers of patients with cancer. After taking permissions from the institution ethics committee, the data were collected. Data were collected after obtaining informed consent from the participants ensuring their voluntary participation. The participants were assured regarding their anonymity of participation, confidentiality, and the strict academic use of the data collected. Based on the findings thus obtained, recommendations for the development of necessary interventions for burnout will be designed. Thus, several interventions for the health care providers as well as family caregivers who undergo complexities in psychosocial. After the completion of the study, the participants were debriefed.
The study included five measures, namely, the Professional Quality of Life (ProQOL) scale, Perceived Stress Scale, 12-Item General Health Questionnaire (GHQ-12), 5-Item World Health Organization Well-Being Index, and the Brief COPE inventory. Other details such as the sociodemographic characteristics of the health care providers and family caregivers were also collected.
ProQOL (version 5)[10] is a 5-point Likert scale and has 10 items assigned to each of the three subscales—compassion satisfaction, burnout, and secondary trauma. However, in this study, it was solely used for the measurement of burnout in the participants. It is self-administered and consists of 30 items, originally developed for professionals working in human services. The scale was adopted to be administered among family caregivers of patients with cancer to explore and understand the same. The scale does not yield a composite score. The scale also allows for the categorization of scores, low, average (medium), and high levels, for each category. Scores of 43 or less are categorized as low, scores around 50 as average (medium) level of burnout, and scores of 57 and more as high level of burnout.
The Perceived Stress Scale was used to measure stress. The scale is a 10-item, 4-point Likert scale used to assess participants' perception of stressors in daily life, occurrence of major events in life, and notable changes in coping within the past 1 month.[11]
The GHQ-12, consisting of 12-item and a 4-point Likert scale, was used to measure psychological morbidity.[12]
Well-being was measured by the 5-Item World Health Organization Well-Being Index. It is a 5-item and 6-point Likert scale used to measure participant's positive mood, levels of vitality, and general interests.[13]
Coping was measured with the Brief COPE Inventory. It is a 28-item instrument consisting of 3 broad dimensions, namely, problem-focused, emotion-focused, and avoidant coping, obtaining three separate scores for each subscale.[14] There is no composite score available for this inventory.
Inclusion and Exclusion Criteria
This study recruited health care providers inclusive of doctors and nurses, who have been working in the fields of oncology for more than 1 year, along with family caregivers who have been taking care of patients with cancer over a period of 1 year. Participants with psychological illnesses were excluded from the study.
Primary and Secondary Outcome
Primarily, the study found that there is a significant difference in the burnout experienced by health care professionals and family caregivers, showing that professionals scored higher on burnout when compared with the family caregivers.
The secondary outcome of the study suggests that although family caregivers have scored lower on burnout when compared with the health care professionals, it is important to equally address both the groups and provide suitable interventions to handle the levels of burnout.
Statistical Analysis
Descriptive statistics were carried out to gain an overview of participants' sociodemographic characteristics such as gender, age, marital status, and socioeconomic status. Statistical analyses such as analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were conducted to estimate the variation in the means of burnout in health care providers and family caregivers. Logistic regression analysis and contingency analysis were used to find out the levels of burnout in health care providers and family caregivers. All statistical tests and analyses were carried out using SPSS 21.0 for Windows.
Ethics
The study has been conducted in compliance with the protocol that has gained the approval of the Institutional Ethics Committee of the University of Hyderabad. The approval number as given by ethics committee is “UH/IEC/2018/24” (December 21, 2021). All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Results
[Table 1] provides characteristics of the sample. The mean age of the participants was 34.6 years. Most participants were female (63.8%) and were in the age group of 28 to 37 years (39.2%). The majority of the study participants reported to be married (62.1%), and a majority of them were categorized as belonging to the middle social class (43%).
|
Variables |
Professional caregiver (n = 153), n (%) |
Family caregiver (n = 156), n (%) |
|
|---|---|---|---|
|
Gender |
Male |
39 (25.5) |
73 (46.8) |
|
Female |
114 (74.5) |
83 (53.2) |
|
|
Age, y |
18–27 |
34 (22.2) |
20 (12.9) |
|
28–37 |
72 (47.1) |
49 (31.6) |
|
|
38–47 |
25 (16.3) |
39 (25.2) |
|
|
48–57 |
21 (13.7) |
25 (16.1) |
|
|
≥58 |
1 (0.7) |
23 (14.2) |
|
|
Marital status |
Unmarried |
72 (47.1) |
28 (17.9) |
|
Married |
75 (49) |
117 (75) |
|
|
Separated/divorced/widow(er) |
6 (3.9) |
11 (7.1) |
|
|
Monthly income, ₹ |
1,000–7,000 |
– |
105 (67.3) |
|
8,000–15,000 |
– |
51 (32.7) |
|
|
30,000–55,000 |
17 (11.1) |
– |
|
|
57,000–80,000 |
82 (53.6) |
– |
|
|
≥100,000 |
54 (35.3) |
– |
|
|
Source of variance |
SS |
df |
MS |
F |
|---|---|---|---|---|
|
Perceived stress |
2,183.15 |
1 |
2,183.15 |
40.62*** |
|
Psychological morbidity |
60.34 |
1 |
60.34 |
1.12 |
|
Well-being |
746.39 |
1 |
746.39 |
13.88*** |
|
Problem-focused coping |
9.72 |
1 |
9.72 |
0.18 |
|
Emotion-focused coping |
1,080.14 |
1 |
1,080.14 |
20.10*** |
|
Avoidant coping |
1,193.88 |
1 |
1,193.88 |
22.2*** |
|
Type of caregiver |
952.91 |
1 |
952.91 |
17.73*** |
|
Error |
16,177.0 |
301 |
|
Parameters |
B |
SE |
t |
|---|---|---|---|
|
Perceived stress |
0.699 |
0.110 |
6.3373*** |
|
Psychological morbidity |
0.132 |
0.125 |
1.069 |
|
Well-being |
−0.098 |
0.026 |
−3.727*** |
|
Problem-focused coping |
0.061 |
0.142 |
0.425 |
|
Emotion-focused coping |
−0.504 |
0.112 |
−4.713*** |
|
Avoidant coping |
0.0872 |
0.185 |
4.713*** |
|
[Type of caregiver = 0] |
4.609 |
1.095 |
4.211*** |
|
[Type of caregiver = 1] |
0a |
– |
– |
|
B |
SE |
Exp(B) |
p |
||
|---|---|---|---|---|---|
|
Low level of burnout |
Perceived stress |
−0.308 |
0.065 |
0.735 |
0.000*** |
|
Psychological morbidity |
−0.041 |
0.067 |
0.960 |
0.541 |
|
|
Well-being |
0.039 |
0.014 |
1.039 |
0.005** |
|
|
Problem-focused coping |
0.014 |
0.070 |
1.014 |
0.845 |
|
|
Emotion-focused coping |
0.104 |
0.055 |
1.109 |
0.050* |
|
|
Avoidant coping |
−0.211 |
0.095 |
0.809 |
0.026* |
|
|
[caregiving = 0] |
−1.668 |
0.591 |
0.189 |
0.005** |
|
|
B |
SE |
Exp( B ) |
Sig. |
||
|
Medium level of burnout |
Perceived stress |
−0.252 |
0.052 |
0.777 |
0.000*** |
|
Psychological morbidity |
−0.012 |
0.052 |
0.988 |
0.822 |
|
|
Well-being |
0.014 |
0.011 |
1.014 |
0.176 |
|
|
Problem-focused coping |
−0.093 |
0.054 |
0.911 |
0.084 |
|
|
Emotion-focused coping |
0.077 |
0.044 |
1.080 |
0.080 |
|
|
Avoidant coping |
−0.216 |
0.072 |
0.805 |
0.003** |
|
|
[caregiving = 0] |
0.002 |
0.435 |
1.002 |
0.996 |
Discussion
The results of the study were threefold: the first aim was to distinguish burnout between health care providers and family caregivers; the second aim was to predict burnout based on measurable characteristics, namely, perceived stress, psychological morbidity, well-being, problem-focused coping, emotion-focused coping, and avoidant coping; and the third aim was to find out the levels of burnout (low, medium, and high) in health care providers and family caregivers of patients with cancer.
The study found a difference between the experience of burnout among the health care providers and family caregivers, thus supporting the first objective. It was seen that health care providers experienced more burnout when compared with family caregivers. This can be explained by the nature of their job, which entails work-related stressors[2] as well as dealing with the emotional exhaustion of patients' pain and death,[3] [15] [16] when compared with their counterparts, family caregivers.
According to the second and third objectives, it was checked whether there was a difference between the two groups with respect to perceived stress, well-being, emotion-focused coping, and avoidant coping. It was seen that there exists a difference between these two groups as mentioned previously. Perceived stress positively predicted burnout, indicating that individuals who perceived stress experienced more burnout. Therefore, overall, this suggests that individuals who score higher on perceived stress are at a higher probability/likelihood of high level of burnout and less likely to belong to low or medium levels of burnout. This has also been found in previous studies[17] and can also be explained by the concept of burnout, i.e., a phenomenon that emerges due to the prolonged exposure to stress and demanding situations,[18] [19] especially in the context of medical field.
Avoidant coping also positively predicted burnout, which showed that individuals who adopted avoidant coping mechanisms to deal with the stressors experienced more burnout. Hence, overall, this suggests that individuals who score higher on avoidant coping are at a higher probability/likelihood of high level of burnout and less likely to belong to low or medium levels of burnout. This finding is in line with the recent research conducted on health care professionals.[20] [21] [22] However, it is important to note that this finding was also contrary to previous research that did not find that coping strategies predicted burnout.[23]
Moreover, it was also seen that emotion-focused coping and well-being negatively predicted burnout. This indicates that individuals who increasingly adopted emotion-focused mechanisms to cope were seen to have lower burnout and vice versa. Thus, overall, this suggests that individuals who score higher on emotional-focused coping are at a higher probability/likelihood of low level of burnout and less likely to belong to the high level of burnout category. This was supported by previous research that stated health care professionals use emotion-focused mechanisms to deal with work-related as well as personal situations, such as having an active social life and maintaining a positive disposition to combat burnout.[22] [24] [25]
Likewise, well-being also predicted burnout negatively, indicating an increased experience of well-being leads to the decreased experience of the burnout and vice versa. Therefore, overall, this suggests that individuals who score higher on well-being are at a higher probability/likelihood of low level of burnout and less likely to belong to high level of burnout.[26]
Conclusion
Major findings of the current study show that health care providers of patients with cancer experience more burnout when compared with family caregivers of patients with cancer. It was also seen that while factors such as perceived stress and avoidant coping predicted and increased the risk of burnout, factors such as well-being and emotion-focused coping decreased the risk of burnout. This indicates a strong need for psychosocial interventions to help the medical professionals deal with the burnout. While their professionalism and regular exposure to all situations may contribute to their strength, the same may also contribute to anticipation and sensitivity to crisis faced by patients and as medical professionals to the challenges. Hence, customized relaxation techniques and stress management programs targeting doctors and nurses and other health professionals are recommended. At the same time, caregivers who are the silent sufferers and do not vent out their psychosocial suffering also need to be paid attention to with suitable psychosocial interventions.
The study included participants from only one state from India; a larger pool will expand the scope of the study. Integrative health team should include not only the health professionals but also family caregivers and other related professionals who can address different aspects of aligned care relevant to the needs of the patients and caregivers. This may minimize the stress both in terms of family caregivers and also health care professionals who get greater support in the health care. Cross-cultural studies comparing the cultural factors leading to the burnout of professionals and family caregivers dealing with patients with cancer are needed to design culture-appropriate interventions to deal with burnout.
Conflict of Interest
None declared.
Note
The manuscript has been read and approved by all the authors, that the requirements for authorship have been met, and that each author believes that the manuscript represents honest work
Authors' Contributions
D.A. conducted the literature search, data acquisition, data analysis, manuscript preparation, and manuscript editing. G.P. was responsible for the concept, design, and manuscript review. C.R.R. handled the statistical analysis.
References
- Jasperse M, Herst P, Dungey G. Evaluating stress, burnout and job satisfaction in New Zealand radiation oncology departments. Eur J Cancer Care (Engl) 2014; 23 (01) 82-88
- Pfaff KA, Freeman-Gibb L, Patrick LJ, DiBiase R, Moretti O. Reducing the “cost of caring” in cancer care: evaluation of a pilot interprofessional compassion fatigue resiliency programme. J Interprof Care 2017; 31 (04) 512-519
- Wentzel D, Brysiewicz P. Integrative review of facility interventions to manage compassion fatigue in oncology nurses. Oncol Nurs Forum 2017; 44 (03) E124-E140
- Spatuzzi R, Giulietti MV, Ricciuti M. et al. Quality of life and burden in family caregivers of patients with advanced cancer in active treatment settings and hospice care: a comparative study. Death Stud 2017; 41 (05) 276-283
- Pines A, Aronson E. Career Burnout: Causes and Cures. Free Press; 1988
- Sale JEM, Smoke M. Measuring quality of work-life: a participatory approach in a Canadian cancer center. J Cancer Educ 2007; 22 (01) 62-66
- Girgis A, Hansen V, Goldstein D. Are Australian oncology health professionals burning out? A view from the trenches. Eur J Cancer 2009; 45 (03) 393-399
- Probst H, Griffiths S, Adams R, Hill C. Burnout in therapy radiographers in the UK. Br J Radiol 2012; 85 (1017): e760-e765
- Jun WH, Cha KS, Lee KL. The mediating effect of depression on the relationship between social support, spirituality and burnout in family members of patients with cancer. Int J Environ Res Public Health 2021; 18 (04) 1727
- Stamm B. The concise manual for the professional quality of life scale. 2010
- Cohen S. Perceived stress in a probability sample of the United States. In Spacapan S, Oskamp S. , eds. The Social Psychology of Health. Sage; 1988: 31-67
- Goldberg DP, Williams P. A User's Guide to the General Health Questionnaire. 1988
- Topp CW, Østergaard SD, Søndergaard S, Bech P. The WHO-5 Well-Being Index: a systematic review of the literature. Psychother Psychosom 2015; 84 (03) 167-176
- Carver CS. You want to measure coping but your protocol's too long: consider the brief COPE. Int J Behav Med 1997; 4 (01) 92-100
- Tjasink M, Soosaipillai G. Art therapy to reduce burnout in oncology and palliative care doctors: a pilot study. Int J Art Ther. 2019; 24 (01) 12-20
- Wentzel DL, Brysiewicz P. A survey of compassion satisfaction, burnout and compassion fatigue in nurses practicing in three oncology departments in Durban, South Africa. Int J Afr Nurs Sci 2018; 8: 82-86
- Singh S, Farrelly A, Chan C. et al. Prevalence and workplace drivers of burnout in cancer care physicians in Ontario, Canada. JCO Oncol Pract 2022; 18 (01) e60-e71
- Maslach C. Burnout: The Cost of Caring. Prentice Hall; 1982
- Farber BA. Introduction: A critical perspective on burnout. In: Farber BA. ed. Stress and Burnout in the Human Service Professions. Pergamon; 1983: 1-20
- Van Oers H. Burnout, compassion fatigue and suicidal ideation in oncology healthcare professionals. J Surg Med. 2021; 5 (07) 718-723
- Behrani A, Nasir J, Khan R, Maqsood L, Sulaiman S. The relationship between empathy, coping strategies, and compassion fatigue in doctors. Pak J Clin Psychol 2020; 19 (02) 61-78
- Ercolani G, Varani S, Peghetti B. et al. Burnout in home palliative care: what is the role of coping strategies?. J Palliat Care 2020; 35 (01) 46-52
- Alharbi J, Jackson D, Usher K. Personal characteristics, coping strategies, and resilience impact on compassion fatigue in critical care nurses: a cross-sectional study. Nurs Health Sci 2020; 22 (01) 20-27
- Yoder EA. Compassion fatigue in nurses. Appl Nurs Res 2010; 23 (04) 191-197
- Partlak Günüşen N, Üstün B, Serçekuş Ak P, Büyükkaya Besen D. Secondary traumatic stress experiences of nurses caring for cancer patients. Int J Nurs Pract 2019; 25 (01) e12717
- Nørøxe KB, Pedersen AF, Bro F, Vedsted P. Mental well-being and job satisfaction among general practitioners: a nationwide cross-sectional survey in Denmark. BMC Fam Pract 2018; 19 (01) 130
Address for correspondence
Publication History
Article published online:
26 June 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
References
- Jasperse M, Herst P, Dungey G. Evaluating stress, burnout and job satisfaction in New Zealand radiation oncology departments. Eur J Cancer Care (Engl) 2014; 23 (01) 82-88
- Pfaff KA, Freeman-Gibb L, Patrick LJ, DiBiase R, Moretti O. Reducing the “cost of caring” in cancer care: evaluation of a pilot interprofessional compassion fatigue resiliency programme. J Interprof Care 2017; 31 (04) 512-519
- Wentzel D, Brysiewicz P. Integrative review of facility interventions to manage compassion fatigue in oncology nurses. Oncol Nurs Forum 2017; 44 (03) E124-E140
- Spatuzzi R, Giulietti MV, Ricciuti M. et al. Quality of life and burden in family caregivers of patients with advanced cancer in active treatment settings and hospice care: a comparative study. Death Stud 2017; 41 (05) 276-283
- Pines A, Aronson E. Career Burnout: Causes and Cures. Free Press; 1988
- Sale JEM, Smoke M. Measuring quality of work-life: a participatory approach in a Canadian cancer center. J Cancer Educ 2007; 22 (01) 62-66
- Girgis A, Hansen V, Goldstein D. Are Australian oncology health professionals burning out? A view from the trenches. Eur J Cancer 2009; 45 (03) 393-399
- Probst H, Griffiths S, Adams R, Hill C. Burnout in therapy radiographers in the UK. Br J Radiol 2012; 85 (1017): e760-e765
- Jun WH, Cha KS, Lee KL. The mediating effect of depression on the relationship between social support, spirituality and burnout in family members of patients with cancer. Int J Environ Res Public Health 2021; 18 (04) 1727
- Stamm B. The concise manual for the professional quality of life scale. 2010
- Cohen S. Perceived stress in a probability sample of the United States. In Spacapan S, Oskamp S. , eds. The Social Psychology of Health. Sage; 1988: 31-67
- Goldberg DP, Williams P. A User's Guide to the General Health Questionnaire. 1988
- Topp CW, Østergaard SD, Søndergaard S, Bech P. The WHO-5 Well-Being Index: a systematic review of the literature. Psychother Psychosom 2015; 84 (03) 167-176
- Carver CS. You want to measure coping but your protocol's too long: consider the brief COPE. Int J Behav Med 1997; 4 (01) 92-100
- Tjasink M, Soosaipillai G. Art therapy to reduce burnout in oncology and palliative care doctors: a pilot study. Int J Art Ther. 2019; 24 (01) 12-20
- Wentzel DL, Brysiewicz P. A survey of compassion satisfaction, burnout and compassion fatigue in nurses practicing in three oncology departments in Durban, South Africa. Int J Afr Nurs Sci 2018; 8: 82-86
- Singh S, Farrelly A, Chan C. et al. Prevalence and workplace drivers of burnout in cancer care physicians in Ontario, Canada. JCO Oncol Pract 2022; 18 (01) e60-e71
- Maslach C. Burnout: The Cost of Caring. Prentice Hall; 1982
- Farber BA. Introduction: A critical perspective on burnout. In: Farber BA. ed. Stress and Burnout in the Human Service Professions. Pergamon; 1983: 1-20
- Van Oers H. Burnout, compassion fatigue and suicidal ideation in oncology healthcare professionals. J Surg Med. 2021; 5 (07) 718-723
- Behrani A, Nasir J, Khan R, Maqsood L, Sulaiman S. The relationship between empathy, coping strategies, and compassion fatigue in doctors. Pak J Clin Psychol 2020; 19 (02) 61-78
- Ercolani G, Varani S, Peghetti B. et al. Burnout in home palliative care: what is the role of coping strategies?. J Palliat Care 2020; 35 (01) 46-52
- Alharbi J, Jackson D, Usher K. Personal characteristics, coping strategies, and resilience impact on compassion fatigue in critical care nurses: a cross-sectional study. Nurs Health Sci 2020; 22 (01) 20-27
- Yoder EA. Compassion fatigue in nurses. Appl Nurs Res 2010; 23 (04) 191-197
- Partlak Günüşen N, Üstün B, Serçekuş Ak P, Büyükkaya Besen D. Secondary traumatic stress experiences of nurses caring for cancer patients. Int J Nurs Pract 2019; 25 (01) e12717
- Nørøxe KB, Pedersen AF, Bro F, Vedsted P. Mental well-being and job satisfaction among general practitioners: a nationwide cross-sectional survey in Denmark. BMC Fam Pract 2018; 19 (01) 130