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      Compassion fatigue among oncologists: the role of grief, sense of failure, and exposure to suffering and death

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          Abstract

          Purpose

          Oncologists cope with unique work characteristics that increase their risk of developing compassion fatigue—that is, burnout and secondary traumatic stress—and can result in reduced capacity and interest in being empathetic to the suffering of others (Stamm B. The concise ProQOL manual, 2010). At the same time, oncologists can experience compassion satisfaction—that is, the positive aspects of caring. This study explored the associations of compassion fatigue and compassion satisfaction with oncologists’ grief and sense of failure beyond their reported exposure to suffering and death.

          Methods

          Seventy-four oncologists completed self-administered questionnaires examining compassion fatigue, compassion satisfaction, grief, exposure to suffering and death, and sense of failure.

          Results

          The oncologists reported that they face the loss of approximately 50% of their patients, and that their patients suffer from profound emotional and physical pain. High levels of compassion fatigue and grief, and moderate levels of sense of failure, were reported. Findings showed a lack of association between exposure to suffering and death and compassion fatigue and satisfaction. However, grief and sense of failure were found to predict both aspects of compassion fatigue: secondary traumatic stress ( p < 0.001, p < 0.003, respectively) and burnout ( p < 0.002, p < 0.025, respectively).

          Conclusions

          These results highlight the importance of the oncologists’ subjective experiences of grief and sense of failure, beyond their reports of exposure to suffering and death, in terms of their levels of compassion fatigue. Implications of these findings include the need to develop interventions for oncologists that will allow them to acknowledge, process, and overcome negative experiences of failure and grief.

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          Most cited references17

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          Compassion fatigue: psychotherapists' chronic lack of self care.

          Psychotherapists who work with the chronic illness tend to disregard their own self-care needs when focusing on the needs of clients. The article discusses the concept of compassion fatigue, a form of caregiver burnout among psychotherapists and contrasts it with simple burnout and countertransference. It includes a multi-factor model of compassion fatigue that emphasizes the costs of caring, empathy, and emotional investment in helping the suffering. The model suggests that psychotherapists that limiting compassion stress, dealing with traumatic memories, and more effectively managing case loads are effective ways of avoiding compassion fatigue. The model also suggests that, to limit compassion stress, psychotherapists with chronic illness need to development methods for both enhancing satisfaction and learning to separate from the work emotionally and physically in order to feel renewed. A case study illustrates how to help someone with compassion fatigue. Copyright 2002 Wiley Periodicals, Inc.
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            Hidden morbidity in cancer: spouse caregivers.

            This study assesses psychological distress among advanced cancer patients and their spouse caregivers, while examining the relative contribution of caregiving burden and relational variables (attachment orientation and marital satisfaction) to depressive symptoms in the spouse caregivers. A total of 101 patients with advanced GI or lung cancer and their spouse caregivers were recruited for the study. Measures included Beck Depression Inventory-II (BDI-II), Caregiving Burden scale, Experiences in Close Relationships scale, and ENRICH Marital Satisfaction scale. A total of 38.9% of the caregivers reported significant symptoms of depression (BDI-II > or = 15) compared with 23.0% of their ill spouses (P < .0001). In a hierarchical regression predicting caregiver's depression, spouse caregiver's age and patient's cancer site were entered in the first step, objective caregiving burden was entered in the second step, subjective caregiving burden was entered in the third step, caregiver's attachment scores were entered in the fourth step, and caregiver's marital satisfaction score was entered in the fifth step. The final model accounted for 37% of the variance of caregiver depression, with subjective caregiving burden (beta = .38; P < .01), caregiver's anxious attachment (beta = .21; P < .05), caregiver's avoidant attachment (beta = .20; P < .05), and caregiver's marital satisfaction (beta = -.18; P < .05) making significant contributions to the model. Spouse caregivers of patients with advanced cancer are a high-risk population for depression. Subjective caregiving burden and relational variables, such as caregivers' attachment orientations and marital dissatisfaction, are important predictors of caregiver depression.
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              Toward an integrative perspective on bereavement.

              For nearly a century, bereavement theorists have assumed that recovery from loss requires a period of grief work in which the ultimate goal is the severing of the attachment bond to the deceased. Reviews appearing in the 1980s noted a surprising absence of empirical support for this view, thus leaving the bereavement field without a guiding theoretical base. In this article, the authors consider alternative perspectives on bereavement that are based on cognitive stress theory, attachment theory, the social-functional account of emotion, and trauma theory. They then elaborate on the most promising features of each theory in an attempt to develop an integrative framework to guide future research. The authors elucidate 4 fundamental components of the grieving process--context, meaning, representations of the lost relationship, and coping and emotion-regulation processes--and suggest ways in which these components may interact over the course of bereavement.

                Author and article information

                Contributors
                bmichalpsy@gmail.com
                Journal
                Support Care Cancer
                Support Care Cancer
                Supportive Care in Cancer
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0941-4355
                1433-7339
                8 August 2019
                2020
                : 28
                : 4
                : 2025-2031
                Affiliations
                [1 ]GRID grid.430432.2, The Academic College of Tel Aviv-Yaffo, ; Tel Aviv, Israel
                [2 ]GRID grid.22098.31, ISNI 0000 0004 1937 0503, Department of Psychology, , Bar-Ilan University, ; Ramat Gan, Israel
                [3 ]GRID grid.469889.2, ISNI 0000 0004 0497 6510, Emek Medical Center, ; Afula, Israel
                [4 ]GRID grid.415593.f, ISNI 0000 0004 0470 7791, The Talya Center for Young Women with Breast Cancer, , Shaare Zedek Medical Center, ; Jerusalem, Israel
                Author information
                http://orcid.org/0000-0002-8711-139X
                Article
                5009
                10.1007/s00520-019-05009-3
                7223813
                31392551
                3d211b17-9e0b-46a1-8c42-931513b43705
                © Springer-Verlag GmbH Germany, part of Springer Nature 2019

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 2 May 2019
                : 24 July 2019
                Funding
                Funded by: The Israel Cancer Association
                Award ID: 20180116
                Award Recipient :
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2020

                Oncology & Radiotherapy
                compassion fatigue,burnout,oncology,grief,sense of failure
                Oncology & Radiotherapy
                compassion fatigue, burnout, oncology, grief, sense of failure

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