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Job stress and job satisfaction of physicians, radiographers, nurses and physicists working in radiotherapy: A multicenter analysis by the DEGRO Quality of Life Work Group


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Ongoing changes in cancer care cause an increase in the complexity of cases which is characterized by modern treatment techniques and a higher demand for patient information about the underlying disease and therapeutic options. At the same time, the restructuring of health services and reduced funding have led to the downsizing of hospital care services. These trends strongly influence the workplace environment and are a potential source of stress and burnout among professionals working in radiotherapy. A postal survey was sent to members of the workgroup "Quality of Life" which is part of DEGRO (German Society for Radiooncology). Thus far, 11 departments have answered the survey. 406 (76.1%) out of 534 cancer care workers (23% physicians, 35% radiographers, 31% nurses, 11% physicists) from 8 university hospitals and 3 general hospitals completed the FBAS form (Stress Questionnaire of Physicians and Nurses; 42 items, 7 scales), and a self-designed questionnaire regarding work situation and one question on global job satisfaction. Furthermore, the participants could make voluntary suggestions about how to improve their situation. Nurses and physicians showed the highest level of job stress (total score 2.2 and 2.1). The greatest source of job stress (physicians, nurses and radiographers) stemmed from structural conditions (e.g. underpayment, ringing of the telephone) a "stress by compassion" (e.g. "long suffering of patients", "patients will be kept alive using all available resources against the conviction of staff"). In multivariate analyses professional group (p < 0.001), working night shifts (p = 0.001), age group (p = 0.012) and free time compensation (p = 0.024) gained significance for total FBAS score. Global job satisfaction was 4.1 on a 9-point scale (from 1 - very satisfied to 9 - not satisfied). Comparing the total stress scores of the hospitals and job groups we found significant differences in nurses (p = 0.005) and physicists (p = 0.042) and a borderline significance in physicians (p = 0.052).In multivariate analyses "professional group" (p = 0.006) and "vocational experience" (p = 0.036) were associated with job satisfaction (cancer care workers with < 2 years of vocational experience having a higher global job satisfaction). The total FBAS score correlated with job satisfaction (Spearman-Rho = 0.40; p < 0.001). Current workplace environments have a negative impact on stress levels and the satisfaction of radiotherapy staff. Identification and removal of the above-mentioned critical points requires various changes which should lead to the reduction of stress.
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Radiation Oncology
Short report
Job stress and job satisfaction of physicians, radiographers, nurses
and physicists working in radiotherapy: a multicenter analysis by
Susanne Sehlen*
, Peter Herschbach
Anja Bayerl
, Steffi Pigorsch
, Jutta Rittweger
, Claudia Dormin
Tobias Bölling
, Hans Joachim Wypior
, Franz Zehentmayr
Wolfgang Schulze
and Hans Geinitz
Department of Radiotherapy and Radiooncology, University Munich, Munich, Germany,
Department of Radiotherapy and
Radiooncology, University Würzburg/Halle, Würzburg, Germany,
Department of Radiotherapy and Radiooncology, University Regensburg,
Regensburg, Germany,
Institute of Psychosomatic Medicine, Psychotherapy and Medical Psychology, Technical University Munich, Munich,
Department of Radiotherapy and Radiooncology, Vienna, Austria,
Department of Radiotherapy and Radiooncology, Technical
University Munich, Munich, Germany,
Department of Radiotherapy and Radiooncology, University Halle, Halle, Germany,
Department of
Radiotherapy and Radiooncology, University Frankfurt, Frankfurt, Germany,
Department of Radiotherapy and Radiooncology, University
Münster, Münster, Germany,
Department of Radiotherapy and Radiooncology, General Hospital Landshut, Germany,
Department of
Radiotherapy and Radiooncology, University Salzburg, Austria and
Department of Radiotherapy and Radiooncology, General Hospital
Bayreuth, Bayreuth, Germany
E-mail: Susanne Sehlen* -; Dirk Vordermark -;
Christof Schäfer -; Peter Herschbach -; Anja Bayerl -;
Steffi Pigorsch -; Jutta Rittweger -; Claudia Dormin -;
Tobias Bölling -; Hans Joachim Wypior -; Franz Zehentmayr -;
Wolfgang Schulze -; Hans Geinitz -
*Corresponding author
Published: 06 February 2009 Received: 29 September 2008
Radiation Oncology 2009, 4:6 doi: 10.1186/1748-717X-4-6 Accepted: 6 February 2009
This article is available from:
©2009 Sehlen et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Ongoing changes in cancer care cause an increase in the complexity of cases which
is characterized by modern treatment techniques and a higher demand for patient information
about the underlying disease and therapeutic options. At the same time, the restructuring of health
services and reduced funding have led to the downsizing of hospital care services. These trends
strongly influence the workplace environment and are a potential source of stress and burnout
among professionals working in radiotherapy.
Methods and patients: A postal survey was sent to members of the workgroup "Quality of Life"
which is part of DEGRO (German Society for Radiooncology). Thus far, 11 departments have
answered the survey. 406 (76.1%) out of 534 cancer care workers (23% physicians, 35% radiographers,
31% nurses, 11% physicists) from 8 university hospitals and 3 general hospitals completed the FBAS
form (Stress Questionnaire of Physicians and Nurses; 42 items, 7 scales), and a self-designed
questionnaire regarding work situation and one question on global job satisfaction. Furthermore, the
participants could make voluntary suggestions about how to improve their situation.
Results: Nurses and physicians showed the highest level of job stress (total score 2.2 and 2.1).
The greatest source of job stress (physicians, nurses and radiographers) stemmed from structural
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BioMed Central
Open Access
conditions (e.g. underpayment, ringing of the telephone) a "stress by compassion" (e.g. "long
suffering of patients", "patients will be kept alive using all available resources against the conviction
of staff"). In multivariate analyses professional group (p < 0.001), working night shifts (p = 0.001),
age group (p = 0.012) and free time compensation (p = 0.024) gained significance for total FBAS
score.Globaljobsatisfactionwas4.1ona9-pointscale(from1very satisfied to 9 not satisfied).
Comparing the total stress scores of the hospitals and job groups we found significant differences in
nurses (p = 0.005) and physicists (p = 0.042) and a borderline significance in physicians (p = 0.052).
In multivariate analyses "professional group" (p = 0.006) and "vocational experience" (p = 0.036)
were associated with job satisfaction (cancer care workers with < 2 years of vocational experience
having a higher global job satisfaction). The total FBAS score correlated with job satisfaction
(Spearman-Rho = 0.40; p < 0.001).
Conclusion: Current workplace environments have a negative impact on stress levels and the
satisfaction of radiotherapy staff. Identification and removal of the above-mentioned critical points
requires various changes which should lead to the reduction of stress.
and financial changes. Ongoing changes to cancer care
include an increase in the complexity of cases, available
treatment options and better informed patients. One
important new stressor is the increasing complexity of
multimodal cancer treatment with difficulties for the
individual health professionals to govern the treatment
in all its details [1-6]. Especially in radiation oncology
treatment has become progressively more complex
within the past 10 to 15 years. Additional challenges
are added with the growing proportion of cancer in the
elderly caused by an augmented life expectancy in
developed countries. At the same time health services
restructuring and reduced public spending has lead to
downsizing of hospital care services [7]. These factors
contribute to an increased individual workload for the
hospital staff.
Breaking bad news is one of a radiotherapists most
difficult duties, yet medical education typically offers
little formal preparation for this important task [8, 9].
Without proper training, the discomfort and uncertainty
associated with breaking bad news may lead physicians
to emotionally distress.
Distress can lead to erosion of patient compliance which
generates new distress for hospital staff [7]. [10]. In
oncology additional strain is produced by the frequency
of the deliverance of bad news and dealing with patient's
death and suffering [11].
These imbalances with increasing demand of human and
material resources on the one hand side and a lack of
sufficient financial sources on the other side have
produced a negative influence on the workplace envir-
onment and are potential sources of stress and burnout
of cancer care workers in radiotherapy [12]. The impetus
for the study was to analyze factors for stress and job
satisfaction of cancer care workers within the context of
different radiotherapy departments in Germany and
Methods and study populations
Recruiting of radiotherapy facilities
Radiotherapy facilities were recruited via the working
group "quality of life" (Arbeitskreis "Lebensqualität")
within the German Society of Radiation Oncology
(DEGRO). Members of the working group were asked
whether they were willing to locally carry out the study
within their department ("local study coordinator").
Each local study coordinator was responsible for the
information and mobilisation of the cancer care workers
(physicians, radiographers, nurses, physicists) within his
radiation oncology facility as well as for the distribution
and recollection of the questionnaires. The local study
coordinators were mailed a study protocol that provided
guidelines for recruiting the participants and the ques-
tionnaires (see below). In addition they were asked to
collect data on the clinic equipment, number of cancer
care workers and patient load. The questionnaires could
be allocated to the participating centre but not to the
individual. For each hospital the works committees gave
consent to proceed with the study. The study was carried
out from August 2006 to February 2007.
Each cancer care worker was asked to give basic data on
the category of her/his professional group, her/his age
(four categories), gender, years of vocational experience
(four categories), wether she/he was working night shifts
or working on weekends and if she/he was getting free
time compensation.
Radiation Oncology 2009, 4:6
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Job stress was evaluated with the "Fragebogen zur
Belastung von Ärzten/Ärztinnen und Krankenpflegekräf-
ten" ("Questionnaire for Ascertaining Stress on Doctors
and Nurses", Herschbach 1989 [13]). The validated
questionnaire comprises 42 items. Each item was self-
scored with the five categorized answers "not at all", "a
little", "a little more", "quite a bit", or "a lot". Higher scores
are associated with higher stress. The questionnaire is
subdivided into 5 scales: "structural conditions" (e. g.
"underpayment", "permanent ringing of the telephone"),
"stress by compassion" (e.g. "against the conviction
patients were kept alive with all resorts"), "problems with
colleagues", "inconvenient patients" and finally "profes-
sional/private life" (e.g. "disruption of home life through
spending long hours at work"). In addition a total score
was built comprising of all 42 items (Fig. 1).
Figure 1
" Stress Questionnaire of physicians and nurses (FBAS), Herschbach 1989.
Radiation Oncology 2009, 4:6
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Global job satisfaction was evaluated with an ad hoc
constructed one dimensional scale with nine categorical
answers (1: very high job satisfaction to 9: total job
Data analysis
The data analysis was carried out with the programme
SPSS14. for Windows. Influencing factors on job stress
and satisfaction were analyzed using the Mann-Whitney
Test or the Kruskall Wallis Test. Stepwise multiple linear
regression analysis was performed for multivariate
analyses. All tests were carried out two-sided. A p-level
of 0.05 or below was considered to be significant.
11 radiotherapeutic treatment facilities in Germany and
Austria participated in the study (8 universities, 3 general
hospitals) comprising 534 cancer care workers. The
overall response rate was 76.1% (n = 406), characteristics
of the participants are given in table 1.
Job stress
Nurses and physicians showed the highest levels of job
stress (mean FBAS total score 2.2 and 2.1, respectively),
whereas radiographers (mean total score 1.7) and
physicists (mean total score 1.0) disclosed lower levels
of job stress (p < 0.001) (table 2). For physicians, nurses
and radiographers the highest stress rates were caused by
"structural conditions" and "stress by compassion"
(table 2). Physicists reported in all low stress levels
with the highest score values in the scales "structural
conditions" and "problems with colleagues". On the
item level the four greatest sources of physician's job
stress were" too much office work" (mean score 3.4),
"time pressure" (mean score 3.36), "ill-defined respon-
sibilities" (mean score 3.13) and "breaking off the
conversation with the patient" (mean score 3.10). For
nurses the greatest stress factors stemmed from "perma-
nent ringing of telephone" (mean score 3.53), "against
the conviction patients were kept alive by all means"
(mean score 3.22), "underpayment" (mean score 3.21)
and "time pressure" (mean score 3.11). Radiographers
rated the following items as the most stressing: "against
the conviction patients were kept alive by all means"
(mean score 2.88), "stress due to patient's disease
progression" (mean score 2.79), "high physical work-
load" (mean score 2.76) and "patients suffering of my
therapy" (mean score 2.74). Physicists expressed as
sources of stress "time pressure" (mean score 2.82),
"underpayment" (mean score 2.34), "ill-defined respon-
sibilities" (mean score 2.19) and "reduction of private
life through high workload" (mean score 2.16) (table 3).
Besides professional group the following variables were
tested for their association with the FBAS total stress score
and with 5 FBAS scales: age category (20-<30, 30-<40, 40-
<50, 50-<60, 60 years) gender, vocational experience (<2,
Table 1: Participants' characteristics
N (total n = 406) percent
professional groups
physicians 82 22,7
nurses 113 31,2
radiographers 128 35,4
physicists 39 10,8
not available 44
female 285 73,6
male 102 26,4
not available 19
age categories
2029 years 93 23,4
3039 years 113 28,5
4049 years 120 30,2
5059 years 65 16,4
60 years 6 1,5
not available 9
< 2 years 52 13,0
2-<5 years 65 16,3
5-<10 years 87 21,8
10 years 196 49,0
not available 6
work load
160 hours/months 225 58,3
> 160 hours/months 161 41,7
not available 20
Working night
no 267 69,9
yes 115 30,1
not available 24
Free time
no 116 28.9
yes 286 71.1
not available 4
Working on
no 195 50,6
yes 190 49,4
not available 21
Night call/weekend
call duties
no 304 80,4
yes 74 19,6
not available 28
Radiation Oncology 2009, 4:6
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2-<5, 5-<10, 10 years), work load (160 vs. > 160 hours/
months), working night shifts (yes vs. no), Night call/
weekend call duties (yes vs. no), working on weekends (yes
vs. no) and possibility of free time compensation (yes vs.
no). In univariate analysis the the following variables were
associated with more job stress: total FBAS score: working
night shifts (p < 0.001) and working on weekends
(p < 0.001); "structural conditions": working night shifts
(p < 0.001), working on weekends (p < 0.001) and no free
time compensation (p = 0.013); "stress by compassion":
female gender (p = 0.038), working night shifts (p < 0.001)
and working on weekends (p < 0.001); "problems with
colleagues": age < 50 years (p = 0.024); "inconvenient
patients": working night shifts (p < 0.001) and working on
weekends (p < 0.001); "professional/private life": male
gender (p = 0.006), working night shifts (p < 0.001), Night
call/weekend call duties (p < 0.001), working on weekends
(p < 0.001), no free time compensation (p < 0.001) and
working more than 160 hours/months (p = 0.001).
Comparing the total stress scores of the hospitals and job
groups we found significant differences in nurses
(p = 0.005) and physicists (p = 0.042) and a borderline
significance in physicians (p = 0.052) (Figure 2).
In addition to the above mentioned variables the
hospital was included in the multivariate analyses. The
following parameters gained significance: total FBAS
score: professional group (p < 0.001), working night
shifts (p = 0.001), age group (p = 0.012) and free time
compensation (p = 0.024); "structural conditions":
professional group (p < 0.001), working on weekends
(p = 0.005) and working night shifts (p = 0.042); "stress
by compassion": professional group (p < 0.001), no
free time compensation (p < 0.001) and age group
(p = 0.032); "problems with colleagues": age
group (p = 0.046); "inconvenient patients": professional
group (p < 0.001), age group (p < 0.001), no free time
compensation (p < 0.001) and working night shifts
(p < 0.001); "professional/private life": working on
weekends (p = 0.002), working night shifts (p = 0.003),
professional group (p = 0.015) and no free time
compensation (p = 0.005).
Table 2: FBAS stress items and profession
Item Total Physician
Mean SD
Mean SD
Mean SD
Mean SD
"too much office work" 2.15 3.40 2.39 1.21 2.15
±1.73 ±1.42 ± 1.69 ± 1.48 ± 1.45
"having conflicting demands on the time" 2.95 3.36 3.11 2.70 2.82
±1.62 ±1.47 ±1.76 ±1.57 ±1.50
"illdefined responsibilities" 2.57 3.13 2.78 2.15 2.19
±1.67 ±1.52 ± 1.60 ± 1.73 ± 1.65
"breaking off a conversation with the patient" 2.40 3.10 2.80 2.17 0.31
±1.68 ±1.54 ± 1.52 ± 1.60 ± 0.87
"disruption of home life through spending long
hours at work"
1.88 2.82 1.31 0.88 2.16
± 1.89 ± 1.93 ± 1.66 ± 1.54 ± 1.78
"underpayment" 2.89 3.07 3.21 2.64 2.34
± 1.74 ± 1.74 ± 1.67 ±1.74 ±1.74
"permanent ringing of telephone" 2.70 2.76 3.53 2.26 1.76
± 1.74 ± 1.78 ± 1.46 ± 1.83 ± 1.62
"against the conviction patients were kept
alive with all resorts"
2.45 1.37 3.22 2.88 0.70
± 1.88 ± 1.62 ± 1.79 ±1.69 ±1.16
"stress due to patient's disease progression" 2.71 2.71 2.93 2.79 1.21
± 1.42 ± 1.35 ± 1.41 ± 1.21 ±1.62
"high physical workload" 2.18 1.16 2.84 2.76 0.64
± 1.66 ± 1.38 ± 1.69 ± 1.33 ±0.90
"patients suffering of my therapy" 2.20 1.93 2.23 2.74 0.42
± 1.67 ± 1.51 ± 1.77 ± 1.53 ±1.09
Radiation Oncology 2009, 4:6
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Job satisfaction
Like job stress satisfaction was associated with profes-
sional group: physicists had the highest satisfaction
values whereas the other professional groups had clearly
lower levels without much difference in between the
three groups (figure 3). There were no other factors that
were associated with job satisfaction in univariate
In multivariate analyses "professional group" (p =
0.006) and "vocational experience" (p = 0.036) were
associated with job satisfaction, with cancer care workers
with less than two years of vocational experience having
a higher global job satisfaction. The total FBAS score
correlated with job satisfaction (Spearman-Rho = 0.40;
p < 0.001).
In this paper we report on job stress and job satisfaction
of cancer care workers in radiation oncology clinics in
Germany and Austria. Although the sample of hospitals
Table 3: FBAS scales/total score and job stress
scale Mean Standard deviation Significance
structural conditions physician 2.5856 .98258
nurse 2.7603 1.13287 P < 0.001
radiographer 2.0297 .94769
physicist 1.4447 .91103
compassion physician 2.1598 .85505
nurse 2.2913 .98817 P < 0.001
radiographer 2.0265 .79141
physicist .8518 .75022
inconvenient patients physician 2.0434 .88469
nurse 2.1789 1.02272 P < 0.001
radiographer 1.5164 .78164
physicist .3110 .65245
job/private life physician 1.8317 1.35409
nurse 1.5705 1.31611 P < 0.001
radiographer .5515 .80870
physicist 1.0128 .97877
problems with colleagues physician 1.7175 1.02362
nurse 1.7637 1.07077 n.s.
radiographer 1.8832 1.08493
physicist 1.4808 1.15781
total score physician 2.1368 .78242
nurse 2.2125 .89627 P < 0.001
radiographer 1.7320 .70041
physicist .9616 .64292
physicians nurses radiographers physicists
Figure 2
Total score of job stress- profession group and clinic
n.s not significant.
Figure 3
Satisfaction and professional group.
Radiation Oncology 2009, 4:6
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is not representative for all radiation therapy facilities in
both countries the collected data fits to previously
published reports in other countries. This is the first
published survey of its kind conducted in German
speaking countries. Considering the high response rate
the data should adequately mirror job stress in the 11
participating hospitals and could serve as a source for
generating hypotheses. Since nearly three quarters of the
participating centres were university hospitals extrapola-
tion to non-university facilities should be carried out
with caution.
The findings of our study indicate that job stress levels
vary between professional groups. Physicians and nurses
rated their job stress higher than radiographers and
medical physicists. Job stress also stemmed from
different sources in between professional groups: physi-
cians, nurses and radiographers were mostly stressed by
structural conditions and compassion while physicists
were stressed -although by a much lower level- by
structural conditions and problems with colleagues. This
is in line with the lower patient contacts of physicists in
routine clinical work. Since the total stress score
correlated with satisfaction medical physicists also
disclosed higher job satisfaction levels than the other
professional groups.
With the aging of the population there will be a growing
demand to recruit health care professionals -especially in
oncology. On the other hand birth rates are low almost
all over the European Union [14]. and will most likely
result a shortage in skilled personnel within the next
years. The health care system has to find ways to attract
young people to find their professional career within this
system and -almost as important- to provide conditions
that they stay within this vocation. Job stress is an
important factor for cancer care workers to consider
alternative work situations [15].
Job stress in itself is not only disturbing for the working
health care individual but can also have a profound
effect on the interaction with the patient considering that
patient in oncology, especially in radiotherapy, have a
high stress level distress [16-18]. Increasing evidence
suggests that physician distress can lead to erosion of
physician compassion [1, 19], patient compliance [10]
and the quality of care physicians deliver [1, 20].
Physicians under stress are reported to have a higher
tendency in treating patients poorly both medically and
psychologically [21]. They are also more likely to make
errors of judgement.
Personal, interpersonal and organisational factors have
been reported to relate to job stress. One of the
organisational factors that required a highly increased
workload from health professionals in the past years is
documentation. Einhorn et al. conducted a postal survey
in 2.493 US oncologists [22]. They report that increased
documentation caused the greatest concern among
respondents and negatively influenced job satisfaction.
More than 40% reported that high documentation
workload lead to diminished patient care and decreases
in teaching (48%) and research (39%). In concordance
with the results of Einhorn et al. [22]. physicians in our
study ranked "too much office work" as the highest job
stressor greatly surpassing other factors commonly
thought to be associated with job strain in oncology
like "stress due to patient's disease progression".
Further important structural conditions that caused high
stress among participants weretimepressure("having
conflicting demands on the time", "breaking off a
conversation with the patient" and "permanent ringing
of the telephone") as well as "underpayment" and "high
physical workload". Grunfeld et al. carried out a survey
in 681 cancer care workers in Ontario [15]. They found
that "having too great volume of work", "having
inadequate staffing to do the job properly", ""feeling
under pressure to make deadlines" and "having conflict-
ing demands on time" were mayor derminants of job
stress. Ernst and colleagues surveyed 249 pediatric nurses
and found that pay was one of the mayor determinants
of job stress [23].
Cancer care workers in our study reported more job
distress when they were working night shifts, and
weekends or were not getting free time compensation
for working long hours. Data from Ǻrkerstedt et al.
support the notion that night time work is hazardous to
a persons' long term well being [24]. For physicians,
nurses and radiographers "structural conditions" and
"patient-compassion" were the major causes of their
stress. Documentation/paperwork decreases the ability
of cancer care workers to spend time with their patients.
Growing incidence of stress by medical specialists can be
caused by recent changes in society. Patients are better
informed, more critical and better protected by law [25].
In addition job security has diminished and plays a
major role. Grunfeld et al. [15]. in their analysis of 681
cancer care workers in Canada disclosed that job stress
increased with workload. To reduce job stress of cancer
care workers in radiation oncology measures should be
undertaken to improve the structural conditions within
the departments. Such measures could be: better defini-
tions of responsibilities for the individual cancer care
worker, delegation of office work to other professional
groups (e. g. data managers, secretaries), optimization
of work processes (quality management) and training of
communication skills and conflict solving strategies of
all professional groups. Several authors showed for
Radiation Oncology 2009, 4:6
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example that stress for hospital nurses correlated with
conflict of doctors [26]. They have to accept that death is
an intrinsic factor of their profession. Thus cancer care
workers have to learn to function at an optimal
emotional and intellectual level despite such strong
stressors [27]. A better balance may be obtained between
Stress by compassion and inconvenient patients were
higher among nurses than among physicians and radio-
graphers. In agreement with other investigators we found
factors that may be greater sources of stress for women
physicians [28]. "The cancer care workers in this survey
felt that the mean level of stress in dependence of years
of vocational experience was similar. These response
suggest that the stress does not get better after comple-
tion of training. Efforts to debunk the myth of "things
getting better" early in training and instead emphasize
the importance of developing balance and strategies for
promoting personal wellness may be warranted" [16].
Although the response rate is high for a physician survey,
response bias remains a possible confounding factor
[29]. Objective job stress like the actual number of hours
the participants had to work or if they were on
temporary employment was not directly measured in
this survey but the fact that subjective job stress
correlated with working night shifts and working week-
ends does indicate that both measures -objective and
subjective- are closely related.
Job stress in this sample of cancer care workers in
radiation oncology departments is highly determined by
structural conditions followed by problems related to
patient compassion. As in Germany and Austria health
care workers and in particular physicians are in short
supply opinion leaders in health care politics and hospital
administrators should try to focus their attention on how
to improve structural conditions and job satisfaction for
this group of professionals. Besides of accepting job stress
as a problem in the field of health care future studies and
strategies might encompass a reduction of the individual
work load, optimization of work processes, a shift of
office work onto other professional groups, training of
communication and conflict solving skills and strategies
for promoting personal wellness and an even balance of
professional and private life.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
SS and HG conceived of the study, and participated in its
design and coordination, performed the statistical
analysis and drafted the manuscript. DV and CS
conceived of the study, participated in its design and
coordination, carried out the analysis in the centres and
drafted the manuscript. AB, SP, JR, CD, TB, HJW, FZ and
WS carried out the analysis in the different centres. PH
conceived of the study, participated in its design and
drafted the manuscript.
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... Low wages are a 'burnout increasing' factor for many nursing groups and other care workers. Moreover, long working hours, for the same pay, can contribute to resentment and burnout (Sehlen et al., 2009). ...
... Another study with ICU nurses found that loud noises were significantly linked to worker detachment from work (Erne et al., 2022). The continuous sound of a phone was considered a major contributing factor to burnout in nurses in oncology wards (Sehlen et al., 2009). ...
... In German cancer care workers, including nurses, work-related stress are primarily associated with increased working hours and high physical workload (Sehlen et al., 2009). Yet, it is noteworthy that the study of Madathil et al., (2014) on 89 nurses working in hospitals in Montana and New York, showed no correlation between high workload and burnout. ...
Full-text available
Background: Professional burnout is usually found in the working environment and affects almost all professional groups, such as nurses, civil servants, educators and many others who may experience moderate to severe cases of burnout symptoms. Although burnout can be found in all professional groups, it is most noticeable among professionals whose work involves constant demands coupled with intense interaction with individuals or groups who have demanding physical and emotional needs. Aim: The general purpose of this review is to investigate the risks and factors that contribute to burnout in nursing staff. Within this context, the specific objectives include the following: Methods: For this critical review's needs, relevant articles were found by searching PubMed using specific seven key words in 12 separate combinations (sub-searches). Thus, PubMed was chosen because this particular database is considered inclusive enough to meet the needs of this review and the search was conducted in English, from 2000 to date. Results: Perusal of the papers per se, leads to a categorization of four major groups and thirteen sub-themes. Thus, this critical review uncovers four main factors that predispose nurses to burnout, namely: Working conditions; Interpersonal factors; Environmental factors and Interactions. Discussion: All nurses the clinical workplace creates a small community. Social support between workers minimizes conflicts in the workplace while increasing productivity. If interpersonal relationships between workers are absent or destroyed, by either work environment factors, negative colleagues or supervisors with poor leadership skills, not only is the peaceful cohabitation between workers lost, but also the organization itself is undermined. Conclusions: It has been recognized by many studies that a positive workplace climate for nurses can play a key role in preventing burnout. A positive working ethos includes supportive relationships between nurses, the head of unit, medical staff, and overall positive leadership style, within an optimum team work spirit in order to prevent or diminish burnout.
... The sum of the scores obtained at seven subscales defines a total score (workability index) that can range from 7 to 49. The WAI score can also be traced to 4 macro-categories: poor (range: 7-27), medium (28)(29)(30)(31)(32)(33)(34)(35)(36), good (37)(38)(39)(40)(41)(42)(43), and very good (44-49). ...
... By contrast, physicians seem maintain a good workability, which can in part be ascribed to the lower physical demand of their tasks [23] and/or to the fact that these workers are less exposed to prolonged direct contact with patients on a routine basis [35]. Another possible reason for this phenomenon may be related to a higher job satisfaction and a greater control over their work tasks, two determinants that are generally found more frequently among physicians than other healthcare professionals. ...
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Healthcare workers’ age is increasingly rising, negatively affecting their physical health. In particular, workability is an emerging phenomenon that predominantly affects healthcare workers. This study aims to assess physical health status and workability among ageing healthcare workers. A cross-sectional study using the Work Ability Index (WAI) was performed. Data were collected in a university hospital in northern Italy. Data were collected voluntary through a questionnaire. Healthcare workers participating in the survey were contacted personally by two resident physicians. Thus, the total number of study participants was 220 among nursing aides, nurses, and physicians. Data were analyzed by performing ANOVA and regression to assess the differences between the healthcare workers and age groups. A generalized linear model was tested to evaluate the effect of age and task on workability. The majority of healthcare workers had good WAI values. Physicians’ workability was higher than nursing aides. Nursing aides suffered more from cardiovascular disorders, while physicians and nurses had more musculoskeletal disorders. However, the distribution was statistically different (χ2 = 24.03, p = 0.00), as most of the physicians’ workability values were good and good, while those of nursing aides and nurses were good and medium. In line with previous studies, the decrease in WAI with ageing is strictly dependent on the type of task assigned. Due to heavy physical tasks, nurses and nurses’ aides showed a greater WAI than physicians. This study highlights the critical issues faced by ageing healthcare professionals. In the near future, it is necessary to find solutions to cope with these changes and devise possible interventions aimed at ameliorating workability.
... Burnout is characterized by emotional exhaustion, depersonalization, and loss of self-worth [31]. Up to 50% of doctors and nurses report symptoms of burnout [32][33][34] with health care organizations cited as a leading cause [35][36][37][38][39][40]. In this longitudinal prospective survey-based study of healthcare workers during the COVID-19 pandemic, higher POS was associated with lower anxiety and risk for burnout. ...
... While previous studies have demonstrated that providers frequently cite organizational causes of burnout [3,[36][37][38][39][40]; characteristics of the person may also contribute to burnout during periods of crisis [43]. We identified several individual factors that were associated with risk for burnout. ...
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Background: Professional burnout represents a significant threat to the American healthcare system. Organizational and individual factors may increase healthcare providers' susceptibility or resistance to burnout. We hypothesized that during the COVID-19 pandemic, 1) higher levels of perceived organizational support (POS) are associated with lower risk for burnout and anxiety, and 2) anxiety mediates the association between POS and burnout. Methods: In this longitudinal prospective study, we surveyed healthcare providers employed full-time at a large, multihospital healthcare system monthly over 6 months (April to November 2020). Participants were randomized using a 1:1 allocation stratified by provider type, gender, and academic hospital status to receive one of two versions of the survey instrument formulated with different ordering of the measures to minimize response bias due to context effects. The exposure of interest was POS measured using the validated 8-item Survey of POS (SPOS) scale. Primary outcomes of interest were anxiety and risk for burnout as measured by the validated 10-item Burnout scale from the Professional Quality (Pro-QOL) instrument and 4-item Emotional Distress-Anxiety short form of the Patient Reported Outcome Measurement Information System (PROMIS) scale, respectively. Linear mixed models evaluated the associations between POS and both burnout and anxiety. A mediation analysis evaluated whether anxiety mediated the POS-burnout association. Results: Of the 538 participants recruited, 402 (75%) were included in the primary analysis. 55% of participants were physicians, 73% 25-44 years of age, 73% female, 83% White, and 44% had ≥1 dependent. Higher POS was significantly associated with a lower risk for burnout (-0.23; 95% CI -0.26, -0.21; p<0.001) and lower degree of anxiety (-0.07; 95% CI -0.09, -0.06; p = 0.010). Anxiety mediated the associated between POS and burnout (direct effect -0.17; 95% CI -0.21, -0.13; p<0.001; total effect -0.23; 95% CI -0.28, -0.19; p<0.001). Conclusion: During a health crisis, increasing the organizational support perceived by healthcare employees may reduce the risk for burnout through a reduction in anxiety. Improving the relationship between healthcare organizations and the individuals they employ may reduce detrimental effects of psychological distress among healthcare providers and ultimately improve patient care.
... Department of Psychology, Medical University of Lublin, Poland ness, trust and kindness. It causes that the patient becomes a participant, not the subject of activities, and also leads to the creation of a situation in which the recipient of care receives a lot of support, experiencing a sense of security and understanding [10,15]. ...
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Introduction. Burnout and empathy affect employees in social professions due to the demanding work environment. Characterized, among others, by: stress, experiencing failure, workload and its multitasking. At the same time, social professions require high interpersonal skills, active listening, communication, empathy, patience and interest from people who practice them. Aim. The aim of the study was to analyze the influence of occupational burnout on showing empathy among medical personnel towards patients. Material and methods. The research was conducted among a group of 104 nurses and 103 doctors, working in hospitals and clinics located in urban areas. The nurses’ mean age is 37,35 (SD=11.32), the doctors’ mean age is 32.50 (SD=8.29).The surveyed persons completed a set of questionnaires: Self-authorship sheet for collecting sociodemographic data, Link Burnout Questionnaire by Massimo Santinello, and Personal Empathy Questionnaire by Zenon Uchnast. Results. The conducted research shows a negative correlation between occupational burnout and the empathy of medical personnel. Research also shows that burnout affects younger medical staff with a short period of work and wage-driven. On the other hand, empathy is visible above the age of 40. Conclusion. The research deepened the knowledge about the factors of burnout, which have an impact on the negative perception of development opportunities, failure to perceive work efficiency and the perception of the professional situation as significantly exceeding the individual’s abilities. Negative correlations between burnout and staff empathy indicate a lack of burnout in empathetic people. However, you should bear in mind that having mature empathy protects you from burnout.
... Individual semi-structured interviews were conducted with stakeholders including experts, managers, or other leaders in the field. The interview questions were based on literature, following a scoping review [19][20][21][22][23] . The interview questions were reviewed by the research team and were cross referenced with similar content from the scoping review. ...
The COVID-19 pandemic has had an exceptional impact on the healthcare profession, and in particular, on the mental health and wellbeing of healthcare workers. The Canadian Association of Medical Radiation Technologists (CAMRT) has been working on ways to prioritize the mental health of their members while increasing advocacy efforts. Conducting a national survey on mental health and interviewing medical radiation technologists (MRTs) highlighted the challenges that exist while also informing which support system components are most needed to improve wellbeing. The purpose of the research is to share the lived experience of Canadian MRTs in relation to their mental health during the pandemic. It adds to the knowledge gained from the survey by exploring in depth accounts of what MRTs felt and experienced during COVID-19. Understanding this challenging time period may aid in developing additional resources and support for MRTs in the workplace. The overall message in healthcare should be, optimize your wellbeing and your patients will be taken care of too. Recommendations to foster this message includes empowering MRTs to advocate for their mental health and wellbeing, promoting timely and adequate supports, monitoring the mental health of our professional landscape and welcoming others to join the conversation. This paper examines what mental health supports are recommended by the MRTs who were interviewed, and the information gathered from the CAMRT Mental Health of Medical Radiation Technologists in Canada 2021 Survey.
... Evidence of the many ways in which the COVID-19 pandemic has affected all aspects of life is continuously being published. Research has identified that pre-pandemic, radiographers and other healthcare professionals were suffering the effects of occupational stress, fatigue and burnout [15][16][17] . To date the wellbeing amongst interventional radiographers during the pandemic has not been assessed. ...
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Background Interventional radiographers have substantially contributed to patient care during the pandemic by providing imaging guidance during minimally invasive procedures. The aim of this research is to quantify the impact of the pandemic on an interventional radiographers’ wellbeing during the COVID-19 pandemic. Methods Ethical approval was the outset of this study. An explanatory sequential mixed methods approach, using questionnaires and interviews, was used to explore and evaluate interventional radiographers wellbeing; physical, mental and social. An electronic self-administered questionnaire was administered to interventional radiographers and a semi-structured interview was conducted on two respondents. Results Responses were received from 40 interventional radiographers. Physical, mental and social wellbeing of interventional radiographers deteriorated since the onset of COVID-19. All forms of wellbeing were negatively impacted during the pandemic with mental wellbeing (82.5%) the most impacted, closely followed by physical (75%) and social wellbeing (50%). Half of responding interventional radiographers reported being “highly stressed” while working during COVID-19. Physical activity levels decreased, caffeine consumption increased and consumption of a healthy diet decreased. Almost all interventional radiographers (95%) had anxiety about passing the virus onto family or friends and 60% of noted a deterioration in relationship with friends. Three key themes identified included the importance of teamwork, the physical demand and mental impacts of working in interventional radiology during the pandemic. Conclusions The COVID-19 pandemic has had a negative effect on interventional radiographers wellbeing. The implications of staff having a diminished sense of wellbeing is that productivity is likely to have been reduced and potentially related burnout can lead to illness. This research highlights the need to focus on identifying methods of addressing the shortcomings in support services and identifying the specific needs of interventional radiographers to improve their wellbeing.
... Susanne Sehlen et al (2009) in his research indicated that physicians and nurses rated their job stress higher that radiographers and medical physicists. Physicians, nurses and radiographers were mostly stressed by structural conditions and compassion while physicists were stressed although by a much lower level by structural conditions and problems with colleagues. ...
Full-text available
This study investigates the relationship between job stress, job satisfaction and health among Medical Laboratory Technicians in Tirunelveli city, Tamilnadu. The sample consists of 100 Medical Laboratory Technicians from 20 leading private hospitals and 10 Diagnostic centers at Tirunelveli city. Purposive sampling technique has been adopted. The study has ranked the various types of stressors including Medical Laboratory technicians' specific stressors. Simple average, weighted average and chi square test have been used to analyze the data. Hypothesis has been framed and tested to find the association of demographic variables and stressors and job satisfaction. The results show that there is no significant relationship between sex and Medical Laboratory Technicians' specific stressors. There is no a significant relationship between marital status and organization related stressors. There is a significant relationship between educational qualification and job satisfaction. Impact of stress on job satisfaction and health has been ranked. The study has ranked the coping style being followed by the Medical Laboratory Technicians. The study has given suitable suggestions to reduce the work stress and improve the job satisfaction and health.
Full-text available
يتعرض القطاع الصحي في العراق في الوقت الراهن الى معوقات متعددة، وبخاصة المستشفيات، وقد انعكس ذلك على أداء الأطباء الاختصاص الذين تعتمد على خدماتهم المستشفيات، ويعد الأطباء الاختصاص هم ثروة لابد من المحافظة عليها وتنميتها، ولكن للأسف يتعرض هؤلاء الأطباء الى ضغوط متنوعة، منها ضعف وعي المجتمع وتفشي الطابع القبلي في المحافظات العراقية، ولذلك يتعرض الأطباء الى ضغوط بالاعتداء بعض الأحيان، ومن ناحية أخرى وجود نقص في الملاكات الطبية وقد برزت هذه المشكلة اثناء تفشي جائحة كورونا، وبرزت عوامل أخرى وهي قلة المستلزمات والأجهزة الطبية، وقد برزت ظاهرة الدوران الوظيفي الخارجي للأطباء الاختصاص، مما انعكس على أداء المستشفيات في محافظة ذي قار عينة البحث، وتأتي أهمية البحث الحالي في تشخيص الأسباب الأساسية من هجرة الأطباء من المستشفيات وضعف اداءهم وتلكؤ في أداء واجباتهم الوظيفية، لذا يهدف البحث إلى تشخيص ضغوط العمل من وجهة نظر الاطباء الاختصاص في المستشفيات ومدى انعكاسه على الرضا الوظيفي. ونسعى الى تطوير نموذج لقياس ضغوط العمل ومدى تأثيره على الرضا الوظيفي، واستكشاف اي من ابعاد ضغوط العمل اكثر تأثيرا في الرضا الوظيفي. تم الاستعانة بالمنهج الوصفي الاستطلاعي، للتعرف على اراء الأطباء بخصوص ضغوط العمل والرضا الوظيفي، وكانت الاستبانة هي الأداة الرئيسة لجمع البيانات، وقد اتم اختيار ثلاث مستشفيات مهمة من مستشفيات محافظة ذي قار، وهي (مستشفى الحسين العام التعليمي، ومستشفى محمد الموسوي، ومستشفى الحبوبي العام التعليمي)، والتي تخدم ما يقارب (815) سريرا، وقد تم استهداف الأطباء الاختصاص كونهم الاكثر تحملا للمسؤولية، وجرى اختبار الفرضيات من خلال استخدام بعض المعالجات الاحصائية، لقد تم توزيع الاستبانة على 68 طبيبا، واسفرت النتائج الى وجود ضغوط عمل عالية لدى الأطباء العاملين في المستشفيات الحكومية، وقد انعكس عبء العمل وصراع الدور وانعدام العدالة التنظيمية الى انخفاض في مستوى رضا الأطباء العاملين في المستشفيات المبحوثة في محافظة ذي قار. توصل البحث إلى اتفاق العينة على ان ضغوط العمل في المستشفيات الحكومية تؤدي الى عدم رضا الأطباء في مستشفياتهم، وهذا يولد انخفاض الأداء والتوتر في العمل، وقد أظهرت النتائج ان صراع الدور وعبئ العمل وعدم العدالة في الوظيفة تؤدي الى المزيد من ضغوط العمل. يبين هذا البحث اسباب ضغوط العمل على الاطباء الاختصاص في المستشفيات الحكومية، ومحاولة معالجة الاسباب وتوفير بيئة عمل ملائمة تعزز من اداء الاطباء في المستشفيات . تتعهد هذه الدراسة بمساعدة مقدمي الخدمة الصحية في القطاع الصحي لمعالجة التحدي المتمثل في زيادة ضغوط العمل والعمل على الحد منها، وتعزيز الرضا الوظيفي للاطباء.
Nurses are among the occupational groups that experience the most intense work stress since they provide care to a stressful group that is sick or at risk of illness. Stigmatization is one of the factors that negatively affect the working life and the functioning of the environment. A high tendency to stigmatize can further increase work stress on employees. The study was conducted in a descriptive and relationship-seeking manner in order to determine the levels of nurses' job stress and tendency to stigmatize, and the relationship between job stress and stigma tendency. The study was carried out with 245 nurses working in a university hospital. The study data were obtained using the personal information form, the Work Stress Scale and the Stigmatization Scale. It was determined that the average score of the nurses' Work Stress Scale is 2.44 ± 0.54 and 75.9% of them have a stress level that creates a stimulus effect and increases success. It was found that the levels of nurses' psychological stigma tendency (49.11 ± 12.00) were below the average; It was found that 31.8% of them had high stigma tendency levels. It has been determined that the Stigmatization Scale of nurses gives the highest scores to the items "Employees with more seniority like to establish authority over young people", "I do not meet with a person whose lifestyle does not suit me outside of work" and "The efficiency of the elderly personnel in the work environment is very low". When the relationship between the nurses' Job Stress Scale and the Stigmatization Tendency Scale general point average is examined; It was determined that there is a weakly significant positive correlation (r = 0.276; p <0.01). In addition, it was found that the job stress levels of nurses with a high stigma tendency were statistically significantly higher (p <0.01). It is recommended to provide training and information on the stigma tendency and coping with work stress with in-service trainings.
Introduction Radiologic technologists (RTs) are among the healthcare staff negatively impacted by job dissatisfaction, occupational stress, and unhealthy lifestyle behaviors, especially during the COVID-19 pandemic. The aim of this study was to assess job satisfaction, lifestyle behaviors, occupational burnout symptoms, and associated factors among RTs in Saudi Arabia. Methods A survey study was conducted from January 2021 to February 2022 using a self-administered questionnaire. The questionnaire gathered socio-demographic information, answers to the Minnesota Satisfaction Questionnaire, lifestyle behaviors, and frequency of occupational burnout symptoms. Data were analyzed to obtain descriptive and inferential statistics. Results A total of 261 RTs completed the survey. Participants were predominantly male and most were working in public hospitals. The overall mean score for job satisfaction was 3.77 (of 5), indicating moderate job satisfaction, with two items showing low satisfaction— compensation (3.33) and advancement (3.28). The overall mean score for lifestyle behaviors was 2.00 (of 3), indicating moderate lifestyle behaviors, with the lowest scores reported in sleep quality (1.92), healthy diet (1.85), and relaxing and unwinding (1.86). For burnout symptoms, the overall mean score was 2.30, indicating moderate burnout level, with the highest score reported in experiencing physical symptoms (2.72). There were significant relationships between job satisfaction, lifestyle behaviors and burnout symptoms. A positive and moderate relationship, r = 0.53 (p < 0.05), was found between job satisfaction and healthy lifestyle behaviors. The burnout relationships with job satisfaction, r = −0.615 (p < 0.05), and healthy lifestyle behaviors, r = −0.524 (p < 0.05), were negative and moderate relationships Conclusion The interrelationships between job satisfaction, lifestyle behaviors, and occupational burnout symptoms suggest that improving lifestyle behaviors and managing burnout symptoms could contribute to higher job satisfaction. Implications for practice Policymakers should focus their efforts in the workplace health promotion programs to play essential roles in promoting healthy lifestyle behaviors and occupational stress management, as well as, improvements of RTs career advancement and compensation.
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Background Despite major changes in health care, the prevalence and predictors of career satisfaction have not recently been comprehensively studied in either women or men physicians. Methods The Women Physicians' Health Study surveyed a nationally representative random sample (n=4501 respondents; response rate, 59%) of US women physicians. Using univariate and logistic regression analyses, we examined personal and professional characteristics that were correlated with 3 major outcomes: career satisfaction, desire to become a physician again, and desire to change one's specialty. Results Women physicians were generally satisfied with their careers (84% usually, almost always, or always satisfied). However, 31% would maybe, probably, or definitely not choose to be a physician again, and 38% would maybe, probably, or definitely prefer to change their specialty. Physician's age, control of the work environment, work stress, and a history of harassment were independent predictors of all 3 outcomes, with younger physicians and those having least work control, most work stress, or having experienced severe harassment reporting the most dissatisfaction. The strongest association (odds ratio, 11.3; 95% confidence interval, 7.3-17.5; P<.001) was between work control and career satisfaction. Other significant predictors (P<.01) of outcomes included birthplace, ethnicity, sexual orientation, having children, stress at home, religious fervor, mental health, specialty, practice type, and workload. Conclusions Women physicians generally report career satisfaction, but many, if given the choice, would not become a physician again or would choose a different specialty. Correctable factors such as work stress, harassment, and poor control over work environment should be addressed to improve the recruitment and retention of women physicians.
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Positron emission tomography (PET) has a potential improvement for staging and radiation treatment planning of various tumor sites. We analyzed the use of 18F-fluorodeoxyglucose (FDG)-PET/computed tomography (CT) images for staging and target volume delineation of patients with head and neck carcinoma candidates for radiotherapy. Twenty-two patients candidates for primary radiotherapy, who did not receive any curative surgery, underwent both CT and PET/CT simulation. Gross Tumor Volume (GTV) was contoured on CT (CT-GTV), PET (PET-GTV), and PET/CT images (PET/CT-GTV). The resulting volumes were analyzed and compared. Based on PET/CT, changes in TNM categories and clinical stage occurred in 5/22 cases (22%). The difference between CT-GTV and PET-GTV was not statistically significant (p = 0.2) whereas the difference between the composite volume (PET/CT-GTV) and CT-GTV was statistically significant (p < 0.0001). PET/CT fusion images could have a potential impact on both tumor staging and treatment planning.
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Radiation medicine has previously utilized planning methods based primarily on anatomic and volumetric imaging technologies such as CT (Computerized Tomography), ultrasound, and MRI (Magnetic Resonance Imaging). In recent years, it has become apparent that a new dimension of non-invasive imaging studies may hold great promise for expanding the utility and effectiveness of the treatment planning process. Functional imaging such as PET (Positron Emission Tomography) studies and other nuclear medicine based assays are beginning to occupy a larger place in the oncology imaging world. Unlike the previously mentioned anatomic imaging methodologies, functional imaging allows differentiation between metabolically dead and dying cells and those which are actively metabolizing. The ability of functional imaging to reproducibly select viable and active cell populations in a non-invasive manner is now undergoing validation for many types of tumor cells. Many histologic subtypes appear amenable to this approach, with impressive sensitivity and selectivity reported. For clinical radiation medicine, the ability to differentiate between different levels and types of metabolic activity allows the possibility of risk based focal treatments in which the radiation doses and fields are more tightly connected to the perceived risk of recurrence or progression at each location. This review will summarize many of the basic principles involved in the field of functional PET imaging for radiation oncology planning and describe some of the major relevant published data behind this expanding trend.
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To investigate the influence of inhomogeneity corrections on stereotactic treatment plans for non-small cell lung cancer and determine the dose delivered to the PTV and OARs. For 26 patients with stage-I NSCLC treatment plans were optimized with unit density (UD), an equivalent pathlength algorithm (EPL), and a collapsed-cone (CC) algorithm, prescribing 60 Gy to the PTV. After optimization the first two plans were recalculated with the more accurate CC algorithm. Dose parameters were compared for the three different optimized plans. Dose to the target and OARs was evaluated for the recalculated plans and compared with the planned values. For the CC algorithm dose constraints for the ratio of the 50% isodose volume and the PTV, and the V20 Gy are harder to fulfill. After recalculation of the UD and EPL plans large variations in the dose to the PTV were observed. For the unit density plans, the dose to the PTV varied from 42.1 to 63.4 Gy for individual patients. The EPL plans all overestimated the PTV dose (average 48.0 Gy). For the lungs, the recalculated V20 Gy was highly correlated to the planned value, and was 12% higher for the UD plans (R2 = 0.99), and 15% lower for the EPL plans (R2 = 0.96). Inhomogeneity corrections have a large influence on the dose delivered to the PTV and OARs for SBRT of lung tumors. A simple rescaling of the dose to the PTV is not possible, implicating that accurate dose calculations are necessary for these treatment plans in order to prevent large discrepancies between planned and actually delivered doses to individual patients.
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The psychophysiology of shift work is mainly related to circadian rhythmicity and sleep-wake phenomena. Individuals on a rotating three-shift or similar system work the night shift at the low phase of circadian rhythm. On retiring to bed in the morning they fall asleep rapidly but are prematurely awakened by their circadian rhythm and exhibit severe sleepiness and reduced performance capacity. In connection with the morning shift the circadian psychophysiology makes it difficult to fall asleep as early as needed during the preceding night. Around 0400 to 0500, when the individuals should rise, they have difficulties awakening because of the sleep loss and the circadian rhythm, which at that point is at its lowest. Subsequently, day work is characterized by sleepiness and reduced performance. It should be emphasized that it does not seem possible to improve one's ability to adjust over time, even with permanent night work. Older age and "morningness" personality are related to higher than average problems in adjusting.
Background: As a result of increased interest and public demand, providing patients with adequate information about radiooncology has become more and more difficult for the doctor. Insufficient patient information can not only cause anxiety for the patient, but can also lead to legal action against the physician. In order to gain a deeper insight into our clinical practice of providing patient information, we developed a special questionnaire. We describe our first experiences in using this questionnaire at our institute. Patients and Methods: We examined the amount of information and Level of satisfaction, as well as the agreement of assessment between patient and physician after the provision of standard patient information before and at the end of radiotherapy. 51 consecutive patients were interviewed with a newly designed questionnaire. The first questioning with 13 items was carried out before radiotherapy and the second with ten items was done at the end of treatment. Sum scores for information and satisfaction were defined and agreement was measured by the weighted K coefficient. Results: Global Level of information and satisfaction was good, and a significant increase in information Level and a significant decline in satisfaction were seen between questionnaire 1 and 2. Agreement between patient and physician was fair, for example intent of treatment resulted in a K coefficient of 0.34, and poor for the doctor's role with a K coefficient of -0.002. Only 52% of the patients who received palliative radiotherapy rated correctly the non-curative intent of treatment, whereas 86% of the patients who received curative radiotherapy made a correct statement. Before radiotherapy, emotional state was often both negatively and positively assessed by the patients. Conclusion: Our short questionnaire is simple and easy to understand. It provides insights into patient information with respect to assessment of the information, satisfaction Level, and agreement between doctor and patient. Therefore, it is suitable for use in the clinical routine. We found a high information and satisfaction score, but Limited agreement between physician and patient. In the future, the questionnaire can be used as an aid to evaluate patient information in everyday practice and to train the communication skills of the physician. Further evaluation of the questionnaire is needed and, in particular, the aspect of patient information with palliative radiotherapy has to be improved.
Background: Burnout is a syndrome of depersonalization, emotional exhaustion, and a sense of low personal accomplishment. Little is known about burnout in residents or its relationship to patient care. Objective: To determine the prevalence of burnout in medical residents and explore its relationship to self-reported patient care practices. Design: Cross-sectional study using an anonymous, mailed survey. Setting: University-based residency program in Seattle, Washington. Participants: 115 internal medicine residents. Measurements: Burnout was measured by using the Maslach Burnout Inventory and was defined as scores in the high range for medical professionals on the depersonalization or emotional exhaustion subscales. Five questions developed for this study assessed self-reported patient care practices that suggested suboptimal care (for example, I did not fully discuss treatment options or answer a patient's questions or I made … errors that were not due to a lack of knowledge or inexperience). Depression and at-risk alcohol use were assessed by using validated screening questionnaires. Results: Of 115 (76%) responding residents, 87 (76%) met the criteria for burnout. Compared with non-bumed-out residents, burned-out residents were significantly more likely to self-report providing at least one type of suboptimal patient care at least monthly (53% vs. 21%; P = 0.004). In multivariate analyses, burnout-but not sex, depression, or at-risk alcohol use-was strongly associated with self-report of one or more suboptimal patient care practices at least monthly (odds ratio, 8.3 [95% Cl, 2.6 to 26.5]). When each domain of burnout was evaluated separately, only a high score for depersonalization was associated with self-reported suboptimal patient care practices (in a dose-response relationship). Conclusion: Burnout was common among resident physicians and was associated with self-reported suboptimal patient care practices.
Die Radiotherapie bringt Tumorpatienten in eine besondere Lebenssituation, in der sie einer Reihe von unterschiedlichen Faktoren ausgesetzt werden, deren Ausprägung weitgehend unbekannt ist. Intention dieser Querschnittsstudie war es, erstmals systematisch die spezifischen Belastungen von Tumorpatienten zu Beginn einer Strahlentherapie aufzuzeigen und einen belastungsunabhängigen Betreuungswunsch zu erheben mit dem Ziel einer Belastungsreduktion und Verbesserung von Lebensqualität und Compliance während einer radioonkologischen Behandlung.
The hypothesis that low job satisfaction among general practitioners may be associated with poor quality prescribing was investigated. One hundred and twenty four (124) general practitioners in England and Wales responded to a questionnaire which included items concerned with aspects of job satisfaction. A record of all prescriptions written during one month was also available for this sample of physicians. The questionnaire data were used to produce a reliable job satisfaction scale, the scores on which were then related to the prescribing of certain drugs which were selected as possible indicators of dysfunctional prescribing.It was found that the prescribing of drugs which are prone to cause adverse reactions, or which aredeemed inappropriate by medical consensus, was associated with low job satisfaction as measured by the scale. This was not true of drugs selected because of problems of dependency or misuse. Physicians with low levels of job satisfaction were also more likely to permit ancillary staff to write prescriptions for potentially hazardous drugs.The relationship between low job satisfaction and incautious prescribing was discussed with referenceto the nature of general practice and the selection of suitable candidates for this work.
Each day physicians encounter stresses that are an intrinsic part of medical practice. Those who are vulnerable may become unable to practice medicine without the intrusion of seriously neurotic or inappropriate behavior: that is, they become impaired physicians. In nonimpaired physicians, adaptations to the unalterable stresses of medicine may be productive and may actually improve the quality of medical care. Unfortunately, adaptations are often unproductive, resulting in poorer quality or uneconomical care, or they may adversely affect the personal lives of the physician and his or her family. A description of physician's stresses and adaptations would facilitate educational, personal, and societal changes that could improve the quality of medical care.