The Cost of Caring

by Amy Smith (as part of her Green Oncology series)

The Cost of Caring

Cost of Caring

(Photo: cover of the book "The Cost of Caring")

The Patient Issue Oncology Pharmacist Issue

For many oncology patients, our goal of treatment is to free them of cancer. However, there are times when we interact with patients who are approaching the end of life.  Recently, a few patients I have had the privilege of caring for have passed away and these situations have lead me to consider how I, as an oncology pharmacist, cope with the decline or death of my patients.  Therefore this posting targets more of the oncology pharmacist rather than the patient. 

Caring for oncology patients is extremely rewarding but it can lead to emotional fatigue.  Emotional fatigue, which is a result of stress from the patient-practitioner relationship, differs from burnout, which is due to complications of the work environment (i.e. coping with backordering of drugs).  As I become more experienced in oncology and build relationships with my patients, I want to be aware of the risk factors and take steps in preventing emotional fatigue.   

Rx Advice

First, I want to determine if I am at risk for emotional fatigue.  Consider the risk factors below and see if you might be at risk:                           

Risk Factors

My Risk Factors

Female gender

Younger practitioner

Single

Caring for dependents

Highly motivated

 

If some of these risk factors apply to you or if you otherwise believe you are at risk of emotional fatigue you may want to be proactive.  With a considerable amount of research in the area, there are a number of efficacious approaches to preventing emotional fatigue. 

The key factor in preventing emotional fatigue is having a strong sense of self-awareness.  Being aware of your interactions with patients and your reaction to patient outcomes will aid in maintaining emotional health.  To increase self-awareness, you may try reflective writing or mindful meditation.  A study involving medical students displayed increase self-awareness and compassion for others when charting objective data in one column and their feelings in response to that data in an adjacent column.  There are a couple of great links through the University of Calgary which are useful if you are looking to start practicing reflective writing (http://www.ucalgary.ca/ssc/node/243).  Mindful meditation is also a quick and easy way to practice being aware of your body’s mental and physical state.  There are many websites and YouTube videos (http://www.youtube.com/watch?v=Jyy0ra2WcQQ) which provide free guided mediations.  There are also numerous free smart phone apps, which also provide free guided mediation (one of my favorites being the “Take A Break” app). 

In addition to increasing self-awareness, there are work environment based factors known to decrease emotional fatigue.  A supportive work environment and training in communication skills allow practitioners to effectively verbalize the pressures of the work environment with colleagues.  I often feel as though I do not want to burden my friends and family with stories about ill patients.  Because of this, and confidentiality reasons, I do not share patient stories outside of work.  Promoting choice and control in the work place, such as how to organize your day or providing your opinion on the direction your department, can also prevent emotional fatigue.  When we feel as though we have choices and control over a situation, anxiety levels decrease and difficult situations appear much more manageable.   

The Bottom Line

Identifying if you are at risk of emotional fatigue by identifying risk factors and becoming more self-aware is one of the first steps in preventing emotional fatigue in your oncology practice.  Consider using meditation, reflective writing and implementing work based support systems to assist in coping with the stressors that accompany caring for this particular group of patients. 

Further Reading

If you are interested in learning more about emotional fatigue and burnout, there are a couple of excellent articles you might be interested in reading. 

Granek, L., Tozer, R., Mazzotta, P., Ramjaun, A. and Krzyzanowska, M.  Nature and Impact of Grief
Over Patient Loss on Oncologists’ Personal and Professional Lives.  Arch Intern Med; 172(12) June 25, 2012

Kearney, M., Weininger, R., Vachon, M., Harrison, R. and Mount, B.  Self-care of Physicians Caring for Patients at the End of Life.  JAMA; 301(11) March 18, 2009. 

There also some presentations an more information by way of the Centre for Practitioner Renewal website

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Amy Smith is a recent graduate of the College of Pharmacy at the University of Saskatchewan.  After completing a hospital residency program with the Regina Qu’Appelle Health Region, Amy began working with the Saskatchewan Cancer Agency in Saskatoon as a pediatric oncology pharmacist.  During her time away from work, Amy enjoys traveling, volunteering and participating in a various athletics including powerlifting and running. 

Amy is a member of CAPhO's Communication Committee.