VOLUME
32
䡠
NUMBER
11
䡠
APRIL
10
2014
JOURNAL OF CLINICAL ONCOLOGY
E
D
I
T
O
R
I
A
L
Take Care of Yourself: We Need You Rebecca S. Guest and Dean F. Bajorin, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY See accompanying article on page 1127
The health and well-being of oncologists is crucial to ensuring patients’ access to clinicians who can provide optimal medical care. The article accompanying this editorial presents the results of a large, national survey examining professional satisfaction among working US oncologists.1 With an eye toward the projected shortage of US medical oncologists by 2020, Shanafelt et al characterize the state of the specialty today, improving our understanding of the prevalence and impact of work-life conflict, burnout, and career satisfaction on an oncologist’s work and retirement plans. This study is part of a growing body of research supporting the ethos that cancer care providers need a proper balance of work-life time commitment and sustenance in the face of growing demands for cancer care. The results of this survey are startling. Only one-third of oncologists were satisfied with work-life balance, lower than all 24 medical specialties. Their analysis identified an approximately 5% decrease in the likelihood of being satisfied with work-life balance with each additional hour worked per week. Medical oncology is a highly demanding profession so we should not be surprised by these results. A separate study reported that 40% of oncologists work greater than 60 hours per week.2 In a tracking survey analyzing 41 specialties, medical oncologists ranked fifth in the annual number of work hours—more than general surgery, urology, and obstetrics and gynecology—surgical specialties considered very demanding in terms of work hours.3 The response to this workload demand is predictable and understandable— dissatisfaction with work-life balance and burnout in this study were the strongest predictors of oncologists’ intent to reduce clinical work hours and leave their current position; 42% cited spending more time with family as the primary reason they are considering reducing clinical work hours. These data imply that our future oncology workforce may be more vulnerable than previously expected, and, that work-life balance and burnout may profoundly affect the supply of cancer care. The American Society of Clinical Oncology (ASCO) workforce study projected an acute shortage of oncologists by 2020 to meet the growing US demand for cancer care.4 One suggested scenario was for 50% of oncologists to delay retirement for 5 years in order to increase the supply of cancer care. That proposed strategy may be overly optimistic; the study by Shanafelt et al1 reported that the majority of oncologists (54%) plan to retire at age 65 or earlier, 21% before age 60. The observation that women were “markedly less likely to be satisfied”1 with work-life balance, confirming other studies, could add additional supply challenges because the proportion of women oncologists in the Journal of Clinical Oncology, Vol 32, No 11 (April 10), 2014: pp 1101-1103
workforce is rapidly increasing. Women represent only 24% of oncologists in the present workforce yet constitute ⬃50% in oncology fellowship training. Young trainees may also be particularly susceptible to the stressors that result in burnout, irrespective of gender. Work-life balance and lifestyle are important to the younger generation, impacting medical students’ choice of specialty.5 The older generation, a crucial source of expert patient care, professional mentorship and leadership, may be affected by personal and spousal health, existential questions about mortality, and financial and identity issues as retirement nears. Collectively, these observations imply that our nation’s future cancer care needs may be in peril if we ignore or insufficiently address stress-related symptoms and burnout in our caregivers. It is reassuring that this study identified providing care to patients with cancer as immensely rewarding. They report that the single most common reason oncologists were planning to retire later than previously planned was that they “enjoyed their work too much to retire,”1 with work enjoyment notably outweighing financial considerations. Kearney et al describe these rewards well—“feelings of satisfaction and gratitude . . . meaningful caregiver-patient relationships; inner selfreflection, connection with peers, family, and community; and a heightened sense of spirituality.”6(p1158) Medical oncologists have much in common with their surgical oncology colleagues, including tremendous responsibility, immense devotion to patients, and a tendency to put personal life behind careers.5,7 Not surprisingly, the oncologists’ profile of average burnout, high career satisfaction, and low satisfaction with work-life balance is similar to surgeons.5 No matter how rewarding the professional life of our caregivers, compromised work-life balance can take its toll on medical and surgical oncologists. The irony is that the coping mechanism that many of us rely on (working harder/longer) can become counter-productive if the self-sacrifice leads to overwhelming fatigue, burnout, or early retirement of the caregiver.8-10 Skeptics may consider a physician’s work-life conflict and burnout to be trivial concerns juxtaposed to the immense challenges of patients struggling with cancer. To the contrary, burnout is an important and prevalent condition, not only causing distress to individual providers, but also, adversely impacting the quality of patient care and the costs of care. For example, the rate of major medical errors reported by American surgeons has been reported to be related to burnout symptoms, and a doctor’s distress and lack of self-care can adversely impact the quality of care provided to patients.9,10 © 2014 by American Society of Clinical Oncology
Information downloaded from jco.ascopubs.org and provided by at J S GERICKE LIBRARY on October 4, 2014 from Copyright © 2014 American Society of Clinical Oncology. All rights reserved. 146.232.129.75
1101
Editorial
The word “burnout” unfortunately conveys an oversimplified, fatalistic impression— conjuring images of burnt-out candles (tragic endings to high-intensity, short-lived careers). We should not fall prey to such an erroneous perception. Burnout involves variable levels of emotional exhaustion, physical exhaustion, depersonalization (treating patients as impersonal objects), and a diminished sense of personal accomplishment. The good news is that the specific challenges to our physicians are becoming clearer, making training in self-recognition and intervention more feasible. Burnout, resulting from prolonged workplace stress, is a reversible state. Effective programs that build physician resilience and enhance physician wellness exist.10,11 Interventional programs employing these strategies are becoming more available in medical centers. Unfortunately, however, resiliency programs are nonexistent in the typical community practices where the majority of cancer care is provided. That deficit needs to be rectified because this survey showed that those oncologists spending a greater time with patients were less likely to be satisfied with work-life balance. Prevention of burnout is better than treatment. Research has identified environmental stressors in the workplace that are modifiable.12 Practices to maximize well-being among physicians caring for patients at the end of life have been well-described and seminal articles could be better publicized by professional organizations and discussed at journal clubs for trainees.6,10,13 Individual provider skills can be acquired through professional workshops that develop skills for selfawareness and self-care. Mindfulness intervention practice reduces stress and can increase compassion towards self and patients, developing enhanced awareness to moment-to-moment experiences in the mind, body, emotions, and environment.14,15 Communication skills training is a compelling and effective intervention. Clinicians who are more comfortable with communication skills and end of life issues have less burnout, and, there are existing, successful communication skills training programs16 that could be scaled up nationally and internationally. Exercise has several advantages—including evidence that it improves both physical and mental health, and a high acceptability rate among physicians susceptible to burnout.12 Efforts are needed to support early recognition of depression from personal and family conflict as well as substance abuse and/or alcohol to solve the stressors. Since excellence in cancer care depends on oncologists who are physically and emotionally at their best, support for oncologists’ health and well-being should be considered a mainstream and appropriate domain of inquiry, education, and practice. ASCO has taken the initiative in raising our awareness of burnout but far more is needed. These initiatives should be followed by concrete efforts by our professional societies and healthcare organizations to address salient issues: (1) Which aspects of burnout should be further studied and how? More granularity is needed, particularly in our heterogenous community of caregivers and healthcare environments. (2) What stressors/factors result in burnout and to what extent? Opportunities for research include the impact on the oncologist of factors such as child care or elder care responsibilities, personal illness, alcohol/drug use, divorce rates, suicidal ideation, medicolegal litigation, and other stressors. (3) Who is more likely/less likely to experience symptoms of burnout, and how should we intervene? Physician differences across generations, gender, geography, and types of practice need to be assessed.17 Interventions, both general and specific, should be developed and measured for effectiveness. (4) Can professional societies partner with each other to improve the status quo? Recent studies show that we have much in common with our 1102
© 2014 by American Society of Clinical Oncology
surgical colleagues, as well as other specialists involved in cancer care. It would be ideal to have buy-in from all professional societies in addressing burnout. (5) Can ASCO and other cancer-related professional societies import for their members effective identification, intervention, and prevention programs from other professions or institutions? Such an effort is critical to help the community-based oncology practices with limited resources. (6) How can we ensure the wellness of our future workforce? ASCO and other organizations (ie, American Society of Hematology, Accreditation Council for Graduate Medical Education, and American Board of Internal Medicine) can impact professional norms, with sustenance for caregivers becoming a fundamental part of training and professional development at all levels. (7) How can ASCO partner with societies representing nonphysician members of the cancer care delivery team? Stressors leading to burnout exist for all cancer care team members so programs building resilience for all care deliverers will help ensure optimal care.18 In closing, oncologists hold a common determination to provide the highest standards of care for their patients. Those standards should similarly apply to oncologists themselves, personally as well as professionally. Take care of yourself. We (patients and families) need you. AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST
The author(s) indicated no potential conflicts of interest. AUTHOR CONTRIBUTIONS
Manuscript writing: All authors Final approval of manuscript: All authors REFERENCES 1. Shanafelt, TD, Raymond M, Kosty M, et al: Satisfaction with work-life balance and the career and retirement plans of US oncologists. J Clin Oncol 32:1127-1135, 2014 2. Shanafelt T, Boone S, Dyrbye L, et al: Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 172:1377-1385, 2012 3. Leigh JP, Tancredi D, Jerant A, et al: Annual work hours across physician specialties. Arch Intern Med 171:1211-1213, 2011 4. Erikson C, Salsberg E, Forte G, et al: Future supply and demand for oncologists: Challenges to assuring access to oncology services. J Oncol Pract 3:79-86, 2007 5. Guest RS, Baser R, Li Y, et al: Cancer surgeons’ distress and well-being: I. The tension between a culture of productivity and the need for self-care. Ann Surg Oncol 18:1229-1235, 2011 6. Kearney MK, Weininger RB, Vachon MLS, et al: Self-care of physicians caring for patients at the end of life: Being connected . . . a key to my survival. JAMA 301:11, 1155-162, 2009 7. Balch CM, Copeland E: Stress and burnout among surgical oncologists: A call for personal wellness and a supportive workplace environment. Ann Surg Oncol 14:3029-3032, 2007 8. Williams ES, Konrad TR, Scheckler DP: Understanding physicians’ intentions to withdraw from practice: The role of job satisfaction, job stress, mental and physical health. Health Care Manag Rev 26:7-19, 2001 9. Gabbard GO, Menninger RW: The psychology of postponement in the medical marriage. JAMA 261:2378-2381, 1989 10. Shanafelt T, Chung H, White H, et al: Shaping your career to maximize personal satisfaction in the practice of oncology. J Clin Oncol 24:4020-4026, 2006 11. Shanafelt TD, Balch CM, Bechamps G, et al: Burnout and medical errors among American surgeons. Ann Surg 251:995-1000.12, 2010 12. Guest RS, Baser R, Li Y, et al: Cancer surgeons’ distress and well-being: II. Modifiable factors and the potential for organizational interventions. Ann Surg Oncol 18:1236-1242, 2011 13. Vachon MLS: Oncology staff stress and related interventions, in: Holland JC, Breitbart WS, Jacobsen PB (eds): Psycho-Oncology (ed 2). New York, NY, Oxford University Press, 2010 JOURNAL OF CLINICAL ONCOLOGY
Information downloaded from jco.ascopubs.org and provided by at J S GERICKE LIBRARY on October 4, 2014 from Copyright © 2014 American Society of Clinical Oncology. All rights reserved. 146.232.129.75
Editorial
14. Krasner MS, Epstein RM, Beckman H, et al: Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA 302:1284-1293, 2009 15. Shapiro S, Astin J, Bishop S, et al: Mindfulness-based stress reduction for health care professionals: Results from a randomized trial. Int J Stress Manag 12:164-176, 2005 16. Bylund CL, Brown R, Gueguen JA, et al: The implementation and assessment of a comprehensive communication skills training curriculum for oncologists. Psychooncology 19:583-593, 2010
17. Zwack J, Schweitzer J: If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Acad Med. 88:382-389, 2013 18. Dougherty E, Pierce B, Ma C, et al: Factors associated with work stress and professional satisfaction in oncology staff. Am J Hosp Palliat Care 26:105111, 2009
DOI: 10.1200/JCO.2013.54.5319; published online ahead of print at www.jco.org on March 10, 2014
■ ■ ■
Best of ASCO Meetings Mark your calendar for the 2014 Best of ASCO Meetings in Boston (August 8-9), Chicago (August 15-16), and Seattle (August 22-23). Featuring practice-changing science and educational highlights from the ASCO Annual Meeting, the Best of ASCO Meetings offer in-depth analysis and discussion of the top scientific abstracts that will directly impact patient care. For additional details, visit boa.asco.org. Each year, ASCO, in conjunction with our cosponsors, organizes a wide array of high-quality meetings, providing educational and scientific programs to advance your understanding of cancer. Join us for one or more of ASCO’s meetings to interact with oncology experts, network with colleagues, and earn CME credit.
www.jco.org
© 2014 by American Society of Clinical Oncology
Information downloaded from jco.ascopubs.org and provided by at J S GERICKE LIBRARY on October 4, 2014 from Copyright © 2014 American Society of Clinical Oncology. All rights reserved. 146.232.129.75
1103
32
䡠
NUMBER
11
䡠
APRIL
10
2014
JOURNAL OF CLINICAL ONCOLOGY
E
D
I
T
O
R
I
A
L
Take Care of Yourself: We Need You Rebecca S. Guest and Dean F. Bajorin, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY See accompanying article on page 1127
The health and well-being of oncologists is crucial to ensuring patients’ access to clinicians who can provide optimal medical care. The article accompanying this editorial presents the results of a large, national survey examining professional satisfaction among working US oncologists.1 With an eye toward the projected shortage of US medical oncologists by 2020, Shanafelt et al characterize the state of the specialty today, improving our understanding of the prevalence and impact of work-life conflict, burnout, and career satisfaction on an oncologist’s work and retirement plans. This study is part of a growing body of research supporting the ethos that cancer care providers need a proper balance of work-life time commitment and sustenance in the face of growing demands for cancer care. The results of this survey are startling. Only one-third of oncologists were satisfied with work-life balance, lower than all 24 medical specialties. Their analysis identified an approximately 5% decrease in the likelihood of being satisfied with work-life balance with each additional hour worked per week. Medical oncology is a highly demanding profession so we should not be surprised by these results. A separate study reported that 40% of oncologists work greater than 60 hours per week.2 In a tracking survey analyzing 41 specialties, medical oncologists ranked fifth in the annual number of work hours—more than general surgery, urology, and obstetrics and gynecology—surgical specialties considered very demanding in terms of work hours.3 The response to this workload demand is predictable and understandable— dissatisfaction with work-life balance and burnout in this study were the strongest predictors of oncologists’ intent to reduce clinical work hours and leave their current position; 42% cited spending more time with family as the primary reason they are considering reducing clinical work hours. These data imply that our future oncology workforce may be more vulnerable than previously expected, and, that work-life balance and burnout may profoundly affect the supply of cancer care. The American Society of Clinical Oncology (ASCO) workforce study projected an acute shortage of oncologists by 2020 to meet the growing US demand for cancer care.4 One suggested scenario was for 50% of oncologists to delay retirement for 5 years in order to increase the supply of cancer care. That proposed strategy may be overly optimistic; the study by Shanafelt et al1 reported that the majority of oncologists (54%) plan to retire at age 65 or earlier, 21% before age 60. The observation that women were “markedly less likely to be satisfied”1 with work-life balance, confirming other studies, could add additional supply challenges because the proportion of women oncologists in the Journal of Clinical Oncology, Vol 32, No 11 (April 10), 2014: pp 1101-1103
workforce is rapidly increasing. Women represent only 24% of oncologists in the present workforce yet constitute ⬃50% in oncology fellowship training. Young trainees may also be particularly susceptible to the stressors that result in burnout, irrespective of gender. Work-life balance and lifestyle are important to the younger generation, impacting medical students’ choice of specialty.5 The older generation, a crucial source of expert patient care, professional mentorship and leadership, may be affected by personal and spousal health, existential questions about mortality, and financial and identity issues as retirement nears. Collectively, these observations imply that our nation’s future cancer care needs may be in peril if we ignore or insufficiently address stress-related symptoms and burnout in our caregivers. It is reassuring that this study identified providing care to patients with cancer as immensely rewarding. They report that the single most common reason oncologists were planning to retire later than previously planned was that they “enjoyed their work too much to retire,”1 with work enjoyment notably outweighing financial considerations. Kearney et al describe these rewards well—“feelings of satisfaction and gratitude . . . meaningful caregiver-patient relationships; inner selfreflection, connection with peers, family, and community; and a heightened sense of spirituality.”6(p1158) Medical oncologists have much in common with their surgical oncology colleagues, including tremendous responsibility, immense devotion to patients, and a tendency to put personal life behind careers.5,7 Not surprisingly, the oncologists’ profile of average burnout, high career satisfaction, and low satisfaction with work-life balance is similar to surgeons.5 No matter how rewarding the professional life of our caregivers, compromised work-life balance can take its toll on medical and surgical oncologists. The irony is that the coping mechanism that many of us rely on (working harder/longer) can become counter-productive if the self-sacrifice leads to overwhelming fatigue, burnout, or early retirement of the caregiver.8-10 Skeptics may consider a physician’s work-life conflict and burnout to be trivial concerns juxtaposed to the immense challenges of patients struggling with cancer. To the contrary, burnout is an important and prevalent condition, not only causing distress to individual providers, but also, adversely impacting the quality of patient care and the costs of care. For example, the rate of major medical errors reported by American surgeons has been reported to be related to burnout symptoms, and a doctor’s distress and lack of self-care can adversely impact the quality of care provided to patients.9,10 © 2014 by American Society of Clinical Oncology
Information downloaded from jco.ascopubs.org and provided by at J S GERICKE LIBRARY on October 4, 2014 from Copyright © 2014 American Society of Clinical Oncology. All rights reserved. 146.232.129.75
1101
Editorial
The word “burnout” unfortunately conveys an oversimplified, fatalistic impression— conjuring images of burnt-out candles (tragic endings to high-intensity, short-lived careers). We should not fall prey to such an erroneous perception. Burnout involves variable levels of emotional exhaustion, physical exhaustion, depersonalization (treating patients as impersonal objects), and a diminished sense of personal accomplishment. The good news is that the specific challenges to our physicians are becoming clearer, making training in self-recognition and intervention more feasible. Burnout, resulting from prolonged workplace stress, is a reversible state. Effective programs that build physician resilience and enhance physician wellness exist.10,11 Interventional programs employing these strategies are becoming more available in medical centers. Unfortunately, however, resiliency programs are nonexistent in the typical community practices where the majority of cancer care is provided. That deficit needs to be rectified because this survey showed that those oncologists spending a greater time with patients were less likely to be satisfied with work-life balance. Prevention of burnout is better than treatment. Research has identified environmental stressors in the workplace that are modifiable.12 Practices to maximize well-being among physicians caring for patients at the end of life have been well-described and seminal articles could be better publicized by professional organizations and discussed at journal clubs for trainees.6,10,13 Individual provider skills can be acquired through professional workshops that develop skills for selfawareness and self-care. Mindfulness intervention practice reduces stress and can increase compassion towards self and patients, developing enhanced awareness to moment-to-moment experiences in the mind, body, emotions, and environment.14,15 Communication skills training is a compelling and effective intervention. Clinicians who are more comfortable with communication skills and end of life issues have less burnout, and, there are existing, successful communication skills training programs16 that could be scaled up nationally and internationally. Exercise has several advantages—including evidence that it improves both physical and mental health, and a high acceptability rate among physicians susceptible to burnout.12 Efforts are needed to support early recognition of depression from personal and family conflict as well as substance abuse and/or alcohol to solve the stressors. Since excellence in cancer care depends on oncologists who are physically and emotionally at their best, support for oncologists’ health and well-being should be considered a mainstream and appropriate domain of inquiry, education, and practice. ASCO has taken the initiative in raising our awareness of burnout but far more is needed. These initiatives should be followed by concrete efforts by our professional societies and healthcare organizations to address salient issues: (1) Which aspects of burnout should be further studied and how? More granularity is needed, particularly in our heterogenous community of caregivers and healthcare environments. (2) What stressors/factors result in burnout and to what extent? Opportunities for research include the impact on the oncologist of factors such as child care or elder care responsibilities, personal illness, alcohol/drug use, divorce rates, suicidal ideation, medicolegal litigation, and other stressors. (3) Who is more likely/less likely to experience symptoms of burnout, and how should we intervene? Physician differences across generations, gender, geography, and types of practice need to be assessed.17 Interventions, both general and specific, should be developed and measured for effectiveness. (4) Can professional societies partner with each other to improve the status quo? Recent studies show that we have much in common with our 1102
© 2014 by American Society of Clinical Oncology
surgical colleagues, as well as other specialists involved in cancer care. It would be ideal to have buy-in from all professional societies in addressing burnout. (5) Can ASCO and other cancer-related professional societies import for their members effective identification, intervention, and prevention programs from other professions or institutions? Such an effort is critical to help the community-based oncology practices with limited resources. (6) How can we ensure the wellness of our future workforce? ASCO and other organizations (ie, American Society of Hematology, Accreditation Council for Graduate Medical Education, and American Board of Internal Medicine) can impact professional norms, with sustenance for caregivers becoming a fundamental part of training and professional development at all levels. (7) How can ASCO partner with societies representing nonphysician members of the cancer care delivery team? Stressors leading to burnout exist for all cancer care team members so programs building resilience for all care deliverers will help ensure optimal care.18 In closing, oncologists hold a common determination to provide the highest standards of care for their patients. Those standards should similarly apply to oncologists themselves, personally as well as professionally. Take care of yourself. We (patients and families) need you. AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST
The author(s) indicated no potential conflicts of interest. AUTHOR CONTRIBUTIONS
Manuscript writing: All authors Final approval of manuscript: All authors REFERENCES 1. Shanafelt, TD, Raymond M, Kosty M, et al: Satisfaction with work-life balance and the career and retirement plans of US oncologists. J Clin Oncol 32:1127-1135, 2014 2. Shanafelt T, Boone S, Dyrbye L, et al: Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 172:1377-1385, 2012 3. Leigh JP, Tancredi D, Jerant A, et al: Annual work hours across physician specialties. Arch Intern Med 171:1211-1213, 2011 4. Erikson C, Salsberg E, Forte G, et al: Future supply and demand for oncologists: Challenges to assuring access to oncology services. J Oncol Pract 3:79-86, 2007 5. Guest RS, Baser R, Li Y, et al: Cancer surgeons’ distress and well-being: I. The tension between a culture of productivity and the need for self-care. Ann Surg Oncol 18:1229-1235, 2011 6. Kearney MK, Weininger RB, Vachon MLS, et al: Self-care of physicians caring for patients at the end of life: Being connected . . . a key to my survival. JAMA 301:11, 1155-162, 2009 7. Balch CM, Copeland E: Stress and burnout among surgical oncologists: A call for personal wellness and a supportive workplace environment. Ann Surg Oncol 14:3029-3032, 2007 8. Williams ES, Konrad TR, Scheckler DP: Understanding physicians’ intentions to withdraw from practice: The role of job satisfaction, job stress, mental and physical health. Health Care Manag Rev 26:7-19, 2001 9. Gabbard GO, Menninger RW: The psychology of postponement in the medical marriage. JAMA 261:2378-2381, 1989 10. Shanafelt T, Chung H, White H, et al: Shaping your career to maximize personal satisfaction in the practice of oncology. J Clin Oncol 24:4020-4026, 2006 11. Shanafelt TD, Balch CM, Bechamps G, et al: Burnout and medical errors among American surgeons. Ann Surg 251:995-1000.12, 2010 12. Guest RS, Baser R, Li Y, et al: Cancer surgeons’ distress and well-being: II. Modifiable factors and the potential for organizational interventions. Ann Surg Oncol 18:1236-1242, 2011 13. Vachon MLS: Oncology staff stress and related interventions, in: Holland JC, Breitbart WS, Jacobsen PB (eds): Psycho-Oncology (ed 2). New York, NY, Oxford University Press, 2010 JOURNAL OF CLINICAL ONCOLOGY
Information downloaded from jco.ascopubs.org and provided by at J S GERICKE LIBRARY on October 4, 2014 from Copyright © 2014 American Society of Clinical Oncology. All rights reserved. 146.232.129.75
Editorial
14. Krasner MS, Epstein RM, Beckman H, et al: Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA 302:1284-1293, 2009 15. Shapiro S, Astin J, Bishop S, et al: Mindfulness-based stress reduction for health care professionals: Results from a randomized trial. Int J Stress Manag 12:164-176, 2005 16. Bylund CL, Brown R, Gueguen JA, et al: The implementation and assessment of a comprehensive communication skills training curriculum for oncologists. Psychooncology 19:583-593, 2010
17. Zwack J, Schweitzer J: If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Acad Med. 88:382-389, 2013 18. Dougherty E, Pierce B, Ma C, et al: Factors associated with work stress and professional satisfaction in oncology staff. Am J Hosp Palliat Care 26:105111, 2009
DOI: 10.1200/JCO.2013.54.5319; published online ahead of print at www.jco.org on March 10, 2014
■ ■ ■
Best of ASCO Meetings Mark your calendar for the 2014 Best of ASCO Meetings in Boston (August 8-9), Chicago (August 15-16), and Seattle (August 22-23). Featuring practice-changing science and educational highlights from the ASCO Annual Meeting, the Best of ASCO Meetings offer in-depth analysis and discussion of the top scientific abstracts that will directly impact patient care. For additional details, visit boa.asco.org. Each year, ASCO, in conjunction with our cosponsors, organizes a wide array of high-quality meetings, providing educational and scientific programs to advance your understanding of cancer. Join us for one or more of ASCO’s meetings to interact with oncology experts, network with colleagues, and earn CME credit.
www.jco.org
© 2014 by American Society of Clinical Oncology
Information downloaded from jco.ascopubs.org and provided by at J S GERICKE LIBRARY on October 4, 2014 from Copyright © 2014 American Society of Clinical Oncology. All rights reserved. 146.232.129.75
1103
