Abstract
BACKGROUND: Significant progress has been made in understanding the factors associated with oncology (onc) PA burnout. However, little is known about what PAs need to mitigate burnout, the availability of resources, and barriers to interventions. METHODS: A national survey of onc PAs was conducted in 2022. PAs completed a quantitative needs assessment to determine the importance of and their perceived skills in topics of self-care, clinical care, and professional development. For importance, “high importance” included ratings of ‘Essential’ or ‘Very Important’; for perceived skill, “high skill” included ratings of ‘Excellent’ or ‘Good’. Engagement with employee assistance programs (EAPs) was examined. Resiliency & Burnout were assessed using the Connor-Davidson Resilience Scale & the Maslach Burnout Inventory. RESULTS: PAs (n = 171) were mostly practicing in medical oncology (66%) and outpatient (66%). The high importance topics most often identified were dealing with difficult patients (93%), dealing with difficult providers (89%), delivering bad news (88%) and coping with death / patient suffering and personal grief (86%). Topics less often reported as high importance included opportunities to be a mentor (61%), professional coaching (59%) and mindfulness skills (53%). PAs frequently reported high skills in dealing with difficult patients (75%), delivering bad news (72%), and resiliency skills (59%). Fewer PAs reported high skills for debriefing following significant events (49%) and mindfulness skills (42%). Burnout (BO) rates were higher for those with lower perceived skills in resiliency (p = 0.03) and dealing with difficult providers and staff (p = 0.03) but did not differ based on importance of any topics. Resiliency significantly increased with increasing levels of reported importance for the mindfulness skills training, cognitive skills training, and debriefing after significant events topics. Resiliency significantly increased with increased levels of perceived skill for all topics explored. Common barriers to well-being EAP participation were lack of time (58%) and concerns about confidentiality and stigma (26%). For PAs with concerns about stigma, resiliency scores were lower (6.4 vs 7.0; p < 0.001) and BO rates were higher (73% vs 47%; p = 0.005). CONCLUSIONS: Perceived deficiencies in resiliency training and managing difficult work relationships correlate with higher rates of burnout in onc PAs. Barriers to participation in EAPs, which may help address these deficits, are common and when present are associated with an alarming rate of burnout and lower resiliency. Cultural change in medicine is needed to reduce perceived and experienced stigmatizing experiences to address burnout. These findings suggest that burnout interventions which focus on building resiliency and managing work relationships are crucial and may be best implemented outside of the workplace.
