Evaluation of Burnout, Coping Strategies and Resilience in Paediatric Oncology Health Care Workers in Cape Town

Background: Burnout is a work-related condition with a significant footprint in the medical profession. It is characterised by emotional exhaustion (EE), depersonalisation (DP), and a low sense of personal accomplishment (PA) at one’s job. Depending on situational and individual factors, the prevalence of burnout among healthcare workers (HCWs) has shown an upward trajectory with peaks in certain medical specialities. Paediatric oncology unit (POU) HCWs are at a high risk of developing burnout because of the immense physical and emotional involvement that can be associated with caring for children with cancer. The burnout process can, however, be influenced by adopted coping strategies and resilience. Research into the phenomenon of burnout and associated factors in POU HCWs is low in South Africa in spite of the global attention it has commanded. Because of the need to institute appropriate and acceptable intervention strategies and to avoid erroneous conclusions often associated with burnout, it is imperative to understand the local prevalence and the possible associated factors. This study, therefore, seeks to establish the prevalence of burnout in POU HCWs and to understand how the adopted coping strategies and level of resilience influence the burnout process in a defined setting. Acknowledging and understanding how these psychosocial factors affect HCWs is fundamental to designing interventions to reduce work-related stress conditions. Objectives: This study seeks to determine the following: prevalence of burnout among POU HCWs in Red Cross War Memorial Children’s Hospital, Cape Town; identify adopted coping strategies by the HCWs; evaluate the level of resilience in the HCWs; and make recommendations that may help reduce burnout in paediatric oncology care and, probably, other fields of health care in South Africa. Methodology: This research used a mixed method approach (quantitative and qualitative) to explore burnout, coping and resilience amongst POU HCWs. A questionnaire consisting of validated instruments (Maslach Burnout Inventory-Human Services Survey [MBI- HSS], Brief Resilience Scale [BRS], the Brief COPE and researcher-designed questions) was used to conduct a survey after obtaining ethical clearance (HREC REF: 051/2017). Depending on preference, electronic or paper-based questionnaires were distributed to POU staff. Data analysis was performed using Microsoft EXCEL (2010 version). Results: The response rate was 50% (n= 25). Five out of the total respondents were dropped due to gross omissions in responses to the survey questions. The majority of the respondents were females (95%), and by profession, nurses had the highest representation (80%). Eightyfive per cent (85%) of the respondents have worked in the POU for more than a year. The burnout prevalence was 15% – 45% across the three dimensions of burnout - high EE (20%), high DP (15%) and reduced PA (45%). The majority (70%) of the respondents were moderately resilient. The coping styles predominantly used by the respondents in this study were positive reframing, religion, acceptance, planning, self-distraction and active coping. The least used coping styles were substance use, denial and behavioural disengagement, which are all maladaptive coping strategies. There was no statistically significant association between burnout and demographic characteristics. However, with a high prevalence of 45%, reduced personal accomplishment (rPA) was also associated with most demographic characteristics. rPA was high in females; age groups 25-25 and 46-60; single and married; respondents with number of children >1; respondents with a graduate level of education; POU professionals that are nurses and administrators; respondents with work experience in medicine and work experience in oncology for less than 10 years. Respondents with low levels of resilience experienced average levels of burnout as evidenced by average EE and DP scores, while those with moderate levels of resilience experienced low burnout as evidenced by low EE and DP scores (P< 0.05) Furthermore, EE and DP correlated negatively with the BRS while PA correlated positively with the BRS. Concerning coping strategies, EE and DP correlated positively with denial, substance use, behavioural disengagement, venting and self-blame. PA correlated positively with emotional support, positive reframing and religion but negatively correlated with active coping. Generally, the respondents expressed the desire for better goal-focused teamwork in the POU as well as the implementation of effective intervention strategies. Conclusion: The prevalence of burnout in this study is between 15% - 45%. The particularly high prevalence of reduced personal accomplishment (45%) is of interest because it cuts across most demographic features. This is suggestive of a stronger influence of situation specific factors, common to all respondents, contributing to burnout. The predominant use of emotion and problem-focused coping methods, and the moderate level of resilience in the majority of the staff appear to be protective against burnout. There is, however, the need and desire for implementation of effective group and institutional intervention programmes for burnout in the POU staff in terms of availability, awareness and accessibility