M. Jasperse

Evaluating stress, burnout and job satisfaction in New Zealand radiation oncology departments

This research aimed to determine the levels of occupational stress, burnout and job satisfaction among radiation oncology workers across New Zealand. All oncology staff practising in all eight radiation oncology departments in New Zealand were invited to participate anonymously in a questionnaire, which consisted of the Maslach Burnout Inventory and measures of stress intensity associated with specific occupational stressors, stress reduction strategies and job satisfaction. A total of 171 (out of 349) complete responses were analysed using spss 19; there were 23 oncologists, 111 radiation therapists, 22 radiation nurses and 15 radiation physicists. All participants, regardless of profession, reported high stress levels associated with both patient-centred and organisational stressors. Participants scored high in all three domains of burnout: emotional exhaustion, depersonalisation and personal accomplishment. Interestingly, although organisational stressors predicted higher emotional exhaustion and emotional exhaustion predicted lower job satisfaction, patient stressors were associated with higher job satisfaction. Job satisfaction initiatives such as ongoing education, mentoring and role extension were supported by many participants as was addressing organisational stressors, such as lack of recognition and support from management and unrealistic expectations and demands. New Zealand staff exhibit higher levels of burnout than Maslach Burnout Inventory medical norms and oncology workers in previous international studies.

Prophylactic use of Mepitel Film prevents radiation-induced moist desquamation in an intra-patient randomised controlled clinical trial of 78 breast cancer patients

PURPOSE Safetac-based soft silicone dressings used in a management setting decrease the severity of radiation-induced acute skin reactions but do not affect moist desquamation rates. Here we investigate the prophylactic use of another Safetac product, Mepitel Film, on moist desquamation rates. MATERIAL AND METHODS A total of 80 breast cancer patients receiving radiation therapy were recruited between October 2012 and April 2013; 78 participants contributed data for analysis. Lateral and medial halves of the skin areas to be irradiated were randomised to Mepitel Film or aqueous cream; skin dose was measured using thermoluminescent dosimeters; skin reaction severity was assessed using RISRAS and RTOG scales. RESULTS Overall skin reaction severity was reduced by 92% (p<0.0001) in favour of Mepitel Film (RISRAS). All patients developed some form of reaction in cream-treated skin which progressed to moist desquamation in 26% of patients (RTOG grades I: 28%; IIA: 46%; IIB: 18%; III: 8%). Only 44% of patients had a skin reaction under the Film, which did not progress to moist desquamation in any of the patients (RTOG grades I: 36%; IIA: 8%). CONCLUSIONS Mepitel Film completely prevented moist desquamation and reduced skin reaction severity by 92% when used prophylactically in our cohort.

Randomized Intra-patient Controlled Trial of Mepilex Lite Dressings versus Aqueous Cream in Managing Radiation-Induced Skin Reactions Postmastectomy

Objective: Severe acute radiation-induced skin reactions occur in a significant proportion of women who receive radiation therapy for breast cancer. We previously showed that Mepilex Lite dressings decreased the severity of erythema. Here we report their effect on the full range of skin reactions in 74 breast cancer patients post-mastectomy. Methods: A total of 80 women were recruited from four hospitals in New Zealand with 74 women contributing a full data set for analysis. The first skin area on the chest wall to develop erythema was randomly divided into two similar halves; one half was treated with Mepilex Lite dressings, the other half with aqueous cream. Skin reactions were assessed using the Radiation-Induced Skin Reaction Assessment Scale. Results: Compared with aqueous cream, Mepilex Lite dressings did not significantly reduce the incidence of moist desquamation but did reduce the overall severity of skin reactions by 41% (p<0.001), the average moist desquamation score by 49% (p=0.043) and the sum of the moist desquamation time for all patches by 28% from 25 to 18 weeks. Most patients preferred the dressings, found them easy to use and very comfortable to wear. Conclusions: Mepilex Lite dressings reduce all aspects of radiation-induced skin reactions.

Establishing radiation therapy advanced practice in New Zealand.

Advanced practice (AP) is of increasing interest to many radiation therapists (RTs) both nationally and internationally. In New Zealand, initial research (2005–2008) showed strong support for the development of an AP role for medical radiation technologists (MRTs). Here, we report on a nationwide survey in which RTs validated and prioritised nine AP profiles for future development.

Evaluation of the training and support received by facilitators of a cancer education and support programme in New Zealand

This study evaluates the training and support provided for facilitators who deliver the Living Well programme. This education and support programme, offered by the Cancer Society of New Zealand since 1991, aims to demystify cancer and its treatments, and develop self-efficacy of cancer patients and their supporters. A purposeful sample of 17 facilitators from five regions across New Zealand participated in semi-structured interviews. Quantitative data on demographics, qualifications and history with the programme were subjected to a frequency analysis. A thematic content analysis was conducted on qualitative data regarding the experiences of the facilitators with the training programme and the level and quality of subsequent support. Facilitators (aged 35-65, 16 of whom were women), came from a variety of socio-economic and educational backgrounds with a significant number having health-related roles and qualifications. Facilitator training was seen as relevant, thorough, effective and good preparation for the demands of the role. The pairing of more experienced staff and volunteers to co-facilitate was a particularly successful aspect of the programme. The main drawbacks were limited access to support, lack of supervision and a perceived lack of appreciation from the organisation for the volunteer facilitators.

A pathway to empowerment: evaluating a cancer education and support programme in New Zealand.

Support programmes often benefit cancer patients and their families. This study evaluates how the Living Well Cancer Education Programme (LWCEP), from the Cancer Society of New Zealand, meets the needs of its clients. A purposeful sample of 21 participants representing the normal range of demographic characteristics (age, gender, diagnosis and geographical location) for the programme, participated in semi-structured interviews. Demographic data were subjected to a frequency analysis. Main data were collected and analysed using a constructivist grounded theory approach regarding the experiences of the participants with being on the programme and recommendations for future development. Of the 21 participants, 14 were cancer patients (eight women and six men) and seven were support people (five women and two men). The LWCEP was described as a safe, supportive and stimulating environment, provided a powerful sense of belonging, empowered participants to gain perspective, enhance their confidence and communication skills and make increasingly informed choices. Consistent with a previous evaluation focussing on the facilitators of the LWCEP, there was a strong desire for better promotion of the programme to the wider community, establishment of a better referral pathway and the potential to offer two separate programmes depending on the stage of a patients journey.

OC-0563: Investigating stress, burnout and job satisfaction within New Zealand radiation therapy departments

Purpose/Objective: International research indicates that oncology care workers are exposed to a variety of unique occupational stressors that put them at significant risk of burnout. This has severe implications for job satisfaction, the retention of staff and arguably the quality of care cancer patients receive whilst on treatment. The current study aimed to obtain a national indication of stress associated with occupational stressors, burnout and job satisfaction within New Zealand (NZ) Radiation Therapy departments. Potential indicators of burnout and job satisfaction were explored, as well as job satisfaction initiatives. Materials and Methods: All staff currently practicing in the eight Radiation Therapy departments in NZ were invited to participate anonymously in a questionnaire hosted on SurveyMonkey via email. The questionnaire contained questions addressing participant characteristics, such as age, work experience and position. The Maslach Burnout Inventory (MBI) was incorporated in order to make direct comparisons with previously published studies, and scales measuring the intensity of stress associated with specific occupational stressors, stress reduction strategies and job satisfaction were included. Incomplete responses were excluded and a total of 171 (out of 349) complete responses were analysed with SPSS 19. Results: Of the 171 responses, 23 identified as oncologists (Os), 111 identified as radiation therapists (RTs), 22 identified as radiation nurses (RNs) and 15 identified as radiation physicists (RPs). All participants, regardless of profession, reported high stress levels associated with both patient-centred and organisational stressors. Participants scored high in all three domains of burnout: emotional exhaustion, depersonalisation and personal accomplishment. Interestingly, although organisational stressors and emotional exhaustion predicted lower job satisfaction, patient stressors were associated with higher job satisfaction. Job satisfaction initiatives such as on-going education, mentoring and role extension were supported by many participants as was addressing organisational stressors, such as lack of recognition and support from management and unrealistic expectations and demands. Conclusions: Staff in NZ exhibit higher levels of burnout than MBI medical norms and international studies conducted in Europe, North America and Australia. In contrast to previous studies, indications of personal accomplishment and job satisfaction were incredibly high. In NZ staff in Radiation Therapy departments may be more at risk of compromising their wellbeing, compelled by the sense of personal accomplishment and satisfaction they derive from their chosen profession.