It is well documented that burnout in medical providers is common (Chen, 2012) and even higher in oncology (Whippen & Canellos, 1991). Self-care is a critical component to sustain a career in the medical field or helping profession. What is less well documented is self-care as a team-based approach. Research supporting a team-based approach for self-care is primarily found in the fields of organizational and industrial psychology. The suggestions offered here come from personal experience in working as an oncology social worker as part of both a medical team and a larger psycho-oncology department within a hospital system. I hope these suggestions will act as a springboard for other departments or groups to explore group self-care practices, in addition to individual self-care approaches.
 

One Team-Based Program

Over time, the oncology social work team at my hospital has developed three major self-care activities that are done as a department:

1. Weekly emails that have taken a few forms.
   1. Sometimes it is a weekly sharing of an uplifting or inspiring poem, which have come to be called the “Friday Pause.”
   2. An email chain of “wins”—simple statements from team members that share a success, such as a patient bringing in their signed Power of Attorney paper or a doctor using an interpreter after many reminders to do so.
2. An annual team retreat. Our supervisor and medical director have advocated for a work day where social workers meet off site for professional development as a group. While this retreat isn’t a “spa day,” it is time together as a team to engage in continuing education and evaluate what is working (or not working) for us as a department. Moreover, it is time as a group away from patient-care needs and without email or phone interruptions.
3. Starting each team meeting with a moment of mindfulness. This is done by someone ringing a bell and leading the group in three deep breaths. This has been an evolving process, with time points set aside for intentional group check-ins to see if these are meeting individual needs. Part of our department culture has been to allow individuals time outside of meetings to think about questions before discussing them as a group. Thus, the solicitation of feedback generally looks like anonymous surveys sent out in email format and followed up by larger group discussion.

Group self-care practices have been explored on the multidisciplinary level as well. Some clinics within the hospital work with social work and/or spiritual care to offer a “Tea for the Soul” (one clinic calls this time “Milk and Cookies”). This generally looks like a space set aside in the clinic or unit where staff can informally come by to enjoy a snack and acknowledge that the work done in the oncology setting can be emotionally heavy. Sometimes a large paper is provided to write a patient name or reflection that can be read by others. Other times copies of a poem are left for staff to take with them. While staff has expressed appreciation of these practices, challenges have included time away from patient care and space availability.

Does Size Matter?

I realize I am fortunate to be part of a robust group of oncology social workers within a large hospital system. In reflection, I do wonder, “Does size matter?” Do group practices of self-care matter if they are done in groups of two versus groups of 10? Self-care has been a trending topic in the helping professions over the past five years; it could be beneficial, however, to move away from the model of self-care as an individual activity that is practiced away from work. Our hospital system recently looked at the association between integrated care practice and burnout factors in primary care physicians, with good indications that integrated care may be a strategy to help curb the trend of physician burn out (Zubatsky, Pettinelli, Salas, & Davis, 2018). The medical care that patients receive in the oncology setting has shifted from a singular-provider approach to a multidisciplinary team-based approach. It seems that a similar approach for self-care could be advantageous as well.

References

Chen, P.W. (2012, August 23). The Widespread Problem of Doctor Burnout. The New York Times. Retrieved from https://cdn.ymaws.com/www.inbar.org/resource/resmgr/Conclave/_Wellness_WidespreadProblemD.pdf.

Whippen, D.A., & Canellos, G.P. (1991). Burnout syndrome in the practice of oncology: Results of a random survey of 1,000 oncologists. Journal of Clinical Oncology, 9, 1916-1920. doi:10.1200/JCO.1991.9.10.1916

Zubatsky, M., Pettinelli, D., Salas, J., & Davis, D. (2018). Associations between integrated care practice and burnout factors of primary care physicians. Family Medicine, 50, 770-774. https://doi.org/10.22454/FamMed.2018.655711