Constant exposure to patient distress and trauma can take a toll on oncology workers, and it often leads to a phenomenon called secondary traumatic stress, or “compassion fatigue,” according to Charles Figley, PhD, Paul Henry Kurzweg Chair in Disaster Mental Health and Director of the Traumatology Institute at Tulane University in New Orleans, LA.
“A lot of people mix up burnout and compassion fatigue,” he said in a webinar hosted by the American Psychosocial Oncology Society in January 2017. “Burnout is when you’re sick of your job; compassion fatigue is when you like your job but you can’t quite manage the emotionality of it.”
Compassion fatigue frequently results in the caregiver’s reduced capacity or interest in being empathic or “bearing the suffering” of their patient and can lead to poor self-care and extreme self-sacrifice on the part of the caregiver. According to Dr Figley, it is imperative that oncology professionals recognize the protective factors, as well as the risk factors, associated with compassion fatigue.
“We’re all compassionate people, and our gift at being able to be empathic comes at a cost from time to time,” he said. “But the compassionate can benefit just as much as the recipients of compassionate care.”
Have Compassion for Yourself
To dispense an empathic response, one has to possess the ability to be empathic and be willing to be exposed to suffering. Therefore, providing an empathic response increases secondary traumatic stress. “You can’t provide an effective empathic response unless you know what’s happening with your patient, but this increases our compassion fatigue because we ‘walk in their shoes’ and see what they’re facing, particularly in regards to their diagnosis,” he said.
Secondary traumatic stress reactions can be evident in a multitude of signs, including having little interest in being around others, clients evoking anxiety, unintentional thoughts about clients, emotional numbing, being easily annoyed or discouraged, or having trouble concentrating.
Regular interaction with traumatized people also yields the potential for prolonged exposure to suffering. “If you’re extraordinarily effective at working with traumatized people, you may be pulled into it even more,” he noted. Working with the suffering can also bring up other traumatic memories—from one’s own life or from the lives of other clients—and if these are awakened, additional strain is put on the caretaker, and a new set of needs and demands is introduced.
High compassion fatigue resilience can be achieved by the practice of self-nurturance, and through the utilization of “protective” practices like detachment, harboring a sense of satisfaction and pride in one’s work, and the development of social support networks at work and at home.
Self-care and compassion fatigue resilience is not something you achieve on your own, he noted. In addition to a trusted friend or family member at home, Dr Figley encourages the identification of an “accountability buddy” at work. “You need a colleague to turn to who understands the work, and for whom you’re responsible as well,” he said. “This is a trusting relationship that can be tremendously useful, and it’s a significant element of social support.”
He also encourages counterbalancing symptoms of compassion fatigue with healthy coping strategies for inducing relaxation response, particularly breath-work, meditation, progressive relaxation, and visual/guided imagery.
“What we’re hoping is that time and attention to resilience will pay off in preventing any unintended negative consequences from doing this type of work,” he explained, noting that resilience is beneficial not only to the well-being of caretakers but also saves organizations the time and cost of training and replacing workers who might have otherwise quit due to their compassion fatigue.
“Resilience needs to be constantly developed and perfected,” he added. “But as we build up resilience to compassion fatigue, it will make us healthier, happier, and better at managing stress.”
