Burnout Syndrome among Doctors in Greek Oncology Departments
,
Abstract
Objective: Economic crisis and austerity has dramatic consequences for health care professionals’ mental health. This study aimed to investigate the prevalence of burnout syndrome among doctors working in public or private oncology departments in Greece and its association with factors determined by economic crisis.
Method: Medical or radiation oncologists who are members of the National Oncology Societies and practicing oncology at least for one year were enrolled in this study. An On-Line questionnaire consisting of the Maslach Burnout Inventory and an informative questionnaire was utilized.
Results: Eighty-six On-Line questionnaires waere analyzed. Radiation oncologists had significantly higher Depersonalization (DP), whereas medical oncologists had significantly higher Emotional Exhaustion (EE) scores. Registrars had higher scores compared to consultants in all subscales of the burnout syndrome. Factors such as ‘‘hospitals are not safe due to the lack or reductions in medical supplies and personnel shortage’’ and ‘‘receiving less than 50% of annual leave’’ were associated with significantly higher levels of EE. Factors such as ‘‘not afraid of moving abroad’’ and ‘‘receiving 100% of annual leave’’ were associated with significantly higher levels of low Personal Accomplishments (PA). The principal component analysis yielded three principal components: ‘future insecurity’, ‘feeling secure while working’ and ‘working conditions associated with burnout syndrome.
Conclusion: Several factors associated with austerity resulting from economic crisis significantly influenced prevalence of burnout syndrome among oncologists in Greece. Further studies need to be conducted to mobilize policy makers to develop and implement policies to improve oncologists' mental health.
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2. Banerjee S, Califano R, Corral J, de Azambuja E, De Mattos-Arruda L, Guarneri V, et al. Professional burnout in European young oncologists: results of the European Society for Medical Oncology (ESMO) Young Oncologists Committee Burnout Survey. Ann Oncol 2017;28:1590-6.
3. World Health Organization. International Statistical Classification of Diseases and Related Health Problems: ICD-10; 2016. Available from:
http://apps.who.int/classifications/icd10/browse/2016/en#/Z73.0[Accessed 11th March 2020]
4. Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. 2016;15(2):103-11.
5. Granek L, Ben-David M, Nakash O, Cohen M, Barbera L, Ariad S, et al. Oncologists' negative attitudes towards expressing emotion over patient death and burnout. Support Care Cancer. 2017;25(5):1607-14.
6. Pantenburg B, Luppa M, König HH, Riedel-Heller SG. Burnout among young physicians and its association with physicians' wishes to leave: results of a survey in Saxony, Germany. J Occup Med Toxicol. 2016;11:2.
7. Blanchard P. Burnout among young European oncologists: a call for action. Ann Oncol. 2017;28(7):1414-5.
8. Bria M, Spanu F, Baban A, Dumitrascu DL.Maslach Burnout Inventory - General Survey: Factorial validity and invariance among Romanian healthcare professionals. Burn Res. 2014;1:103-11.
9. Cañadas-De la Fuente GA, Gómez-Urquiza JL, Ortega-Campos EM, Cañadas GR, Albendín-García L, De la Fuente-Solana EI. Prevalence of burnout syndrome in oncology nursing: A meta-analytic study. Psychooncology. 2018;27(5):1426-33.
10. Kusano AS, Thomas CR, Jr., Bonner JA, DeWeese TL, Formenti SC, Hahn SM, et al. Burnout in United States academic chairs of radiation oncology programs. Int J Radiat Oncol Biol Phys. 2014;88(2):363-8.
11. Salvagioni DAJ, Melanda FN, Mesas AE, González AD, Gabani FL, Andrade SM. Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PLoS One. 2017;12(10):e0185781.
12. Trufelli DC, Bensi CG, Garcia JB, Narahara JL, Abrão MN, Diniz RW, et al. Burnout in cancer professionals: a systematic review and meta-analysis. Eur J Cancer Care (Engl). 2008;17(6):524-31.
13. Blanchard P, Truchot D, Albiges-Sauvin L, Dewas S, Pointreau Y, Rodrigues M, et al. Prevalence and causes of burnout amongst oncology residents: a comprehensive nationwide cross-sectional study. Eur J Cancer. 2010;46(15):2708-15.
14. Karanikola MN, Papathanassoglou ED, Mpouzika M, Lemonidou C. Burnout syndrome indices in Greek intensive care nursing personnel. Dimens Crit Care Nurs. 2012;31(2):94-101.
15. Kumar S. Burnout and doctors: prevalence, prevention and intervention. Healthcare (Basel) 2016;4(3):37.
16. Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89(3):443-51.
17. Ishak WW, Lederer S, Mandili C, Nikravesh R, Seligman L, Vasa M, et al. Burnout during residency training: a literature review. J Grad Med Educ. 2009;1(2):236-42.
18. Amiri M, Khosravi A, Eghtesadi AR, Sadeghi Z, Abedi G, Ranjbar M, et al. Burnout and its Influencing Factors among Primary Health Care Providers in the North East of Iran. PLoS One. 2016;11(12):e0167648.
19. Copur MS. Burnout in Oncology. Oncology (Williston Park). 2019;33(11):687522.
20. Shanafelt TD, Raymond M, Horn L, Moynihan T, Collichio F, Chew H, et al. Oncology fellows’ career plans, expectations, and well-being: do fellows know what they are getting into? J Clin Oncol. 2014;32(27):2991-7.
21. Allegra CJ, Hall R, Yothers G. Prevalence of burnout in the u.s. Oncology community: results of a 2003 survey. J Oncol Pract. 2005;1(4):140-7.
22. Elit L, Trim K, Mand-Bains IH, Sussman J, Grunfeld E. Job satisfaction, stress, and burnout among Canadian gynecologic oncologists. Gynecol Oncol. 2004;94(1):134-9.
23. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714-21.
24. Sinsky C, Colligan L, Li L, Prgomet M, Reynolds S, Goeders L, et al. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Ann Intern Med. 2016;165(11):753-60.
25. Landon BE, Reschovsky J, Blumenthal D. Changes in career satisfaction among primary care and specialist physicians, 1997-2001. Jama. 2003;289(4):442-9.
26. Shanafelt TD, Dyrbye LN, West CP. Addressing Physician Burnout: The Way Forward. Jama. 2017;317(9):901-2.
27. Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM, Leaning MS, et al. Burnout and psychiatric disorder among cancer clinicians. Br J Cancer. 1995;71(6):1263-9.
28. Glasberg J, Horiuti L, Novais MA, Canavezzi AZ, da Costa Miranda V, Chicoli FA, et al. Prevalence of the burnout syndrome among Brazilian medical oncologists. Rev Assoc Med Bras (1992). 2007;53(1):85-9.
29. Dhande M. Writing Out Loud: To Computers, Patients, and Burnout, 2016. JAMA Cardiol. 2016;1(6):639.
30. Lee S, Guo WJ, Tsang A, Mak AD, Wu J, Ng KL, et al. Evidence for the 2008 economic crisis exacerbating depression in Hong Kong. J Affect Disord. 2010;126(1-2):125-33.
31. Rachiotis G, Kourousis C, Kamilaraki M, Symvoulakis EK, Dounias G, Hadjichristodoulou C. Medical supplies shortages and burnout among greek health care workers during economic crisis: a pilot study. Int J Med Sci. 2014;11(5):442-7.
32. Wang J, Smailes E, Sareen J, Fick GH, Schmitz N, Patten SB. The prevalence of mental disorders in the working population over the period of global economic crisis. Can J Psychiatry. 2010;55(9):598-605.
33. Evans-Lacko S, Knapp M, McCrone P, Thornicroft G, Mojtabai R. The mental health consequences of the recession: economic hardship and employment of people with mental health problems in 27 European countries. PLoS One. 2013;8(7):e69792.
34. Gili M, Roca M, Basu S, McKee M, Stuckler D. The mental health risks of economic crisis in Spain: evidence from primary care centres, 2006 and 2010. Eur J Public Health. 2013;23(1):103-8.
35. Avčin BA, Kučina AU, Sarotar BN, Radovanović M, Plesničar BK. The present global financial and economic crisis poses an additional risk factor for mental health problems on the employees. Psychiatr Danub. 2011;23 Suppl 1:S142-8.
36. Sargent-Cox K, Butterworth P, Anstey KJ. The global financial crisis and psychological health in a sample of Australian older adults: a longitudinal study. Soc Sci Med. 2011;73(7):1105-12.
37. Chan CH, Caine ED, You S, Fu KW, Chang SS, Yip PS. Suicide rates among working-age adults in South Korea before and after the 2008 economic crisis. J Epidemiol Community Health. 2014;68(3):246-52.
38. Miret M, Caballero FF, Huerta-Ramírez R, Moneta MV, Olaya B, Chatterji S, et al. Factors associated with suicidal ideation and attempts in Spain for different age groups. Prevalence before and after the onset of the economic crisis. J Affect Disord. 2014;163:1-9.
39. ten Have M, van Dorsselaer S, de Graaf R. The association between type and number of adverse working conditions and mental health during a time of economic crisis (2010-2012). Soc Psychiatry Psychiatr Epidemiol. 2015;50(6):899-907.
40. Snorradóttir Á, Vilhjálmsson R, Rafnsdóttir GL, Tómasson K. Financial crisis and collapsed banks: psychological distress and work related factors among surviving employees--a nation-wide study. Am J Ind Med. 2013;56(9):1095-106.
41. Chang SS, Stuckler D, Yip P, Gunnell D. Impact of 2008 global economic crisis on suicide: time trend study in 54 countries. Bmj. 2013;347:f5239.
42. Drydakis N. The effect of unemployment on self-reported health and mental health in Greece from 2008 to 2013: a longitudinal study before and during the financial crisis. Soc Sci Med. 2015;128:43-51.
43. Mattei G, Ferrari S, Pingani L, Rigatelli M. Short-term effects of the 2008 Great Recession on the health of the Italian population: an ecological study. Soc Psychiatry Psychiatr Epidemiol. 2014;49(6):851-8.
44. Modrek S, Cullen MR. Health consequences of the 'Great Recession' on the employed: evidence from an industrial cohort in aluminum manufacturing. Soc Sci Med. 2013;92:105-13.
45. Astell-Burt T, Feng X. Health and the 2008 economic recession: evidence from the United Kingdom. PLoS One. 2013;8(2):e56674.
46. Loerbroks A, Bosch JA, Douwes J, Angerer P, Li J. Job insecurity is associated with adult asthma in Germany during Europe's recent economic crisis: a prospective cohort study. J Epidemiol Community Health. 2014;68(12):1196-9.
47. Mucci N, Giorgi G, Roncaioli M, Fiz Perez J, Arcangeli G. The correlation between stress and economic crisis: a systematic review. Neuropsychiatr Dis Treat. 2016;12:983-93.
48. Simou E, Koutsogeorgou E. Effects of the economic crisis on health and healthcare in Greece in the literature from 2009 to 2013: a systematic review. Health Policy. 2014;115(2-3):111-9.
49. Msaouel P, Keramaris NC, Tasoulis A, Kolokythas D, Syrmos N, Pararas N, et al. Burnout and training satisfaction of medical residents in Greece: will the European Work Time Directive make a difference? Hum Resour Health. 2010;8:16.
50. Maslach C, Jackson S. The measurement of experienced burnout. J Organ Behav. 1981;2:99-113.
51. Grunfeld E, Whelan TJ, Zitzelsberger L, Willan AR, Montesanto B, Evans WK. Cancer care workers in Ontario: prevalence of burnout, job stress and job satisfaction. Cmaj. 2000;163(2):166-9.
52. Cohen J. Statistical Power Analysis for the Behavioral Sciences (2nd ed.). , New Jersey: Lawrence Erlbaum Associates, Publishers; 1988.
53. Ifanti AA, Argyriou AA, Kalofonou FH, Kalofonos HP. Financial crisis and austerity measures in Greece: their impact on health promotion policies and public health care. Health Policy. 2013;113(1-2):8-12.
54. Mossialos E, Allin S, Davaki K. Analysing the Greek health system: a tale of fragmentation and inertia. Health Econ. 2005;14(Suppl 1):S151-68.
55. Notara V, Koupidis SA, Vaga E, Grammatikopoulos IA. Economic crisis and challenges for the Greek healthcare system: the emergent role of nursing management. J Nurs Manag. 2010;18(5):501-4.
56. Dyrbye LN, Shanafelt TD. Physician burnout: a potential threat to successful health care reform. Jama. 2011;305(19):2009-10.
57. Bourne T, Shah H, Falconieri N, Timmerman D, Lees C, Wright A, et al. Burnout, well-being and defensive medical practice among obstetricians and gynaecologists in the UK: cross-sectional survey study. BMJ Open. 2019;9(11):e030968.
58. Panagioti M, Geraghty K, Johnson J. How to prevent burnout in cardiologists? A review of the current evidence, gaps, and future directions. Trends Cardiovasc Med. 2018;28(1):1-7.
59. Panagioti M, Panagopoulou E, Bower P, Lewith G, Kontopantelis E, Chew-Graham C, et al. Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-analysis. JAMA Intern Med. 2017;177(2):195-205.
60. Montgomery A, Panagopoulou E, Esmail A, Richards T, Maslach C. Burnout in healthcare: the case for organisational change. Bmj. 2019;366:l4774.
61. Wisetborisut A, Angkurawaranon C, Jiraporncharoen W, Uaphanthasath R, Wiwatanadate P. Shift work and burnout among health care workers. Occup Med (Lond). 2014;64(4):279-86.
62. Corrigan L, O'Leary C, Kroes J, Farooq AR, Horgan A, Calvert P, et al. Professional burnout, work patterns and career satisfaction in medical oncologists in Ireland. Ir J Med Sci. 2020;189(2):711-8.
63. Kalafati M. How Greek healthcare services are affected by the Euro crisis. Emerg Nurse. 2012;20(3):26-7.
64. Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995-1000.
65. Leung J, Rioseco P, Munro P. Stress, satisfaction and burnout amongst Australian and New Zealand radiation oncologists. J Med Imaging Radiat Oncol. 2015;59(1):115-24.
66. Mampuya WA, Matsuo Y, Nakamura A, Hiraoka M. Evaluation of the prevalence of burnout and psychological morbidity among radiation oncologist members of the Kyoto Radiation Oncology Study Group (KROSG). J Radiat Res. 2017;58(2):217-24.
67. Shanafelt TD, Gradishar WJ, Kosty M, Satele D, Chew H, Horn L, et al. Burnout and career satisfaction among US oncologists. J Clin Oncol. 2014;32(7):678-86.
68. Rath KS, Huffman LB, Phillips GS, Carpenter KM, Fowler JM. Burnout and associated factors among members of the Society of Gynecologic Oncology. Am J Obstet Gynecol. 2015;213(6):824.e1-9.
69. Jolliffe IT. Principal Component Analysis (2nd ed.). New York: Springer-Verlag Inc; 2002.
2. Banerjee S, Califano R, Corral J, de Azambuja E, De Mattos-Arruda L, Guarneri V, et al. Professional burnout in European young oncologists: results of the European Society for Medical Oncology (ESMO) Young Oncologists Committee Burnout Survey. Ann Oncol 2017;28:1590-6.
3. World Health Organization. International Statistical Classification of Diseases and Related Health Problems: ICD-10; 2016. Available from:
http://apps.who.int/classifications/icd10/browse/2016/en#/Z73.0[Accessed 11th March 2020]
4. Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. 2016;15(2):103-11.
5. Granek L, Ben-David M, Nakash O, Cohen M, Barbera L, Ariad S, et al. Oncologists' negative attitudes towards expressing emotion over patient death and burnout. Support Care Cancer. 2017;25(5):1607-14.
6. Pantenburg B, Luppa M, König HH, Riedel-Heller SG. Burnout among young physicians and its association with physicians' wishes to leave: results of a survey in Saxony, Germany. J Occup Med Toxicol. 2016;11:2.
7. Blanchard P. Burnout among young European oncologists: a call for action. Ann Oncol. 2017;28(7):1414-5.
8. Bria M, Spanu F, Baban A, Dumitrascu DL.Maslach Burnout Inventory - General Survey: Factorial validity and invariance among Romanian healthcare professionals. Burn Res. 2014;1:103-11.
9. Cañadas-De la Fuente GA, Gómez-Urquiza JL, Ortega-Campos EM, Cañadas GR, Albendín-García L, De la Fuente-Solana EI. Prevalence of burnout syndrome in oncology nursing: A meta-analytic study. Psychooncology. 2018;27(5):1426-33.
10. Kusano AS, Thomas CR, Jr., Bonner JA, DeWeese TL, Formenti SC, Hahn SM, et al. Burnout in United States academic chairs of radiation oncology programs. Int J Radiat Oncol Biol Phys. 2014;88(2):363-8.
11. Salvagioni DAJ, Melanda FN, Mesas AE, González AD, Gabani FL, Andrade SM. Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PLoS One. 2017;12(10):e0185781.
12. Trufelli DC, Bensi CG, Garcia JB, Narahara JL, Abrão MN, Diniz RW, et al. Burnout in cancer professionals: a systematic review and meta-analysis. Eur J Cancer Care (Engl). 2008;17(6):524-31.
13. Blanchard P, Truchot D, Albiges-Sauvin L, Dewas S, Pointreau Y, Rodrigues M, et al. Prevalence and causes of burnout amongst oncology residents: a comprehensive nationwide cross-sectional study. Eur J Cancer. 2010;46(15):2708-15.
14. Karanikola MN, Papathanassoglou ED, Mpouzika M, Lemonidou C. Burnout syndrome indices in Greek intensive care nursing personnel. Dimens Crit Care Nurs. 2012;31(2):94-101.
15. Kumar S. Burnout and doctors: prevalence, prevention and intervention. Healthcare (Basel) 2016;4(3):37.
16. Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89(3):443-51.
17. Ishak WW, Lederer S, Mandili C, Nikravesh R, Seligman L, Vasa M, et al. Burnout during residency training: a literature review. J Grad Med Educ. 2009;1(2):236-42.
18. Amiri M, Khosravi A, Eghtesadi AR, Sadeghi Z, Abedi G, Ranjbar M, et al. Burnout and its Influencing Factors among Primary Health Care Providers in the North East of Iran. PLoS One. 2016;11(12):e0167648.
19. Copur MS. Burnout in Oncology. Oncology (Williston Park). 2019;33(11):687522.
20. Shanafelt TD, Raymond M, Horn L, Moynihan T, Collichio F, Chew H, et al. Oncology fellows’ career plans, expectations, and well-being: do fellows know what they are getting into? J Clin Oncol. 2014;32(27):2991-7.
21. Allegra CJ, Hall R, Yothers G. Prevalence of burnout in the u.s. Oncology community: results of a 2003 survey. J Oncol Pract. 2005;1(4):140-7.
22. Elit L, Trim K, Mand-Bains IH, Sussman J, Grunfeld E. Job satisfaction, stress, and burnout among Canadian gynecologic oncologists. Gynecol Oncol. 2004;94(1):134-9.
23. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714-21.
24. Sinsky C, Colligan L, Li L, Prgomet M, Reynolds S, Goeders L, et al. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Ann Intern Med. 2016;165(11):753-60.
25. Landon BE, Reschovsky J, Blumenthal D. Changes in career satisfaction among primary care and specialist physicians, 1997-2001. Jama. 2003;289(4):442-9.
26. Shanafelt TD, Dyrbye LN, West CP. Addressing Physician Burnout: The Way Forward. Jama. 2017;317(9):901-2.
27. Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM, Leaning MS, et al. Burnout and psychiatric disorder among cancer clinicians. Br J Cancer. 1995;71(6):1263-9.
28. Glasberg J, Horiuti L, Novais MA, Canavezzi AZ, da Costa Miranda V, Chicoli FA, et al. Prevalence of the burnout syndrome among Brazilian medical oncologists. Rev Assoc Med Bras (1992). 2007;53(1):85-9.
29. Dhande M. Writing Out Loud: To Computers, Patients, and Burnout, 2016. JAMA Cardiol. 2016;1(6):639.
30. Lee S, Guo WJ, Tsang A, Mak AD, Wu J, Ng KL, et al. Evidence for the 2008 economic crisis exacerbating depression in Hong Kong. J Affect Disord. 2010;126(1-2):125-33.
31. Rachiotis G, Kourousis C, Kamilaraki M, Symvoulakis EK, Dounias G, Hadjichristodoulou C. Medical supplies shortages and burnout among greek health care workers during economic crisis: a pilot study. Int J Med Sci. 2014;11(5):442-7.
32. Wang J, Smailes E, Sareen J, Fick GH, Schmitz N, Patten SB. The prevalence of mental disorders in the working population over the period of global economic crisis. Can J Psychiatry. 2010;55(9):598-605.
33. Evans-Lacko S, Knapp M, McCrone P, Thornicroft G, Mojtabai R. The mental health consequences of the recession: economic hardship and employment of people with mental health problems in 27 European countries. PLoS One. 2013;8(7):e69792.
34. Gili M, Roca M, Basu S, McKee M, Stuckler D. The mental health risks of economic crisis in Spain: evidence from primary care centres, 2006 and 2010. Eur J Public Health. 2013;23(1):103-8.
35. Avčin BA, Kučina AU, Sarotar BN, Radovanović M, Plesničar BK. The present global financial and economic crisis poses an additional risk factor for mental health problems on the employees. Psychiatr Danub. 2011;23 Suppl 1:S142-8.
36. Sargent-Cox K, Butterworth P, Anstey KJ. The global financial crisis and psychological health in a sample of Australian older adults: a longitudinal study. Soc Sci Med. 2011;73(7):1105-12.
37. Chan CH, Caine ED, You S, Fu KW, Chang SS, Yip PS. Suicide rates among working-age adults in South Korea before and after the 2008 economic crisis. J Epidemiol Community Health. 2014;68(3):246-52.
38. Miret M, Caballero FF, Huerta-Ramírez R, Moneta MV, Olaya B, Chatterji S, et al. Factors associated with suicidal ideation and attempts in Spain for different age groups. Prevalence before and after the onset of the economic crisis. J Affect Disord. 2014;163:1-9.
39. ten Have M, van Dorsselaer S, de Graaf R. The association between type and number of adverse working conditions and mental health during a time of economic crisis (2010-2012). Soc Psychiatry Psychiatr Epidemiol. 2015;50(6):899-907.
40. Snorradóttir Á, Vilhjálmsson R, Rafnsdóttir GL, Tómasson K. Financial crisis and collapsed banks: psychological distress and work related factors among surviving employees--a nation-wide study. Am J Ind Med. 2013;56(9):1095-106.
41. Chang SS, Stuckler D, Yip P, Gunnell D. Impact of 2008 global economic crisis on suicide: time trend study in 54 countries. Bmj. 2013;347:f5239.
42. Drydakis N. The effect of unemployment on self-reported health and mental health in Greece from 2008 to 2013: a longitudinal study before and during the financial crisis. Soc Sci Med. 2015;128:43-51.
43. Mattei G, Ferrari S, Pingani L, Rigatelli M. Short-term effects of the 2008 Great Recession on the health of the Italian population: an ecological study. Soc Psychiatry Psychiatr Epidemiol. 2014;49(6):851-8.
44. Modrek S, Cullen MR. Health consequences of the 'Great Recession' on the employed: evidence from an industrial cohort in aluminum manufacturing. Soc Sci Med. 2013;92:105-13.
45. Astell-Burt T, Feng X. Health and the 2008 economic recession: evidence from the United Kingdom. PLoS One. 2013;8(2):e56674.
46. Loerbroks A, Bosch JA, Douwes J, Angerer P, Li J. Job insecurity is associated with adult asthma in Germany during Europe's recent economic crisis: a prospective cohort study. J Epidemiol Community Health. 2014;68(12):1196-9.
47. Mucci N, Giorgi G, Roncaioli M, Fiz Perez J, Arcangeli G. The correlation between stress and economic crisis: a systematic review. Neuropsychiatr Dis Treat. 2016;12:983-93.
48. Simou E, Koutsogeorgou E. Effects of the economic crisis on health and healthcare in Greece in the literature from 2009 to 2013: a systematic review. Health Policy. 2014;115(2-3):111-9.
49. Msaouel P, Keramaris NC, Tasoulis A, Kolokythas D, Syrmos N, Pararas N, et al. Burnout and training satisfaction of medical residents in Greece: will the European Work Time Directive make a difference? Hum Resour Health. 2010;8:16.
50. Maslach C, Jackson S. The measurement of experienced burnout. J Organ Behav. 1981;2:99-113.
51. Grunfeld E, Whelan TJ, Zitzelsberger L, Willan AR, Montesanto B, Evans WK. Cancer care workers in Ontario: prevalence of burnout, job stress and job satisfaction. Cmaj. 2000;163(2):166-9.
52. Cohen J. Statistical Power Analysis for the Behavioral Sciences (2nd ed.). , New Jersey: Lawrence Erlbaum Associates, Publishers; 1988.
53. Ifanti AA, Argyriou AA, Kalofonou FH, Kalofonos HP. Financial crisis and austerity measures in Greece: their impact on health promotion policies and public health care. Health Policy. 2013;113(1-2):8-12.
54. Mossialos E, Allin S, Davaki K. Analysing the Greek health system: a tale of fragmentation and inertia. Health Econ. 2005;14(Suppl 1):S151-68.
55. Notara V, Koupidis SA, Vaga E, Grammatikopoulos IA. Economic crisis and challenges for the Greek healthcare system: the emergent role of nursing management. J Nurs Manag. 2010;18(5):501-4.
56. Dyrbye LN, Shanafelt TD. Physician burnout: a potential threat to successful health care reform. Jama. 2011;305(19):2009-10.
57. Bourne T, Shah H, Falconieri N, Timmerman D, Lees C, Wright A, et al. Burnout, well-being and defensive medical practice among obstetricians and gynaecologists in the UK: cross-sectional survey study. BMJ Open. 2019;9(11):e030968.
58. Panagioti M, Geraghty K, Johnson J. How to prevent burnout in cardiologists? A review of the current evidence, gaps, and future directions. Trends Cardiovasc Med. 2018;28(1):1-7.
59. Panagioti M, Panagopoulou E, Bower P, Lewith G, Kontopantelis E, Chew-Graham C, et al. Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-analysis. JAMA Intern Med. 2017;177(2):195-205.
60. Montgomery A, Panagopoulou E, Esmail A, Richards T, Maslach C. Burnout in healthcare: the case for organisational change. Bmj. 2019;366:l4774.
61. Wisetborisut A, Angkurawaranon C, Jiraporncharoen W, Uaphanthasath R, Wiwatanadate P. Shift work and burnout among health care workers. Occup Med (Lond). 2014;64(4):279-86.
62. Corrigan L, O'Leary C, Kroes J, Farooq AR, Horgan A, Calvert P, et al. Professional burnout, work patterns and career satisfaction in medical oncologists in Ireland. Ir J Med Sci. 2020;189(2):711-8.
63. Kalafati M. How Greek healthcare services are affected by the Euro crisis. Emerg Nurse. 2012;20(3):26-7.
64. Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995-1000.
65. Leung J, Rioseco P, Munro P. Stress, satisfaction and burnout amongst Australian and New Zealand radiation oncologists. J Med Imaging Radiat Oncol. 2015;59(1):115-24.
66. Mampuya WA, Matsuo Y, Nakamura A, Hiraoka M. Evaluation of the prevalence of burnout and psychological morbidity among radiation oncologist members of the Kyoto Radiation Oncology Study Group (KROSG). J Radiat Res. 2017;58(2):217-24.
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| Files | ||
| Issue | Vol 17 No 2 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v17i2.8906 | |
| Keywords | ||
| Burnout Syndrome Economic Recession Greece Oncology | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Pittaka M, Sakellakis M, Metaxas V, Kardamakis D, Wagland R. Burnout Syndrome among Doctors in Greek Oncology Departments. Iran J Psychiatry. 2022;17(2):162-176.
