2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

SELF-CARE FOR ONCOLOGISTS
Fig. 1. Consequences of self-care or no
self-care for self and patients.
planning and decisions. The World Health Organization
defines wellness as “the optimal state of health of individuals
and groups” and explains that there are “two focal
concerns: the realization of the fullest potential of an individual
physically, psychologically, socially, spiritually, and
economically, and the fulfillment of one’s role expectations in
the family, community, place of worship, workplace, and
other settings.” 21 Thus defined, a physician’s duties to himself
or herself span the totality of life experience and affect
not only himself or herself but also those with whom he or
she interacts.
The oncologist’s responsibilities to self can be conceptualized
in three domains: professional, personal, (physical,
psychological, mental, and spiritual), and interpersonal (relational,
family, social, and community) (Fig. 1). The following
sections briefly describe each domain and provide
pragmatic approaches to self-care within each. Because
many of the basic elements of self-care are straightforward
and likely familiar to most oncologists, only simple guidelines
and principles are presented, with discussion of facilitators
for their implementation. There is no one-size-fits-all
approach; each oncologist, knowing himself or herself best,
must craft an approach that fits well with his or her own
preferences, characteristics, and circumstances.
Duties to Self within the Three Domains of
Responsibility
Professional. Most, if not all, oncologists enter medicine
with a strong sense of professional responsibility. Upholding
this initial commitment is integral to positive self-esteem
and a sense of personal integrity. Activities to maintain and
further develop one’s professional competence, such as conferences
and symposia, and to pursue one’s own professional
interests, such as committee work and research, offer mechanisms
for cultivating professional competence. Ensuring a
mix of responsibilities and some time away from patient care
is important. Goal setting in the professional domain is a
method of articulating personal standards of excellence and
holding one’s self accountable to personally meaningful
progress—a form of self-care.
Because caring for people at or near the end of life can be
especially burdensome, exacting a toll in terms of the individual’s
mental and emotional resources, specific strategies
to build palliative care skills can help with self-care. Some
strategies are to hone one’s skills and confidence in delivering
bad news; obtain palliative care–specific training
through conferences and training videos; develop relationships
with palliative care colleagues and call on them
frequently; debrief after difficult cases and losses, and take
time to acknowledge that “this is hard”; recognize that some
patients affect us more than others, and that this is normal;
and finally, when a death occurs, take time to reflect, allow
yourself to grieve, attend the funeral, reconnect with the
family, write a letter, and smile at the gift of knowing the
person when alive.
In the professional setting, we must care for ourselves and
the teams within which we work. A few strategies for care of
self and others in the work environment are to manage the
volume of time spent in patient care; ensure that the team
has mechanisms in place to debrief and share stressful
experiences; allow staff time to get together outside the
workplace; role model good personal and professional habits
(e.g., time off for important family events and prioritization
of exercise) and promote these for all members of the team;
and be attuned to any signs of burnout among team members
and educate them to be alert to these signs in self and
others. A well-functioning, personally healthy team provides
an important support network for the oncologist which can
undergird self-care for each individual and for the team as a
whole.
Personal. Table 1 presents recommendations for personal
self-care in the domains of physical, psychological and cognitive,
and spiritual wellness. Although most oncologists
will agree to the needs listed and to the corresponding
recommendations and although it is important to promote
these to patients, far fewer actually succeed in integrating
these or other self-care strategies into daily living. (Table 1
is intended not to provide a comprehensive list of self-care
needs, recommendations, or strategies but rather to offer
an initial set of practical suggestions. Knowing himself or
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