Compassion fatigue and satisfaction in oncology professionals: an integrative review

Saura, Ana Paula Neroni Stina; Valóta, Izabel Alves das Chagas; Santos, Maiara Rodrigues dos; Silva, Rodrigo Marques da; Calache, Ana Lucia Siqueira Costa

doi:10.1590/1983-803420233073EN

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Research • Rev. Bioét. 31 • 2023 • https://doi.org/10.1590/1983-803420233073EN copy

Compassion fatigue and satisfaction in oncology professionals: an integrative review

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Abstract

This integrative review investigates the factors that may promote or harm the quality of life of oncology professionals, according to compassion fatigue and satisfaction criteria. Bibliographic research was conducted on the CINAHL, Embase, Web of Science, PsycINFO, Scopus, MEDLINE and Virtual Health Library databases. Primary studies published in Portuguese, Spanish and English were included. Of the 909 articles found, 18 were selected for analysis by three independent reviewers. Data were summarized in tables and thematic categories. Sociodemographic factors, internal and external to the individual, can alter professional quality of life. In conclusion, intrinsic and subjective characteristics, as well as work environment aspects, contribute to the development of compassion fatigue and satisfaction.

Compassion fatigue; Burnout, professional; Oncology nursing; Quality of life; Neoplasms; Health personnel

Database	Term search
Scopus	(TITLE-ABS-KEY (“compassion fatigue” OR “compassion satisfaction”)) AND (cancer OR neoplas* OR oncology) AND (LIMIT-TO (LANGUAGE, “English”) OR LIMIT-TO (LANGUAGE, “Portuguese”) OR LIMIT-TO (LANGUAGE, “Spanish”))
Embase	(‘malignant neoplasm’ OR ‘cancer therapy’ OR oncology OR cancer OR neoplasm OR tumor) AND (‘compassion fatigue’/exp OR ‘compassion satisfaction’) AND ([english]/lim OR [portuguese]/lim OR [spanish]/lim) AND [embase]/lim
PsycINFO	((Any Field: (cancer) OR Any Field: (neoplas*) OR Any Field: (oncology)) OR (IndexTermsFilt: (“Oncology”) OR IndexTermsFilt: (“Neoplasms”))) AND ((IndexTermsFilt: (“Compassion Fatigue”)) OR (Any Field: (“compassion fatigue”)) OR (Any Field: (“compassion satisfaction”)));
Web of Science	Tópico: (“compassion fatigue”) OR Tópico: (“compassion satisfaction”) AND Tópico: (cancer) OR Tópico: (neoplas*) OR Tópico: (oncology);
BVS	(tw:((tw:((tw:(fadiga por compaixão)) OR (tw:(compassion fatigue)) OR (tw:(fatiga por compasión)))) OR (tw:(satisfação por compaixão)) OR (tw:(compassion satisfaction)) OR (tw:(satisfacción por compasión)))) AND (tw:(cancer OR neoplasm* OR oncology)) AND (instance:“regional”);
MEDLINE	((“compassion fatigue” OR “Compassion satisfaction”)) AND (cancer OR neoplas* OR oncology)
CINAHL	(compassion fatigue OR compassion satisfaction) AND (cancer OR neoplasm* OR oncology)

Article	Objectives	Identification and number of subjects	Study site	Instruments used	Study design
1 ¹²12. Jang I, Kim Y, Kim K. Professionalism and professional quality of life for oncology nurses. J Clin Nurs [Internet]. 2016 [acesso 16 jan 2023];25(19-20):2835-45. DOI: 10.1111/jocn.13330 https://doi.org/10.1111/jocn.13330...	To identify the relationship between professionalism and professional quality of life among oncology nurses	Oncology nurses 285 subjects	General outpatient clinic and chemotherapy clinic of two tertiary hospitals	– Hall’s Professionalism Inventory Scale – Professional Quality of Life 5	Quantitative study
2 ¹³13. Finley BA, Sheppard KG. Compassion fatigue: exploring early-career oncology nurses’ experiences. Clin J Oncol Nurs [Internet]. 2017 [acesso 16 jan 2023];21(3):E61-6. DOI: 10.1188/17.CJON.E61-E66 https://doi.org/10.1188/17.CJON.E61-E66...	To explore CF experiences among early-career nurses	Nurses 5 subjects	General cancer hospital	– Semi-structured interview	Phenomenological, qualitative study.
3 ¹⁴14. Wu S, Singh-Carlson S, Odell A, Reynolds G, Su Y. Compassion fatigue, burnout, and compassion satisfaction among oncology nurses in the United States and Canada. Oncol Nurs Forum [Internet]. 2016 [acesso 16 jan 2023];43(4):E161-9. DOI: 10.1188/16.ONF.E161-E169 https://doi.org/10.1188/16.ONF.E161-E169...	To examine the experience of oncology nurses regarding CF, BO and CS. To identify differences experienced by US and Canadian nurses	Oncology nurses 549 subjects	Canadian Association of Oncology and Oncology Nursing Society	– Professional Quality of Life 5 – Abendroth Demographic Questionnaire	Quantitative study
4 ¹⁵15. Mooney C, Fetter K, Gross BW, Rinehart C, Lynch C, Rogers FB. Preliminary analysis of compassion satisfaction and compassion fatigue with considerations for nursing unit specialization and demographic factors. J Trauma Nurs [Internet]. 2017 [acesso 16 jan 2023];24(3):158-63. DOI: 10.1097/JTN.0000000000000284 https://doi.org/10.1097/JTN.000000000000...	To characterize CF, BO and CS among nurses at a community hospital, comparing specialties (ICU and oncology)	ICU and oncology nurses 102 subjects	Community hospital	– Professional Quality of Life 5	Quantitative study
5 ¹⁶16. Perry B, Toffner G, Merrick T, Dalton J. An exploration of the experience of compassion fatigue in clinical oncology nurses. Can Oncol Nurs J [Internet]. 2011 [acesso 16 jan 2023];21(2):91-105. DOI: 10.5737/1181912x2129197 https://doi.org/10.5737/1181912x2129197...	To identify CF and BO predictors in nurses	Oncology nurses 19 subjects	Oncology hospitals	– Questionnaire – Reports of CF experiences	Descriptive exploratory qualitative study
6 ¹⁷17. Potter P, Deshields T, Divanbeigi J, Berger J, Cipriano D, Norris L et al. Compassion fatigue and burnout: prevalence among oncology nurses. Clin J Oncol Nurs [Internet]. 2010 [acesso 16 jan 2023];14(5):E56-62. DOI: 10.1188/10.CJON.E56-E62 https://doi.org/10.1188/10.CJON.E56-E62...	To explore the prevalence of CF and BO among oncology professionals	Nurses, nursing technicians, physicians and radiology technicians 153 subjects	Oncology teaching hospital	– Structured interview – Professional Quality of Life 4	Descriptive quantitative study
7 ¹⁸18. Kleiner S, Wallace JE. Oncologist burnout and compassion fatigue: investigating time pressure at work as a predictor and the mediating role of work-family conflict. BMC Health Serv Res [Internet]. 2017 [acesso 16 jan 2023];17(1):639. DOI: 10.1186/s12913-017-2581-9 https://doi.org/10.1186/s12913-017-2581-...	To identify CF and BO predictors among Canadian oncologists	Oncologists 312 subjects	Canadian Medical Association of various oncology hospitals	– Professional Quality of Life 5 – Emotional Exhaustion Subscale – Maslach Burnout Inventory	Quantitative study
8 ¹⁹19. Denigris J, Fisher K, Maley M, Nolan E. Perceived quality of work life and risk for compassion fatigue among oncology nurses: a mixed-methods study. Oncol Nurs Forum [Internet]. 2016 [acesso 16 jan 2023];43(3):E121-31. DOI: 10.1188/16.ONF.E121-E131 https://doi.org/10.1188/16.ONF.E121-E131...	To examine the factors that influenced the quality of life of oncology nurses and the risk of CF	Oncology nurses 20 subjects	Teaching hospital	– Semi-structured interview – Adapted questionnaire, using ProQoL questions	Descriptive mixed study
9 ²⁰20. Bellicoso D, Trudeau M, Fitch MI, Ralph MR. Chronobiological factors for compassion satisfaction and fatigue among ambulatory oncology caregivers. Chronobiol Int [Internet]. 2017 [acesso 16 jan 2023];34(6):808-18. DOI: 10.1080/07420528.2017.1314301	To understand how internal chronotype factors (personality types) and sleep quality influence the various components that contribute to professional quality of work	Oncologists, oncology nurses, pharmacists, radiotherapists 128 subjects	Oncology outpatient clinic	– Morningness Eveningness – Pittsburgh Sleep Quality Index – Professional Quality of Life – 10-Item Personality Inventory	Quantitative study
10 ²¹21. Duarte J, Pinto-Gouveia J. The role of psychological factors in oncology nurses’ burnout and compassion fatigue symptoms. Eur J Oncol Nurs [Internet]. 2017 [acesso 16 jan 2023];28:114-21. DOI: 10.1016/j.ejon.2017.04.002 https://doi.org/10.1016/j.ejon.2017.04.0...	To understand the relationships between several dimensions of the positive domain (CS): empathy, self-compassion and the negative domains (BO and CF) of professional quality of life	Oncology nurses 221 subjects	Public hospitals	– Professional Quality of Life 5	Quantitative study
11 ²²22. Perry B. Why exemplary oncology nurses seem to avoid compassion fatigue. Can Oncol Nurs J [Internet]. 2008 [acesso 16 jan 2023];18(2):87-99. DOI: 10.5737/1181912x1828792 https://doi.org/10.5737/1181912x1828792...	To explore the experiences of exemplary nurses in avoiding CF	Oncology nurses 7 subjects	Oncology hospital	– Semi-structured interview	Phenomenological, qualitative study
12 ²³23. Galiana L, Arena F, Oliver A, Sanso N, Benito E. Compassion satisfaction, compassion fatigue, and burnout in Spain and Brazil: ProQOL Validation and Cross-cultural Diagnosis. J Pain Symptom Manage [Internet]. 2017 [acesso 16 jan 2023];53(3):598-604. DOI: 10.1016/j.jpainsymman.2016.09.014 https://doi.org/10.1016/j.jpainsymman.20...	To identify the psychometric properties of the Spanish and Portuguese versions of the Professional Quality of Life 4 scale	Oncology professionals (physicians, nurses, pharmacists, nutritionists) 546 subjects	Online platform	– Professional Quality of Life 4	Quantitative study
13 ²⁴24. Fukumori T, Miyazaki A, Takaba C, Taniguchi S, Asai M. Cognitive reactions of nurses exposed to cancer patients’ traumatic experiences: a qualitative study to identify triggers of the onset of compassion fatigue. Psychooncology [Internet]. 2018 [acesso 16 jan 2023];27(2):620-5. DOI: 10.1002/pon.4555 https://doi.org/10.1002/pon.4555...	To describe components of nurses’ cognitive reactions to exposure to traumatic experiences for the onset of CF	Oncology nurses 30 subjects	6 hospitals in Japan	Semi-structured interview	Descriptive qualitative study
14 ²⁵25. Granek L, Nakash O, Cohen M, Ben-David M, Ariad S. Oncologists´ communication about end of life: the relationship among secondary traumatic stress, compassion satisfaction, and approach and avoidance communication. Psychooncology [Internet]. 2017 [acesso 16 jan 2023];26(11):1980-6. DOI: 10.1002/pon.4289 https://doi.org/10.1002/pon.4289...	To verify the association between CS, STS and communication about end of life of cancer patients	Oncologists 79 subjects	Online platform	Professional Quality of Life 5 Communication about End of Life Survey	Quantitative study
15 ²⁶26. Yu H, Jiang A, Shen J. Prevalence and predictors of compassion fatigue, burnout and compassion satisfaction among oncology nurses: a cross-sectional survey. Int J Nurs Stud [Internet]. 2016 [acesso 16 jan 2023];57:28-38. DOI: 10.1016/j.ijnurstu.2016.01.012 https://doi.org/10.1016/j.ijnurstu.2016....	To describe and explore the prevalence of predictors of professional quality of life (CF, BO, CS) in terms of psychological factors (empathy, personality and coping style) and social factors (social support)	Oncology nurses 650 subjects	10 hospitals in Shanghai (China)	– Chinese version of Professional Quality of Life 5 – Translated version of the Jefferson Scale of Empathy – Chinese Big Five Personality Inventory brief version	Transversal, quantitative study,
16 ²⁷27. Al-Majid S, Carlson N, Kiyohara M, Faith M, Rakovski C. Assessing the degree of compassion satisfaction and compassion fatigue among critical care, oncology, and charge nurses. J Nurs Adm [Internet]. 2018 [acesso 16 jan 2023];48(6):310-15. DOI: 10.1097/NNA.0000000000000620 https://doi.org/10.1097/NNA.000000000000...	To assess the level of satisfaction and compassion fatigue (CF) among intensive care and oncology nurses	Direct care nurses 38 subjects Nurse managers 10 subjects	US hospital	Professional Quality of Life 5	Quantitative study
17 ²⁸28. Fernandes INM, Almeida KR, Rocha FC, Andrade Neto GR, Guedes MS, Gonçalves FF et al. Analysis of the lifestyle of oncology health professionals. Rev Enferm UFPE On Line [Internet]. 2018 [acesso 16 jan 2023];12(10):2583-9. DOI: 10.5205/1981-8963-v12i10a237209p2583-2589-2018 https://doi.org/10.5205/1981-8963-v12i10...	To evaluate the lifestyle and its association with CF in oncology health professionals	Oncology health providers, namely: physicians, nurses, nursing technicians, pharmacists, nutritionists, psychologists and social workers 22 subjects	Referral hospital in oncology in Minas Gerais	Administration of the “Fantastic Lifestyles” questionnaire	Quantitative, descriptive and transversal study
18 ²⁹29. Sarra A, Feuz C. Examining the prevalence of compassion fatigue and burnout in radiation therapists caring for palliative cancer patients. J Med Imaging Radiat Sci [Internet]. 2018 [acesso 16 jan 2023];49(1):49-55. DOI: 10.1016/j.jmir.2017.10.008 https://doi.org/10.1016/j.jmir.2017.10.0...	To investigate the prevalence of CF and BO in radiotherapists who provide care to patients with palliative cancer	Radiotherapists 42 subjects	Radiotherapy center	Professional Quality of Life 5	Quantitative, transversal study

Article	Factors that promote professional quality of life (CS – positive pole)	Factors that impair professional quality of life (CF – BO/STS)
1 ¹²12. Jang I, Kim Y, Kim K. Professionalism and professional quality of life for oncology nurses. J Clin Nurs [Internet]. 2016 [acesso 16 jan 2023];25(19-20):2835-45. DOI: 10.1111/jocn.13330 https://doi.org/10.1111/jocn.13330...	Being of legal age; having greater experience in the oncology area; professionalism (having the technical knowledge required for the job)	Being single; being under 40; being younger than your peers; having less experience in oncology
2 ¹³13. Finley BA, Sheppard KG. Compassion fatigue: exploring early-career oncology nurses’ experiences. Clin J Oncol Nurs [Internet]. 2017 [acesso 16 jan 2023];21(3):E61-6. DOI: 10.1188/17.CJON.E61-E66 https://doi.org/10.1188/17.CJON.E61-E66...	Finding a higher purpose at work (helping people in need)	Bonding more intensely with patient and family (internalizing pain and fears); being exposed to a high number of deaths; feeling guilty about the short time to provide high-quality care; witnessing dehumanized care (centered on aggressive and painful treatments); being unable to share feelings
3 ¹⁴14. Wu S, Singh-Carlson S, Odell A, Reynolds G, Su Y. Compassion fatigue, burnout, and compassion satisfaction among oncology nurses in the United States and Canada. Oncol Nurs Forum [Internet]. 2016 [acesso 16 jan 2023];43(4):E161-9. DOI: 10.1188/16.ONF.E161-E169 https://doi.org/10.1188/16.ONF.E161-E169...	Working in a healthy and cohesive environment; being an older nurse; teamwork	Being a younger nurse (<40 years old); presenting depressive symptoms, with health condition changes (headache); having personal financial problems; having a traumatic death experience; tending to sacrifice own personal and psychological needs in favor of patients.
4 ¹⁵15. Mooney C, Fetter K, Gross BW, Rinehart C, Lynch C, Rogers FB. Preliminary analysis of compassion satisfaction and compassion fatigue with considerations for nursing unit specialization and demographic factors. J Trauma Nurs [Internet]. 2017 [acesso 16 jan 2023];24(3):158-63. DOI: 10.1097/JTN.0000000000000284 https://doi.org/10.1097/JTN.000000000000...	Taking part in social and emotional support groups; being a male nurse; having more experience in the oncology area; having more children	Male nurses; married nurses who use some kind of substance or drug
5 ¹⁶16. Perry B, Toffner G, Merrick T, Dalton J. An exploration of the experience of compassion fatigue in clinical oncology nurses. Can Oncol Nurs J [Internet]. 2011 [acesso 16 jan 2023];21(2):91-105. DOI: 10.5737/1181912x2129197 https://doi.org/10.5737/1181912x2129197...	Having greater knowledge of CF through continuing education and being promoted thanks to teamwork	Physical and emotional stress; excessive emotional attachment to patient; lack of peer support; lack of institutional support
6 ¹⁷17. Potter P, Deshields T, Divanbeigi J, Berger J, Cipriano D, Norris L et al. Compassion fatigue and burnout: prevalence among oncology nurses. Clin J Oncol Nurs [Internet]. 2010 [acesso 16 jan 2023];14(5):E56-62. DOI: 10.1188/10.CJON.E56-E62 https://doi.org/10.1188/10.CJON.E56-E62...	Working in outpatient settings	Less experience in oncology
7 ¹⁸18. Kleiner S, Wallace JE. Oncologist burnout and compassion fatigue: investigating time pressure at work as a predictor and the mediating role of work-family conflict. BMC Health Serv Res [Internet]. 2017 [acesso 16 jan 2023];17(1):639. DOI: 10.1186/s12913-017-2581-9 https://doi.org/10.1186/s12913-017-2581-...	Workplace culture with more flexible working hours	Being a woman; having less experience in oncology; experiencing greater pressure at work
8 ¹⁹19. Denigris J, Fisher K, Maley M, Nolan E. Perceived quality of work life and risk for compassion fatigue among oncology nurses: a mixed-methods study. Oncol Nurs Forum [Internet]. 2016 [acesso 16 jan 2023];43(3):E121-31. DOI: 10.1188/16.ONF.E121-E131 https://doi.org/10.1188/16.ONF.E121-E131...	Self-understanding	The disease itself (cancer); lack of communication between nurses and physicians
9 ²⁰20. Bellicoso D, Trudeau M, Fitch MI, Ralph MR. Chronobiological factors for compassion satisfaction and fatigue among ambulatory oncology caregivers. Chronobiol Int [Internet]. 2017 [acesso 16 jan 2023];34(6):808-18. DOI: 10.1080/07420528.2017.1314301	Better sleep quality; acceptability; extroversion; emotional stability; conscientiousness	Job dissatisfaction
10 ²¹21. Duarte J, Pinto-Gouveia J. The role of psychological factors in oncology nurses’ burnout and compassion fatigue symptoms. Eur J Oncol Nurs [Internet]. 2017 [acesso 16 jan 2023];28:114-21. DOI: 10.1016/j.ejon.2017.04.002 https://doi.org/10.1016/j.ejon.2017.04.0...	Cognitive and affective empathy, self-compassion and empathic concern	Psychological inflexibility
11 ²²22. Perry B. Why exemplary oncology nurses seem to avoid compassion fatigue. Can Oncol Nurs J [Internet]. 2008 [acesso 16 jan 2023];18(2):87-99. DOI: 10.5737/1181912x1828792 https://doi.org/10.5737/1181912x1828792...	Empathy; communication with patients	Lack of communication; poor spirituality
12 ²³23. Galiana L, Arena F, Oliver A, Sanso N, Benito E. Compassion satisfaction, compassion fatigue, and burnout in Spain and Brazil: ProQOL Validation and Cross-cultural Diagnosis. J Pain Symptom Manage [Internet]. 2017 [acesso 16 jan 2023];53(3):598-604. DOI: 10.1016/j.jpainsymman.2016.09.014 https://doi.org/10.1016/j.jpainsymman.20...	Working in palliative care	Less experience
13 ²⁴24. Fukumori T, Miyazaki A, Takaba C, Taniguchi S, Asai M. Cognitive reactions of nurses exposed to cancer patients’ traumatic experiences: a qualitative study to identify triggers of the onset of compassion fatigue. Psychooncology [Internet]. 2018 [acesso 16 jan 2023];27(2):620-5. DOI: 10.1002/pon.4555 https://doi.org/10.1002/pon.4555...	Meaning of life reassessment; desire to share feelings with colleagues; desire to support patients and their families; compassion for patient and family	Feeling of professional inadequacy; brooding over a situation similar to that of the patient, experienced by the actual nurse or a family member; dissatisfaction with the medical team; desire to avoid offering patient care; conflict between belief and reality; feeling powerless in the face of cancer
14 ²⁵25. Granek L, Nakash O, Cohen M, Ben-David M, Ariad S. Oncologists´ communication about end of life: the relationship among secondary traumatic stress, compassion satisfaction, and approach and avoidance communication. Psychooncology [Internet]. 2017 [acesso 16 jan 2023];26(11):1980-6. DOI: 10.1002/pon.4289 https://doi.org/10.1002/pon.4289...	Greater proactivity and direct communication with end-of-life patients	Distanced communication with end-of-life patients
15 ²⁶26. Yu H, Jiang A, Shen J. Prevalence and predictors of compassion fatigue, burnout and compassion satisfaction among oncology nurses: a cross-sectional survey. Int J Nurs Stud [Internet]. 2016 [acesso 16 jan 2023];57:28-38. DOI: 10.1016/j.ijnurstu.2016.01.012 https://doi.org/10.1016/j.ijnurstu.2016....	Having empathy, social support; working in a tertiary hospital; openness and conscientiousness; having training in the psychological care of patients; receiving psychological training	Working in secondary hospitals; neuroticism and passive coping
16 ²⁷27. Al-Majid S, Carlson N, Kiyohara M, Faith M, Rakovski C. Assessing the degree of compassion satisfaction and compassion fatigue among critical care, oncology, and charge nurses. J Nurs Adm [Internet]. 2018 [acesso 16 jan 2023];48(6):310-15. DOI: 10.1097/NNA.0000000000000620 https://doi.org/10.1097/NNA.000000000000...	Working in direct care; communicating and discussing with team after traumatic events; communication.	Working longer in management
17 ²⁸28. Fernandes INM, Almeida KR, Rocha FC, Andrade Neto GR, Guedes MS, Gonçalves FF et al. Analysis of the lifestyle of oncology health professionals. Rev Enferm UFPE On Line [Internet]. 2018 [acesso 16 jan 2023];12(10):2583-9. DOI: 10.5205/1981-8963-v12i10a237209p2583-2589-2018 https://doi.org/10.5205/1981-8963-v12i10...	Being religious; cultivating and maintaining pleasurable relationships	Not being religious; being under 40
18 ²⁹29. Sarra A, Feuz C. Examining the prevalence of compassion fatigue and burnout in radiation therapists caring for palliative cancer patients. J Med Imaging Radiat Sci [Internet]. 2018 [acesso 16 jan 2023];49(1):49-55. DOI: 10.1016/j.jmir.2017.10.008 https://doi.org/10.1016/j.jmir.2017.10.0...	Positivity; helping others; self-compassion	High patient load; fast-paced clinical environment

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[1] Correspondence: Ana Paula Neroni Stina Saura – Rua Doutor Luiz Migliano, 1870, ap. 32 A, Jardim Caboré CEP 07511-001. São Paulo/SP, Brasil.