The aim of this study is to explore the prevalence of CF, CS and BO among the clinical staff of the oncology department at Universitas Academic Hospital Annex in the Free State province, South Africa. The objectives of the study included assessing the risk levels of clinical oncology staff for CF and BO, as well as their potential for CS. Additionally, the researchers sought to identify which clinical professionals are most at risk of CF and BO.

An analytical cross-sectional design was employed, with a standardised questionnaire, the Compassion Satisfaction/Fatigue Self-Test for Helpers.¹³ The questionnaire was developed by Stamm as a standardised tool to assess the positive and negative effects of helping others.¹⁴ The Self-Test is a validated self-report tool and is widely used in healthcare research, including oncology, and has demonstrated acceptable reliability in diverse settings, supporting its suitability for this study.¹⁵

The researchers used an analytical cross-sectional study to systematically collect new, real-time data from a defined group of participants without existing records to measure and analyse numerical variables at the time of collection.¹⁶ The questionnaire was self-administered to the clinical oncology staff at the research site. It consisted of 66 questions that measured and determined the levels of CF, BO and CS that clinical staff experience. The questionnaires were collected on a weekly basis to ensure participants had sufficient time to complete them and could do so in their own time and place of convenience. The initial predetermined period, communicated to participants when the questionnaires were distributed, was 4 weeks. However, this needed to be extended because of an initial slow response rate. The total collection time was thus 7 weeks. The questionnaire was written in English, the administrative language of the department. Information regarding the study and potential participation was provided in the form of a participant information sheet. The information sheet thoroughly explained the voluntary nature of the study and that informed consent was given by willingly completing the questionnaire. The questionnaire was distributed to clinical staff at the research site during three routine meetings attended by oncologists and registrars, as well as the heads of the allied health departments clinically involved in patient care (e.g. nurses and radiographers). It was also given to oncologists and the heads of allied health departments, who were asked to distribute the questionnaire within their teams. The questionnaires, informational posters about the study (with QR codes to an online version of the questionnaire) and collection boxes (for completed hardcopy questionnaires) were placed in areas easily accessible to potential participants, such as break rooms and admin stations.

A standardised scoring guideline was used to calculate a total score for each participant; responses to specific questions were assigned certain values, which were then added to calculate a total score. Each question had a numerical value of 0 to 5. The total score was calculated by adding the scores of each category (CS, CF and BO). The categories of the CS section consisted of low, modest, good, high or extremely high risk. The categories of the CF section consisted of extremely low, low, moderate, high or extremely high risk, and the categories of the BO section consisted of extremely low, moderate, high or extremely high risk.

Each participant’s final score corresponded to predetermined ranges, which indicated their potential risk for CF and BO and potential levels of CS. The aim of the questionnaire, as mentioned previously, was to explore the clinical staff members’ experience of CF, BO and CS. Due to limitations in space, however, this article primarily focuses on the participants’ experience of CF.

The research was conducted at the Oncology Department at Universitas Academic Hospital Annex, on the grounds of the National District Hospital in Bloemfontein, South Africa. The department serves as the major oncology department for the Free State province, as well as for oncology patients from the Northern Cape and Lesotho. The department was accessible to researchers and granted permission for the study. The department makes use of systemic and radiation therapy for the treatment of adolescent and adult cancers, while radiation therapy is used for the treatment of children. No researchers were employed at the hospital at the time of this study.

The study population encompassed all staff from the oncology department who were willing to participate under fully informed consent. The population thus included the oncologists, palliative staff, nurses, radiographers, social workers and others employed in the 2024 calendar year. For anonymity, no confounders (age and experience) were gathered. The following inclusion criteria were thus applied:

The only exclusion criterion employed was that the participants were clinical staff (staff who directly deal with health-related information). Non-clinical staff were thus excluded from the sample, as they have no health-related responsibilities. As per the request of the head of the Department of Oncology, administrative staff were also included in this study as their regular engagement with detailed patient information and coordination of care provides substantial exposure to patients’ clinical conditions.

Total population sampling was used. A staff list, provided by the Head of Oncology, showed that a total of 160 clinical staff members worked in the department at the time of the study; however, the distribution across different clinical occupations was not made available.

Initially, 105 responses were received out of a possible 160, equalling a response rate of 65.6%. Responses from participants who did not meet the inclusion criteria were excluded, leaving a total of 94 responses that underwent statistical analyses. In all, 10.48% of responses were not used because they did not meet the criteria.

The study proceeded with no interruptions, and no deviations were made from the initial proposal. An adequate amount of statistically valid data was captured, enabling the researchers to answer the research question. Participants were not made aware of their scores according to the scoring guideline.

In piloting the study, the questionnaires were distributed electronically to registrars and consultants at the University of the Free State, a department with clinical staff accessible to the research team with only registrars and consultants available at the time. Total population sampling, or sampling of all individuals within the defined criteria, was utilised, and staff members were subject to the same selection criteria as the main study population, being clinical staff. In total, there were nine participants available during the pilot study, which provided insight into the suitability of the chosen data collection method as well as the feasibility and acceptability of the questionnaire itself.

The pilot study also clarified the time participants would need to complete the questionnaire and enabled the researchers to correct problematic variables where necessary. Participants in the pilot study, just as in the main study, were not made aware of their results according to the scoring guideline. The pilot study was well received, and the questionnaire proved feasible and acceptable. It was also easily completed by the pilot participants. Some minor edits were made to the questionnaire (e.g. spelling mistakes). The average response time was 7 min 48 s. The collected responses from the pilot study were not included in the final study population.

Numerical variables were summarised by medians, minimums, maximums, or means and standard deviations. Categorical variables were summarised by frequencies and percentages.

The differences between groups were evaluated using appropriate statistical tests (Chi-Square and Fisher’s Exact Test) for unpaired data. A data analyst from the Department of Biostatistics (University of the Free State) assisted with the statistical analyses of the data using Statistical Analysis Software (SAS 9.4). The additional statistical tests were, however, abandoned, as explained in the results section.

Before the study and pilot study commenced, ethical clearance was obtained from the University of the Free State Health Sciences Research Ethics Committee (HSREC) (UFS-HSD2024/0399/2708). Approval for the study was also obtained from the Head of Oncology (Universitas Hospital) and the Acting Director of Family Medicine (University of the Free State). No member of the research team was employed or known to the hospital during the time of this study.

The findings from this study indicate that the overall prevalence of CF among clinical oncology staff at Universitas Academic Hospital Annex is notably high. Most of the participants (97.2%) across specialties within oncology reported high levels of CF. This aligns with results reported in previous studies, which showed that, in general, clinical oncology staff experience moderate to high levels of CF.^{5,7,9,10,11,12} Interestingly, however, the findings from this study showed that the majority of the clinical participants were at a low risk of BO (n = 57.3%). This finding differs from the majority of studies reviewed, which reported moderate to high levels of both CF and BO among oncology professionals. The experience of CF and BO are seemingly exacerbated by various factors such as: (1) staff shortages, (2) interpersonal conflict, (3) poor management support, (4) a lack of job expectation clarity, (5) poor education and (6) long working hours^{4,5,7,8,9,11,12,18} which is further supported by subjective work time pressure as a strong predictor for both CF and BO. The significance of this time pressure increases when it is mediated by work-family conflict. A lack of personal self-care has also been reported as a significant predictor of CF and BO.⁵ The contrasting results regarding BO reported in the current study were unexpected and may indicate that the abovementioned factors are not as prevalent among clinical staff members at Universitas Academic Hospital Annex. The underlying reason for this finding is unclear and can only be speculated upon. Further investigation is recommended.

The potential for CS among most of the participating clinical staff members (81.3%) was extremely low. This result is mostly in keeping with most of the literature reviewed, which found that clinical professionals in the field of oncology frequently experience moderate to low levels of CS. A number of factors seem to either contribute to or hinder the experience of CS, including the amount of rest and leisure time a professional has,⁴ the amount and type of self-care a professional engages in,⁵ and the levels of social, peer and workplace support received.^11,19

In the current study, nurses and radiographers were identified as the clinical professionals at the greatest risk of suffering from CF and of having low potential for CS. Notably, radiographers had the highest scores for CF and the lowest potential for CS. This differs somewhat from previous literature, most of which identified nurses^3,4,7 as the professionals most at risk of CF, followed by oncologists.^9,10 Important to note that nurses and radiographers were the two largest groups of clinical professionals who participated in the study, making up 61% and 15% of the total sample, respectively. However, despite this potential skewing of the data, it is valuable to note that extended periods spent with suffering and dying patients and family members, as well as exposure to trauma, pain and grief, are some of the factors that may contribute to the high prevalence of CF among these clinical professionals.^5,7,11,12

Overall, the results of the current study are mostly in keeping with previous research. Where differences between findings have been identified (e.g. the lack of a relationship between burnout and CF), these may be explained by research-specific factors such as the diversity of geographic settings and healthcare systems, differing disciplinary fields, and varying research aims and objectives. Another contributing factor to the varying results within the literature is the dearth of literature focusing on entire oncology teams.

During the study, the researchers encountered some limitations. Some questionnaires were completed by participants who did not specify their occupation and were thus excluded from the study. A few questionnaires were also incomplete, with some questions unanswered, impacting the ability to do a comprehensive analysis. The subset of participants with fully complete responses across all three categories was insufficient to support meaningful comparative analyses. A further possible limitation is that the results are dependent on the truthfulness of participants. However, because of the nature of the study, the researchers do not predict that participants had reason to be untruthful in their responses. Lastly, potential confounders (e.g. age, sex and years in role) were not collected to preserve participant anonymity.

Ethical considerations included the right to privacy of personal information, voluntary participation, the right to withdraw without repercussion and implied consent. All data were stored on Research Electronic Data Capture (REDCap), a secure web application for managing databases,¹⁷ which is behind the University of the Free State’s firewall. All participant information collected was anonymous and complied with the national Protection of Personal Information Act (POPIA). Participants incurred no costs. Refusal to participate in the study had no detrimental effect on any employees, and appropriate precautions were taken to limit harm to participants. The participants’ psycho-social well-being was treated with great care, and the contact details of the University of the Free State psychologists were provided in case the participants felt the need for professional help. The right to access and control the collected data was limited exclusively to the eight members of the research team and the research supervisor. Finally, the participants were provided with the contact details of relevant authorities via the participant information sheet, should they want to gain access to their responses or the final research findings in the future.

Further investigations into the causes of the highly skewed data of nursing professionals and radiographers should be completed. This could pave the way to improving psychosocial well-being for staff working in these specialisms. Other possible areas for further investigation include the replication of this study in other healthcare departments, which will enable comparisons between the experiences of CF, BO and CS by clinical staff from other medical specialties (e.g. paediatrics, trauma and geriatrics). Such replication studies could lead to further investigation into the causes of low psychosocial well-being within healthcare departments and what can be done to improve it. The final recommendation is for hospital management to encourage staff to practice peer support when necessary and provide them with the contact information of counsellors should they require psychosocial help.¹⁹