Quantitative Assessment of Workload and Stressors in Clinical Radiation Oncology

Mazur, Lukasz M.; Mosaly, Prithima R.; Jackson, Marianne; Chang, Sha X.; Burkhardt, Katharin Deschesne; Adams, Robert D.; Jones, Ellen L.; Hoyle, Lesley; Xu, Jing; Rockwell, John; Marks, Lawrence B.

doi:10.1016/j.ijrobp.2012.01.063

Cited by 91Healthcare professionals’ stress and burnoutPatient Safety and Medication ErrorsAdvances in Oncology and Radiotherapy

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Quantitative Assessment of Workload and Stressors in Clinical Radiation Oncology

Mazur, Lukasz M., Mosaly, Prithima R., Jackson, Marianne, Chang, Sha X., Burkhardt, Katharin Deschesne, Adams, Robert D., Jones, Ellen L., Hoyle, Lesley, Xu, Jing, Rockwell, John, Marks, Lawrence B.·2012·International Journal of Radiation Oncology*Biology*Physics

DOI 10.1016/j.ijrobp.2012.01.063

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Abstract

Purpose Workload level and sources of stressors have been implicated as sources of error in multiple settings. We assessed workload levels and sources of stressors among radiation oncology professionals. Furthermore, we explored the potential association between workload and the frequency of reported radiotherapy incidents by the World Health Organization (WHO). Methods and materials Data collection was aimed at various tasks performed by 21 study participants from different radiation oncology professional subgroups (simulation therapists, radiation therapists, physicists, dosimetrists, and physicians). Workload was assessed using National Aeronautics and Space Administration Task-Load Index (NASA TLX). Sources of stressors were quantified using observational methods and segregated using a standard taxonomy. Comparisons between professional subgroups and tasks were made using analysis of variance ANOVA, multivariate ANOVA, and Duncan test. An association between workload levels (NASA TLX) and the frequency of radiotherapy incidents (WHO incidents) was explored (Pearson correlation test). Results A total of 173 workload assessments were obtained. Overall, simulation therapists had relatively low workloads (NASA TLX range, 30-36), and physicists had relatively high workloads (NASA TLX range, 51-63). NASA TLX scores for physicians, radiation therapists, and dosimetrists ranged from 40-52. There was marked intertask/professional subgroup variation (P<.0001). Mental demand (P<.001), physical demand (P=.001), and effort (P=.006) significantly differed among professional subgroups. Typically, there were 3-5 stressors per cycle of analyzed tasks with the following distribution: interruptions (41.4%), time factors (17%), technical factors (13.6%), teamwork issues (11.6%), patient factors (9.0%), and environmental factors (7.4%). A positive association between workload and frequency of reported radiotherapy incidents by the WHO was found (r = 0.87, P value=.045). Conclusions Workload level and sources of stressors vary among professional subgroups. Understanding the factors that influence these findings can guide adjustments to the workflow procedures, physical layout, and/or communication protocols to enhance safety. Additional evaluations are needed in order to better understand if these findings are systemic.

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The NASA-Task Load Index (NASA-TLX) is a widely applied and valid tool used to measure workload.
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Self-citation
Developing an Integrated Evaluation Model for Physician Comprehensive Workload Tethered to Outpatient Practice: An Empirical Study From China
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Background
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Usability testing of radiotherapy systems as a medical device evaluation tool to inform hospital procurement decision-making
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“The NASA-TLX questionnaires have been extensively used in evaluating workload experienced by radiation therapists.(20,26,27) The output of the NASA-TLX questionnaires is scored from 0 to 100, with lower scores indicating the lower perceived workload.”
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30 Years of Radiotherapy Service in Southern Thailand: Workload vs Resources
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Time Setting of Stretching to Improve Response speed of Transportation Drivers in Malang City
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Effect of Simulation-Based Training and Neurofeedback Interventions on Radiation Technologists’ Workload, Situation Awareness, and Performance
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Exploring Association between Perceived Usability of Dosimetry Quality Assurance Checklist and Perceived Cognitive Workload of Dosimetrists in Clinical Settings
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An Interview Study of Work- and Home-based Stressors in Radiation Therapists and Radiation Oncology Nurses: Implications for Provision of Psychotherapy Services to Cancer-care Health Professionals
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Quality Improvement in External Radiation Therapy Using a Departmental Incident Reporting System and Multidisciplinary Team Efforts
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Workload Analysis using NASA-TLX and SWAT METHODS in Shop Floor Company X
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Physiological Evaluation and Quantification of Physician’s Cognitive Workload During Interaction with Computer Based Clinical System
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Dosimetrist Workload Management Framework for Radiation Therapy Pre-treatment Operations
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Mental Workload Assessment and Its Effects on Middle and Senior Managers in Manufacturing Companies
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Influential
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Quantitative Assessment of Workload and Stressors in Clinical Radiation Oncology: A Step toward Improving Patient Safety
Mazur, L. M., Mosley, P., Jackson, M., Chang, S., Burkhardt, K. D., Adams, R., Jones, E. L., Xu, J., Rockwell, J., & Marks, L. B. (2011) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2011.06.288 · Cited by 4
Self-citation
Association Between Workload and Errors in Clinical Radiation Oncology
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Self-citation
Relating physician’s workload with errors during radiation therapy planning
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Self-citation
Empirical Evaluation of Workload of the Radiation Oncology Physicist During Radiation Treatment Planning and Delivery
Mosaly, P. R., Mazur, L. M., Jackson, M., Chang, S., Burkhardt, K. D., Jones, E. L., Xu, J., Rockwell, J., & Marks, L. B. (2011) · Proceedings of the Human Factors and Ergonomics Society Annual Meeting · doi:10.1177/1071181311551156 · Cited by 1
Self-citation
Subjective and objective quantification of physician’s workload and performance during radiation therapy planning tasks
Mazur, L. M., Mosaly, P. R., Hoyle, L., Jones, E. L., & Marks, L. B. (2013) · Practical Radiation Oncology · doi:10.1016/j.prro.2013.01.001 · Cited by 84
Self-citation

Authors: Mazur, L. M., Mosaly, P. R., Jackson, M., Chang, S. X., Burkhardt, K. D., Adams, R. D., Jones, E. L., Hoyle, L., Xu, J., Rockwell, J., & Marks, L. B.
Affiliations: University of North Carolina at Chapel Hill (US)
North Carolina State University (US)
Corresponding author: Mazur, Lukasz M.
ORCID: Mazur, Lukasz M.
Jackson, Marianne
Chang, Sha X.
Adams, Robert D.
Xu, Jing
Marks, Lawrence B.
Venue: International Journal of Radiation Oncology*Biology*Physics
Publisher: Elsevier BV
Published: 2012-08
Volume: 83
Issue: 5
Pages: e571-e576
ISSN: 0360-3016 (ISSN-L)
DOI: 10.1016/j.ijrobp.2012.01.063
OpenAlex: W2000776865
Cited by: 91
References: 18
Citations by year: 2026: 6 · 2025: 6 · 2024: 4 · 2023: 5 · 2022: 7 · 2021: 8 · 2020: 8 · 2019: 8 · 2018: 6 · 2017: 10 · 2016: 8 · 2015: 4 · 2014: 4 · 2013: 7
FWCI: 8.51
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: International Journal of Radiation Oncology*Biology*Physics (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advances in Oncology and Radiotherapy
Keywords: workload, occupational stressors, NASA-TLX, radiation therapists, dosimetrists, radiotherapy safety, interruptions, teamwork, mental demand, physical demands, effort
MeSH terms: Analysis of Variance, Humans, North Carolina, Safety, Software, Stress, Psychological, Task Performance and Analysis, Time Factors, United States, Workload, United States National Aeronautics and Space Administration, Radiation Oncology, Medical Errors

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Quantitative Assessment of Workload and Stressors in Clinical Radiation Oncology

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