Six in 10 Americans live with at least one chronic condition, such as heart disease, cancer, or diabetes. As an employer or human resources manager, you’re undoubtedly aware that acute events related to these conditions can adversely affect employees’ health and work productivity. But did you also know that, as a result of managing chronic conditions, these employees often experience “treatment-related burnout,” which can negatively affect their health and job performance?
Burnout is a chronic state characterized by physical, mental, and emotional exhaustion. It occurs when ongoing stress diminishes a person’s energetic resources. For example, similar to how job-related pressures may lead to occupational burnout, management of a chronic condition may lead to treatment fatigue (also known as treatment-related burnout), or a combination of both.
Employees with chronic conditions already have a two-fold higher chance of developing depression, which may increase absenteeism or otherwise impact their job performance. Furthermore, the coexistence of burnout in employees managing chronic conditions accelerates the development of depressive symptoms and may induce apathy, cynicism, or professional inefficacy. As we have seen in the Great Resignation during the COVID-19 pandemic, employees are migrating to jobs where their emotional and mental health needs are acknowledged by their employers. Ultimately, then, it is in the employer’s best interest to ensure managers can identify signs of burnout among employees and eliminate stressors when they can to reduce anxiety and promote better overall health.
To understand what it’s like to experience treatment-related burnout, imagine you have a chronic condition like type 2 diabetes (T2D). At the time of diagnosis, your doctor gives you a medical device that looks like a garage door opener (your new glucose meter) and a laundry list of resources and must-dos. Suddenly, you have to keep up with dietary restrictions, exercise requirements, weight loss goals, medications, daily finger sticks to test blood glucose levels, and more. Once you recover from the shock of diagnosis, you do your best to absorb all the information, figure out which resources and tools you need, and begin implementing the necessary changes in your daily life.
Managing T2D isn’t easy; it requires a lot of your energy and attention every day. And despite your best efforts, your blood glucose still may not be well managed. Sticking to a prescribed diet is a challenge. Some days you forget to take your medications. And you may struggle to shed excess weight. Eventually you throw up your hands and say, “This isn’t working. What’s the point of trying?”
The key issue here is this: there’s more to chronic condition management than loading up people with information about what to do and when to do it, which behaviors to adopt and which ones to avoid. Treatment fatigue, or treatment-related burnout, is a real phenomenon, with real and detrimental impacts on the self-care practices and job performance of people with chronic conditions. For an employer, helping employees manage their chronic conditions successfully over the long term requires acknowledging the reality of burnout and mitigating its effects.
The hypothetical example above illustrates burnout. Burnout is part of the four-stage psychological process a person undergoes following a diagnosis:
- Initial Shock: Adjusting to the reality of having a chronic condition.
- Action & Maintenance: Incorporating available information and tools into life, habits and personal resources, and making changes towards improving health.
- Burnout: Experiencing physical, mental and/or emotional overwhelm from condition-related tasks.
- Recovery: Developing coping strategies to overcome burnout.
This process is similar to the “stages of change” model developed by DiClemente and Prochaska in the 1970s to assess the readiness of a person with a chronic health issue to engage in new, healthier behaviors.
A person’s level of engagement with tools and resources for chronic condition management is different at each stage. However, someone experiencing “burnout” will largely disengage from available resources and self-care practices, such as diet, exercise and health monitoring (e.g., checking blood pressure). As a result, health may suffer, the medical condition may worsen, and the person’s presence and productivity at work may decline.
The Many Roads to Burnout
Anyone managing a chronic condition is at risk of burnout, and it can occur at any time. In fact, most people with chronic conditions will experience burnout, often several times, due to one of the many causes:
- On top of the responsibilities of daily life, the never-ending workload of condition-related tasks eventually overwhelms the person’s time, energy, abilities, and personal resources.
- People who take the “perfectionist” approach in condition management may aim to do everything right every day. Ultimately, this approach is unsustainable, or the person gives up after realizing their “perfect” efforts have produced no tangible benefits.
- Regardless of health outcomes, lack of positive recognition, can lead to a low sense of satisfaction, loss of motivation, cynical or pessimistic attitudes, and the false idea that declining health is inevitable.
- The high standards set by the medical community can feel impossible to achieve without ongoing support. For example, a doctor may instruct someone with hypertension to lose a certain amount of weight, but cannot offer them daily support to achieve this goal. As a result, the person may feel abandoned and think, “I have to figure this out on my own,” or they feel powerless or ashamed because “I can’t seem to lose the weight.”
- Relationship and family issues can complicate condition management. Stressful life events, such as a difficult divorce or the death of a parent, can leave people feeling their self-care efforts aren’t worthwhile. In some cases, they may perceive their condition as an unnecessary burden on their children, spouse, or partner.
Salving the Burn
As an employer or HR manager, it’s essential to recognize that burnout is a risk for your employees with chronic conditions. Unfortunately, it is part and parcel of their lifelong process. While it is not in your power to prevent burnout entirely, there are steps your organization can take to support employees who experience burnout and reduce its impact on your workforce.
- Help identify the signs of impending burnout. Psychological distress is a forerunner to burnout and often occurs in people with chronic conditions. Condition-specific distress screening tools, such as the Diabetes Distress Scale (DDS), can help identify burnout’s warning signs and present opportunities to mitigate it.
- Support recovery from burnout and help keep it at bay. Coaching, counseling, and other programs can teach employees with chronic conditions valuable strategies for handling burnout and coping with day-to-day stress so that burnout occurs less frequently. Additionally, boosting their health literacy with tools that help them better obtain, process, and understand the information they need to make appropriate healthcare decisions can reduce pre-burnout distress.
- Give employees the recognition they need. Coaching services and digital health technologies can provide positive reinforcement that keeps people with chronic conditions motivated to stay healthy.
Management of a chronic condition, and the burnout that comes with it, is an ongoing journey that is ultimately unique for each person. Employers must arm their workforces with the resources people need to manage their chronic conditions and address burnout successfully. Doing so can enable employers to improve employees’ health and quality of life while reducing absenteeism and the negative impacts on productivity caused by poor health and burnout.
Harpreet Nagra, PhD, is the vice president of behavior science at One Drop.
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