title: Quantitative assessment of workload and stressors in clinical radiation oncology.
abstract: OBJECTIVE
  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
  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.
authors.affiliation: Department of Radiation Oncology, Box 7512, University of North Carolina, Chapel Hill, NC 27514, USA. lukasz_mazur@ncsu.edu
authors.forename: Lukasz M
authors.initials: LM
authors.lastname: Mazur
authors.forename: Prithima R
authors.initials: PR
authors.lastname: Mosaly
authors.forename: Marianne
authors.initials: M
authors.lastname: Jackson
authors.forename: Sha X
authors.initials: SX
authors.lastname: Chang
authors.forename: Katharin Deschesne
authors.initials: KD
authors.lastname: Burkhardt
authors.forename: Robert D
authors.initials: RD
authors.lastname: Adams
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Jones
authors.forename: Lesley
authors.initials: L
authors.lastname: Hoyle
authors.forename: Jing
authors.initials: J
authors.lastname: Xu
authors.forename: John
authors.initials: J
authors.lastname: Rockwell
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Marks
mesh_terms: D000704:Analysis of Variance; D006801:Humans; D019300:Medical Errors / Q000523:psychology* / Q000706:statistics & numerical data; D009657:North Carolina; D018787:Radiation Oncology / Q000706:statistics & numerical data; D012449:Safety; D012984:Software / Q000592:standards; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology*; D013647:Task Performance and Analysis; D013997:Time Factors; D014481:United States; D018557:United States National Aeronautics and Space Administration; D016526:Workload / Q000523:psychology*