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Despite extensive research looking at the phenomenon of burnout, little is known about how individuals working in traditionally high-burnout occupations understand the term. Interviews were conducted with six teachers working in state schools in England centring on how the term burnout was understood and how it was used or encountered. Reflexive thematic analysis was employed from a critical realist perspective to analyse the data generated. All participants described burnout as a stress-related condition, yet for some participants the point at which stress became burnout was unclear leading to an understanding that burnout was the point at which one was unable to work. Many participants highlighted an individualistic understanding of burnout, perceiving it as representing an individual deficit rather than an organisational failing. This was often reinforced by where the term was encountered (at work or in the media) and was linked to the stigma many participants associated with burnout. This paper concludes that individualistic framings of burnout obscure its organisational determinants while reinforcing notions that mental well-being is something which should be personally – and privately – managed by individuals. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although tyrosine kinase inhibitors (TKIs) are tolerated relatively well in patients with chronic myeloid leukemia (CML), there is a wide range of adverse events that make indefinite therapy challenging for some patients. OBJECTIVE: To examine the clinical and financial impacts of an oncology clinical pharmacy specialist (CPS)-initiated TKI discontinuation process in a real-world population of patients with CML. METHODS: This retrospective, descriptive analysis included adults from 2 integrated healthcare delivery systems who had been screened under collaborative CPS and oncologist TKI discontinuation programs and were receiving a TKI between January 1, 2019, and September 30, 2020. Using health chart data, the CPS systematically reviewed patients and obtained information on TKI discontinuation eligibility based on the National Comprehensive Cancer Network’s treatment guidelines. The patients were followed until December 31, 2020, or until the termination of their health plan membership. The analysis outcomes included the numbers of patients who were existing TKI discontinuation candidates, who were future TKI discontinuation candidates, whose managing oncologist agreed with a pharmacist’s recommendation that they were a TKI discontinuation candidate, who consented to TKI discontinuation, who discontinued TKI therapy, who resumed TKI therapy, and whose TKI costs were avoided (based on the last TKI dispensed). RESULTS: The 133 study patients with CML were primarily older age, male, White, and had received a TKI for >6 years. In all, 41 (30.8%) and 87 (65.4%) patients were identified as existing and future TKI discontinuation candidates, respectively. The managing oncologists agreed with pharmacists that 36 (87.8%) of the 41 patients were TKI discontinuation candidates and, of these 36 patients, 24 (66.7%) consented to TKI discontinuation with 23 (95.8%) of these 24 patients discontinuing TKI therapy. A total of 18 (78.3%) of the 23 patients discontinued receiving TKI therapy through the follow-up. The median TKI cost avoided was $148,462 per patient, for a total cost avoided of $3,485,642. CONCLUSIONS: The pharmacist-initiated TKI discontinuation programs that were analyzed were associated with the systematic screening of patients with CML to formally discontinue TKI treatment while avoiding TKI treatment–related costs. [ABSTRACT FROM AUTHOR]