A Scoping Review of Compassion Fatigue Among Oncology Nurses Caring for Adult Patients

Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it."5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26Background Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF).To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients.A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting.Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF.Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF.Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.In 2020, there were more than 19 million new cases of cancer diagnosed worldwide, a figure predicted to increase to more than 30 million by 2040.1 A cancer diagnosis sees a patient begin an illness trajectory whereby they may remain within the healthcare system for many years during intensive treatment, regular surveillance and follow-up, possible cancer reoccurrence, and end-of-life care.The introduction of COVID-19 restrictions in 2020 brought about changes within the health care setting that impacted the provision of cancer care. These restrictions saw lengthy delays within elective diagnostic and surgical procedures, which impacted rates of cancer diagnosis. Within Australia, healthcare services saw the annual number of actual cancer-related diagnostic procedures 8% lower than expected.2 In countries such as the Netherlands, a 40% decline in weekly cancer incidences was reported while the United Kingdom, experienced a 75% decline in referrals for suspected cancer.3 There are concerns that delays in diagnosis and treatment may contribute to a more advanced stage of cancer at diagnosis. This leads to poorer patient outcomes including greater disease-related consequences and survival rates.4Oncology nurses have frequent contact with oncology patients and their families during their cancer journey. At the very core of oncology nursing is empathetic caring, providing emotional support while administering required therapies and controlling symptoms and adverse effects. Providing compassionate care during the patient's cancer journey allows a nurse to develop a therapeutic rapport with patients, enhancing the quality of care provided. Compassion is defined as a "sympathetic consciousness of others' distress together with a desire to alleviate it. "5 Compassion is not only essential to develop therapeutic patient relationships but also is a cornerstone of nursing care. Compassionate care improves the patient experience while providing the nurse with a degree of compassion satisfaction (CS), the intrinsic motivation, and satisfaction that arises from helping others.6,7Nonetheless, compassionate care can come at a cost to the health and well-being of the nurse. Long-term and frequent contact with patients during traumatic or difficult experiences can lead to the development of compassion fatigue (CF).8 Compassion fatigue is "the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress."9 Compassion fatigue is a gradual process that leaves the affected person with decreased feelings of compassion or empathetic ability in relation to another person's suffering.9 Nurses experiencing CF are unable to show empathy or engage or enter into a caring relationship with a person, a fundamental quality of nursing care.10 This eventually results in apathy and detachment.11The impact of CF is felt not only by the nurse, but also by the patient and organization.12 At an individual level, nurses with CF can experience mood swings, irritability, anxiety, and employ negative coping strategies such as alcohol and drug misuse.13,14 Physical symptoms may include headaches, digestive problems, sleep disturbances, fatigue, and cardiac symptoms.13,14 Compassion fatigue also impacts the quality and safety of healthcare delivery and in turn patient and family satisfaction. As a consequence of CF, nurses may avoid patients, demonstrate a lack of motivation, feel unfit for practice, frequently use sick days, and experience decreased workplace satisfaction, all of which can eventuate in a desire to leave the profession.13,15The Professional Quality of Life (ProQOL) scale is a widely used scale that assesses levels of CS, the pleasure derived from helping others and CF. Compassion fatigue is further explored as burnout (BO) and secondary traumatic stress (STS).16 Burnout refers to the psychological state of exhaustion directly linked to work-related stress,17 whereas STS arises from exposure to people who have experienced trauma.16 The presence of high levels of CS is viewed as a protective barrier to the development of CF.16A number of systematic literature reviews have assessed the prevalence rates of CF within the oncology nursing population. These reviews, which included between 15 and 21 studies, reported that oncology nurses have low levels of CS ranging between 19%,18 20%,19 and 22%.20 These results were substantially lower than the CS levels of 48% found in a review by Zhang et al21 that included findings from 21 studies of the general nursing population. Compassion fatigue levels within these cohorts of nurses were found to be as high as 53%21 although this is still lower than the 60% found within a review of 15 studies involving oncology nurses.18 These reviews provide a preliminary overview of the prevalence of CF among oncology nurses. The present scoping review allows for an expanded synthesis of the current literature. Findings from both qualitative and quantitative studies on the topic have been included, including possible interventions to minimize the impact of CF on oncology nurses.Given the International Council of Nurses identification of a global nursing shortage of 5. 9 million nurses in 2020,22 coupled with the predicted increasing severity of oncology patients due to COVID-related delays in diagnosis and treatment, it is imperative to identify what is currently known about CF among oncology nurses caring for adult patients to ensure they can be adequately supported for a sustainable future health workforce.A scoping review allows for a comprehensive overview while clearly identifying key knowledge gaps for areas for future research. All research methods can also be included, which adds further depth to the information gained.23 This review was conducted based on the scoping review framework by Arksey and O'Malley23 and further developed by Joanne Briggs Institute.24The scoping review was guided by the following questions: (1) What contributes to CF among oncology nurses caring for adult patients? (2) What individual, interpersonal, and organizational factors mitigate CF among oncology nurses?Inclusion criteria were primary peer-reviewed research published in English language journals from January 2011 up until December 2021 that addressed CF within oncology nurses caring for adult patients in any setting. To be included, the primary focus of the research article needed to specifically address CF as a whole. Articles that discussed CS or BO individually without relating back to CF were excluded. Exclusion criteria were as follows: (1) studies that included non-nursing healthcare professionals, or nursing students or focused on pediatric patients; (2) gray literature; (3) non-research publications; and (4) any literature reviews including systematic reviews. A 10-year search period was selected to ensure only relevant research was included.The search was conducted in December 2021 using the following electronic databases: PubMed, PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Scopus. MeSH and key search terms identified included "oncology nurse," "oncology nursing," "oncology nurses," "cancer nurse," "cancer nursing," "cancer nurses" "compassion fatigue," "compassion satisfaction" "burnout," "secondary traumatic stress," "stress, secondary traumatic," "vicarious trauma," "trauma, vicarious," "secondary trauma," "trauma, secondary," "traumatic stress," "secondary post traumatic stress," "emotional exhaustion," "psychological stress." Boolean operators AND/OR were also used to expand the search strategy.The database search produced 474 records, and no additional articles meeting the inclusion criteria were identified through manual search. A total of 204 articles were screened after removing the duplicates. Online screening was completed using the software "Rayyan."25 Articles were screened and reviewed by title and abstract by J.B. and M.C., and where consensus could not be reached, consultation occurred (A.S.). A total of 182 articles did not meet the inclusion criteria. The full text review resulted in the removal of one study that did not meet the eligibility criteria. Reference lists of included studies and systematic reviews were reviewed by J.B. to identify any research not captured through the electronic database search. Finally, a total of 21 articles from 19 studies were included in this review as shown in the Figure (articles from Duarte and Pinto-Gouveia,27,28 Wentzel et al,29 Wentzel and Brysiewicz30 were merged into 2 studies). This review provides an overarching map of the available research literature; therefore, no critical appraisal or risk-of-bias assessment was completed on the articles reported, consistent with the scoping review framework. 24PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article retrieval process.26