Understanding the cost of caring in medicine through personhood: A systematic scoping review of compassion fatigue, vicarious trauma and secondary traumatic stress.

Abstract

Supporting seriously ill patients and their families through the illness trajectory renders physicians susceptible to compassion fatigue (CF). Traditionally characterized as emotional and physical exhaustion following sustained empathic engagement, emerging research suggests that CF involves deeper disruptions to belief systems and professional identity formation (PIF), alongside an interplay with other trauma-related strain including secondary traumatic stress (STS) and vicarious trauma (VT) within the broader 'cost of caring' framework. However, such conceptual understanding remains fragmented and poorly synthesized in physician populations. This systematic scoping review (SSR) maps existing literature on CF, STS and VT among physicians in adult medical specialties, using the Ring Theory of Personhood to examine their defining features, exacerbating and mitigating factors, and existing interventions. This SSR employed the modified Systematic Evidence-Based Approach that integrates human and AI-based resources. The research team systematically searched PubMed, Embase, PsycINFO, CINAHL and Google Scholar for articles published from 1st January 2000-30th June 2025, supplemented by searches on Elicit AI Pro. Eligible articles underwent content and thematic analyses, augmented by ChatGPT o3 Pro. Of 18,396 database abstracts and 497 Elicit AI Pro abstracts identified, 986 non-duplicate articles underwent full-text review, with 122 meeting the inclusion criteria. CF, STS and VT encompass moral, cognitive, relational and identity-related dimensions that shape belief systems and PIF. Sharing overlapping features, these constructs sit along a continuum, where early features of CF-including exhaustion, depersonalization and boundary erosion-may progress toward STS' characteristic post-traumatic stress-type intrusions. Unaddressed, these acute reactions can evolve into enduring cognitive and existential alterations denoting VT. This trajectory can be interrupted by individual and environmental protective factors. Reframing CF, STS and VT as a continuum of escalating strain disrupting physicians' PIF highlights the need for stage-specific interventions and effective assessment tools that better capture this expanded notion.