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Monday, July 5, 2010

Self Care of the Palliative Care Clinician

In reviewing the hospice and palliative medicine (HPM) fellowship lecture series for our upcoming academic year, Karin (the fellowship director) and I (hospice site director) talked a bit about self-care as part of a well-rounded curriculum.  We have 6 hours of the nearly 100 hours of lecture/small group dedicated to self-care sessions with the faculty, fellows, and community professionals who attend the lectures.  It may seem like a small percentage but when compared to other specialties this is a lot of time dedicated solely to avoiding burnout beyond the normal de-briefings that occur at the point of care during the clinical week.

From discussions with other fellowship programs, self care is a focus for many good programs. Which got me thinking, for all we talk about caregiver fatigue, secondary PTSD, self-care, burnout avoidance, etc., I could not recall seeing any self-care outcome studies for palliative care or hospice professionals of any discipline.  By now we surely have enough doctors to study, and for years we have had enough nurses and social workers and chaplains in hospice agencies to give us a pretty good 'n' for data.  What I did find on a basic search were many articles with themes of 'watch-out/caution' or 'tips for avoiding burnout.'  Same for lectures I have seen at regional and national meetings, mostly tips about prevention, but no outcomes based studies.

To better understand the outcomes, we may need to look to the literature for ICU and Oncology staff for some ideas of what we may need to ask of ourselves and our peers.  They seem to be the two areas that have some focused studies.  Some ideas/questions for study:
  • Number of staff leaving hospice/palliative medicine for other specialties
  • Change in empathy/burnout scores with time on service/workload
  • Levels of death acuity (deaths experienced/per unit of time +/- 'goodness' of dying process as marker of stress for the clinician)
  • Impact of death acuity on empathy/burnout scores
  • Effectiveness of formal workplace efforts to deal with stressors related with HPM work
  • Incidence of depression, anxiety or other psychological morbidities
  • Incidence/level of alcohol and drug use
  • General health overview (weight, exercise, diet, preventive care compliance, smoking incidence, completeness of advance directives ;-) )

I have embedded two slide decks for Self-Care talks I have given in the past.  Both are open access for viewing and downloading from SlideShare.  The first one is from a joint presentation I gave with David F. Giansiracusa in 2007 for the AAHPM Fellowship Directors conference. The second is are my slides from my talk in 2009 for the the University of Kansas HPM fellowship.

Taking Care of Oneself: For Yourself, Your Fellows, and Your Programs

What we model for self-care can also impact our patients, their families, and especially learners and other co-workers.  Are there other questions you would ask your peers as a group?  What worries you about the impact our work has on us? And what do you do to find your balance?

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Taylor River
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