Title: Strategies to Combat Burnout while Caring for the Dying
Authors: Dua Khan, OMS3; Ronald Walser, DPT
Introduction
Burnout is the state of mental, emotional, and physical exhaustion caused by prolonged exposure to stress. Burnout not only potentially impairs the quality of care for patients, but also the quality of life of physicians. Hospice and Palliative care practitioners frequently encounter mortality, making physicians in these fields highly susceptible to burnout. The purpose of this study was to investigate strategies found in literature that End-of Life (EoL) physicians can employ to better care for themselves and subsequently, their patients.
Methods
A literature search was conducted in PubMed, CINAHAL and Cochrane databases in December 2021 and January 2022. Key words included: “end-of-life,” “physician burnout,” and “palliative care.” These searches resulted in 106 potential sources. Exclusion criteria were: surveys, articles whose outcomes were not focused on burnout prevention, articles that did not focus on physician burnout, and articles that were purely personal reflections. Application of exclusion criteria resulted in 24 relevant articles that were included in this literature review.
Results
The 24 articles revealed that preventing physician burnout in EoL care requires a multifaceted approach that includes both personal care strategies and institutional approaches. Strategies that were listed in multiple articles were included in these results. Recommended individual burnout preventative strategies include taking care of oneself physically, emotionally/cognitively, spiritually, and maintaining good relationships. Personal care strategies to combat burnout should include exercise, meditation, psychotherapy, humor, mental reframing, creating a social network, creating boundaries, and focusing on the meaning of life. Institutional approaches and responsibilities should include having like-minded leaders who actively listen; providing ample staffing; providing time for group reflection; and holding mindful art therapy sessions to reduce death anxiety, and enhance emotional awareness and introspection.
Discussion
To prevent physician burnout from occurring in the vulnerable fields of EoL care, this review identifies approaches that physicians should employ in their self-care. Just as EoL care requires a multidimensional approach to fully care for a patient, physician burnout may be reduced or prevented when physicians actively partake in comprehensive self-care, and their institutions recognize and support these measures. These burnout prevention strategies could potentially be utilized by physicians in other high-stress specialties that frequently encounter death. Most of the studies included in this review had small sample sizes, likely due to the small, specialized field of Hospice and Palliative care. Future studies focusing on the applicability of the identified burnout prevention activities could help other physicians outside of EoL care.
Thank you for addressing this important topic. As a judge, I was wondering if you found any effective way in the literature about how institutions could promote proactive personal self-care.
Also, I was wondering why you excluded research that did not include essays or reflections.
Hi Judge Dr. Habecker, thank you for your questions. Literature showed that institutions that provide group therapy sessions and group reflection meetings with skilled facilitators helped promote better self-care, increase team motivation, and foster greater sense of support. It was also found that having proper, adequate staffing was a protective factor against burnout, so it is the institution’s responsibility to provide a full, supportive care team.
I excluded personal essays and reflections because they only provided an individual’s personal anecdotes and perceptions on burnout and didn’t have any concrete evidence to support their claims. I do believe there is a lot to learn from these creative essays, however I did not think they are applicable as literature.
Thank you for your comment!
Judge: Thank you for sharing your research findings. I’m curious if your research demonstrated any significant correlation between physician burnout and years of practice in high-stress specialties?
Hi Judge Jennifer, thank you for your response. Due to the small, specialized field of Hospice/Palliative Care, I did not come across any literature discussing the rate of burnout against varying years of practice. I would hypothesize that Hospice and Palliative Care physicians who have practiced for more years experience a higher rate of burnout because they have accumulated more stress and higher patient loads. However, I could also see that physicians with fewer years of practice could also have a higher intensity of burnout because they haven’t developed relationships at work, are newer to the field and the adjustment of their new career could impact them more. If we have more literature on these topics, I think this would be a very good research question to further investigate.
Thank you for your question!
Thank you for your presentation, Student Dr. Khan. I am one of the judges evaluating your poster. Did the literature address differences in burnout rates for care teams of different sizes?
Hi Judge Amanda, thank you for your response. Due to the small, specialized field of Hospice/Palliative Care, I did not come across any literature discussing the differences in burnout rates for different size care teams. As staffing shortages lead to higher rates of burnout, I would hypothesize that smaller care teams more frequently experience burnout. I think, larger care teams have more members to support each other and lean on, and this could be a protective factor. This would be a very good research question to further investigate.
Thank you for your question!
Thank you for your answer!