ARE PALLIATIVE CARE PROVIDERS: ON FIRE OR BURNED OUT?

Transcription

1 ARE PALLIATIVE CARE PROVIDERS: ON FIRE OR BURNED OUT? Burnout happens to highly motivated and committed professionals the type of people who choose to go into hospice and palliative care. Eric Widera, MD Director of Hospice and Palliative Care at San Francisco VAMC

2 OBJECTIVES What is Burnout? Define burnout and describe its domains Discuss prevalence of burnout among palliative care providers and other physicians Review the professional and personal consequences of burnout Discuss strategies for preventing and combating burnout Syndrome of depersonalization, emotional exhaustion, and low personal accomplishment leading to decreased effectiveness at work Maslach Burnout Inventory Developed 1980, validated over last 30 years 22 item survey evaluates the 3 domains of burn-out 3 Sub-Scales: Depersonalization, Emotional Exhaustion and Low Personal Accomplishment Respondents rate frequency on 7 point Likert scale Normative national samples of like professionals 3 Stages of Burnout Emotional Exhaustion 1 st response to excessive work demands Characterized by feelings of being overwhelmed, overloaded, overworked and trapped Depersonalization Response to emotional exhaustion Defensive coping strategy Excessive detachment Personal Accomplishment Response to / result of continued depersonalization Decline in one s feelings of competence and successful achievement

3 Burnout Defined Burnout is the index of the dislocation between what people are and what they have to do. It represents an erosion in value, dignity, spirit, and will an erosion of the human soul. It is a malady that spreads gradually and continuously over time, putting people into a downward spiral from which it s hard to recover. Study group: sample of physicians from all disciplines from American Association Physician Masterfile Control group: Representative sample of US population aged Of 814,022 US physicians, 7288 responded (0.9%) Maslach and Leiter (1997) OVERALL BURNOUT RATE = 45% Shanafelt et al.

4 Shanafelt et al. Shanafelt et al.

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6 N = 360 nurses Why palliative care nurses have lower burnout scores than other nurses: these professionals have chosen on their own initiative a unit / service where they enjoy providing care, where they feel useful to patients and families and where they carry out consistent and valued teamwork. N=73 N=156 N=37

7 Professional Consequences of Burnout Perceived Errors Reported Error last 3 months 9% Medical Errors: Definition 1 : A commission or omission with potentially negative consequences for the patient that would have been judged wrong by skilled and knowledgeable peers at the time it occurred, independent of whether there were any negative consequences 1 JAMA 265:2089 Distinct from complications Greatest contributing factor Lapse judgment 32% A system issue 15% Degree of stress/burnout 13% Lapse concentration 13% Fatigue 7% Lack of knowledge 5% Other 16%

8 Emotional Exhaustion is Associated with Increased Medical Errors Burnout Medical Errors Depersonalization is Associated with Increased Medical Errors Personal Accomplishment & Medical Errors 4% Personal Accomplishment Medical Errors

9 Burnout Independently Increases the Risk of Medical Error 2-Fold Burnout Medical Errors Substance Abuse Personal Consequences of Burnout Approximately 15% of all physicians will be impaired at some time in their career and unable to meet professional responsibilities because of mental illness, alcoholism or drug dependency Boisaubin and Levine: Am J Med Sci 2001;322: Alcohol abuse in American College of Surgeons Survey: Male surgeons: 13.8% Female surgeons: 25.4% Oreskovich MR, Kaups KA, Balch CM, et al. The prevalence of substance use disorders among American surgeons. Arch Surg

10 Strategies for Prevention and Treatment of Burnout WHO HOW WHEN Prevention Responsibility of all physicians and of the healthcare organizations in which they work Explicit promotion of physician well-being Physicians should be guided --from the earliest years of training-- to cultivate methods of personal renewal, emotional selfawareness, connection with social support systems, and a sense of mastery and meaning in their work Spickard A, Gabbard G, Christensen JF. Mid-career burnout in generalist and specialist physicians: definitions, risk factors and prevention. JAMA 288: Five-Step Process to Personal and Professional Wellness: 1) Identifying core values 2) Career shaping/optimization 3) Identification and management of practice-specific stressors 4) Achieving balance between personal and professional goals 5) Nurturing personal wellness strategies Shanafelt. Ann. Surgical Oncology, Feb 2008

11 Step 1: Identifying Core Values 1)What are my greatest priorities in life? 2) Do I have adequate balance between my personal and professional lives? 3) If I could relive the past year, what would I spend more time doing? What would I spend less time doing? 4) What would I like my life to be like in 10 years? Shanafelt. Ann. Surgical Oncology, Feb 2008 Be guided by a compass, not a clock Step 2:Career Shaping / Optimization Each clinician must continuously map their career pathway integrate personal and professional goals Step 3: Identification and Management of Practice-Specific Stressors OR Partnering Delegating Additional training Talk to mentors Balch CM and Copeland E. Annals of Surgical Oncology 14(11):

12 Step 4: Achieving Balance Between Personal and Professional Goals Recognize the inherent tradeoffs of decisions consider both personal and professional accomplishments when evaluating overall success Step 4: Achieving Balance Between Personal and Professional Goals Time away from work should be more than simply a chance to rest for another work day Shanafelt. Ann. Surgical Oncology, Feb 2008 Step 5: Nurturing Personal Wellness Strategies The best prevention for burnout is to actively nurture and protect personal and professional well-being on all levels: physical, emotional, psychological and spiritual Practical Advice for Palliative Care Providers Debriefing session to discuss difficult cases Self-awareness Exercise: increases good hormone, burns off stress Accommodate need for time off without creating more stress for rest of team Promote strong teamwork Teach good communication skills Add variety into job so it isn t all patient care Emphasize life/work balance Spickard A, Gabbard G, Christensen JF. JAMA 288:

13 Looking Out for Each Other We assume our colleagues are in good health, and as such frequently ignore the early warning signs of impairment or the significance of disruptive behavior patterns We need to recognize and manage impaired and disruptive behavior in a far more rigorous manner than we have in the past. Let us all strive to take very good care of each other. Anthony D. Whittemore MD Presidential Address American Surgical Association April 23, 2009 Summary Burnout is common among palliative medicine providers = 62% There are serious professional and personal consequences of burnout Burnout can be both prevented and treated through active recognition and continuous personal selfevaluation PALLIATIVE CARE PROVIDERS: ON FIRE OR BURNED OUT? Bridget N. Fahy, MD, FACS bfahy@salud.unm.edu University of New Mexico Palliative Care Update 28 October 2016