Frequency and Prediction of Burnout Among Physicians Who Completed Palliative Care Fellowship Training - A 10 Year Survey

Evaluation of a Five-Minute Meditation Intervention During Weekly Palliative Care Clinical Rounds

Introduction: Palliative care professionals experience high levels stress and burnout. Meditation improves stress and well-being, with group interventions more promising than individual-level efforts. This study assessed participation, satisfaction, helpfulness, and integration of a five-minute group meditation during weekly educational rounds. Methods: Seventy clinicians were invited to complete an anonymous Qualtrics survey assessing study variables. Responses were analyzed using variations of t-tests, ANOVAs, chi-squared tests, and regression analyses in IBM SPSS (Version 23). Results: Twenty-three clinicians (59%) reported participation in meditation during rounds, with no significant differences by gender or years worked. Twenty-one respondents also engaged in meditation at least weekly outside of rounds (54%), averaging 53 minutes (n = 21) a week, and doing so mostly after work hours (n = 18, 72%). Participation was associated with perceived stress reduction and control, and satisfaction with meditation (odds ratio: 1.46 [95% confidence interval: 1.01-2.13], p = 0.05). Clinicians in psychosocial roles showed no different engagement outside of rounds, and those less engaged did not report greater time-related barriers. Discussion: Most round attendants participated in the five-minute meditation, perceived it as useful, and reported use after rounds. Findings justify further research to better characterize its potential in enhancing well-being.

You've Got A Friendtor in Me: Innovations in Peer Mentoring for Mid-Career Palliative Care Clinicians

Introduction: Mentoring is crucial to professional success, but little is known about the professional development needs of mid-career hospice and palliative medicine (HPM) clinicians. Methods: An interprofessional "friendtor" group of five HPM clinicians from three academic medical centers met monthly and for a year-end focus group. A thematic analysis was used to develop a coding structure and identify overarching themes from these discussions. Results: Several themes emerged that highlight the importance of peer support when navigating major life decisions, boundary-setting, and non-clinical practice challenges, celebrating friendtors' personal and professional milestones, and having a productive space for shared academic pursuits. Discussion: Given the challenges and vulnerabilities the field of HPM is experiencing with workforce sustainability and burnout, the importance of developing supports outside of traditional mentorship paradigms is a valuable area of focus. Our work suggests that a friendtorship model may be an effective tool for sustaining mid-career HPM clinicians.

Using Contemplative Medicine to Harness Compassion in the Palliative Care Setting: Lessons Learned

Background

Burnout is common among palliative care clinicians caring for patients with a serious illness. Contemplative medicine is an emerging approach that aims to utilize Buddhist concepts of mindfulness, insight, and compassion to address unspoken suffering in clinicians.

Objectives

To introduce and share contemplative medicine practices with Hospice Palliative Medicine (HPM) fellows participating in two academic programs in New York.

Methods

Pilot educational sessions in contemplative medicine were conducted following a Contemplative Medicine Fellowship's relationship-centered and cohort-based curriculum. A short survey assessing HPM fellows' attitudes toward core competencies in contemplative medicine was administered to seven HPM fellows.

Results

Participants agreed that being present with those who are suffering are healing acts by themselves and that contemplative medicine can complement HPM fellows' skillsets when providing care to patients with serious illnesses. Common themes like "being awake" and "low self-compassion" were discussed by participants during the sessions. Techniques like pausing and mindful breathing were found helpful to practice throughout a busy workday.

Discussion

Incorporating contemplative medicine practices into an HPM fellowship may provide opportunities to (1) promote learner emotional development and (2) teach learners self-awareness of how difficult emotions can affect communication with patients.

The Administrative Burden on Palliative Academic Physicians

CONTEXT

Burnout is frequently a workload-related syndrome among palliative care physicians. Mandatory administrative activities contribute to this workload. The purpose of this study was to measure the amount of time involved in multiple required administrative activities and the cost of this on academic healthcare facilities.

METHODS

We measured all mandatory and non-mandatory activities that need to be completed by faculty and reviewed them with all Department of Palliative, Rehabilitation, and Integrative Medicine members for accuracy.

RESULTS

Every faculty member spends annually an approximate average of 5300 minutes on administrative activities (approximately the equivalent of 29 consults plus 133 follow-ups). Using the department net average per encounter, the approximate value of these encounters is $36,936 for each faculty member (about 11 clinical days).

CONCLUSION

Academic palliative care physicians are required to complete a number of administrative activities. Institutions do not keep a registry of these activities and do not accommodate for them with a reduction in the annual clinical productivity requirements. We recommend that regulatory agencies and institutions work together to better regulate this list of tasks and their frequency.

We Care: A Wellness Intervention Project for Palliative Care Physicians

There is a trend toward burnout in palliative care physicians. Due to this, a five-session curriculum has been designed with resiliency tools, coping skills, and spirituality in order to train palliative care fellows in an inpatient setting. More research is needed on this curriculum, but preliminary findings have shown a positive response.

Burnout among palliative care providers

BACKGROUND

Burnout among health care professionals contributes to high job turnover. Within the United States, burnout among specialty palliative care (PC) providers will accentuate provider shortage problems.

OBJECTIVES

This systematic review was conducted to answer the question "what is known about burnout among specialty PC providers practicing in the United States?" More specifically, it was designed to identify the rate of burnout and factors that influence or mitigate it among PC nurse practitioners (NPs), physician assistants (PA), and physicians and to inform future research.

DATA SOURCES

An electronic literature search of studies conducted in the United States between 2012 and September 2022 was completed in Embase, PubMed, CINAHL, and PsycINFO.

CONCLUSIONS

Analysis of 14 studies showed that there are five primary themes related to burnout among PC providers: (1) the rate of burnout, (2) the physical, psychological, and clinical manifestations of burnout, (3) predictors of burnout, (4) factors of resiliency, and (5) interventions piloted to decrease burnout. The majority of studies have delineated the physician role but have failed to determine the rate and factors of burnout among PC NPs and PAs.

IMPLICATIONS FOR PRACTICE

As NPs and PAs are integral to the PC provider workforce, future research should be designed to understand more clearly how burnout affects these two PC roles to inform efforts to sustain the PC workforce.

The Tween Years: Thriving as a Mid-Career Academic Hospice and Palliative Medicine Clinician

In the young and rapidly evolving field of hospice and palliative medicine (HPM), the transition from early to mid-career can be a precarious time. The high rates of burnout and low rates of work-life balance and satisfaction found in mid-career jeopardize our field's ability to maintain a healthy workforce. In this series, we present three cases that highlight common issues encountered during the early to mid-career transition in academic HPM and present several strategies for navigating challenges. A web of mentors/connections, academic map, and continuing education to enhance teaching skills are several concrete tools explored. To sustain a robust HPM workforce, such practical and structured supports during the particularly challenging mid-career transition are crucial.

Health Care Provider Attitudes and Beliefs Toward Nonmedical Opioid Use in Patients with Cancer Pain

Background: Data on health care providers' (HCPs') perceptions about patients with cancer pain and nonmedical opioid use (NMOU) are lacking. We examined the perceptions and attitudes of HCPs and assessed the usefulness of an interdisciplinary opioid stewardship program (OSP) while caring for these patients. Methods: An anonymous cross-sectional survey was conducted among the supportive care HCPs between September and November 2021. Results: Of 85 HCPs, 64 responded (75%) to the survey. Participants perceived that NMOU is underdiagnosed (42/64; 67%), and caring for such patients is difficult (58/64, 91%) and time consuming (54/64, 87%). A majority (50/51, 98%) were aware of the OSP, and (48/51; 94%) found it helpful. Conclusion: HCPs reported that NMOU is underdiagnosed and is challenging to manage. They endorsed the utility of an OSP in managing patients with concurrent cancer pain and NMOU. Future research should identify ways to standardize care and integrate OSP in routine supportive oncology practice.