How Leaders, Teams and Organisations can prevent Burnout and build Resilience: a thematic analysis’

2020 ◽  
pp. bmjspcare-2020-002774
Author(s):  
Mervyn Yong Hwang Koh ◽  
Hwee Sing Khoo ◽  
Marysol Dalisay Gallardo ◽  
Allyn Hum
Keyword(s):  
Palliative Care ◽  
Social Workers ◽  
Thematic Analysis ◽  
Well Being ◽  
Analysis Approach ◽  
Open Communication ◽  
Building Resilience ◽  
Palliative Care Teams ◽  
The Mean ◽  
Adequate Staffing

ContentBurnout occurs commonly in palliative care. Building resilience helps to mitigate the effects of burnout. Little is known about the importance of leaders, teams and organisations in preventing burnout and promoting resilience in palliative care.ObjectivesWe studied palliative care clinicians with more than a decade’s experience looking into their experiences on the role leaders, teams and organisations play in burnout and resilience.Patients and methodsThis is a thematic analysis focusing on how leaders, teams and organisations influence burnout and resilience. 18 palliative care clinicians—5 doctors, 10 nurses and 3 social workers—who worked in various palliative care settings (hospital, home hospice and inpatient hospice) were interviewed using semistructured questionnaires. The mean age of the interviewees was 52 years old, and the mean number of years practising palliative care was 15.7 years (ranging from 10 to 25 years). The interviews were recorded verbatim and were transcribed and analysed using a thematic analysis approach.ResultsThe following themes featured prominently in our study. For leaders: being supportive, caring and compassionate, being a good communicator and showing protective leadership. With teams: being like-minded, caring for the team, sharing the burden and growing together. For organisations: having a strong commitment to palliative care, supporting staff welfare and development, open communication, adequate staffing and organisational activities promoting staff well-being were described as protective against burnout and promoting resilience.ConclusionLeaders, teams and organisations play an important role in helping palliative care teams to reduce burnout and promote resilience.

scholarly journals Video Intervention to Increase Knowledge About and Interest in Palliative Care Among MSW Students

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 70-70
Author(s):  
Cathy Berkman
Keyword(s):  
Palliative Care ◽  
Social Work ◽  
End Of Life ◽  
Social Workers ◽  
End Of Life Care ◽  
Social Work Students ◽  
Life Care ◽  
Video Intervention ◽  
Msw Students ◽  
The Mean

Abstract As the population ages and more people live longer with chronic and life-limiting illnesses, more healthcare professionals with palliative care skills are needed. Social workers are part of the palliative care team, but there is little, if any, content on palliative and end-of-life care in MSW programs. A 24-minute video featuring nine palliative and hospice social workers was produced with two goals: 1) increase knowledge of social work students about palliative and end-of-life care; and 2) interest social work students in a career in palliative social work. MSW students from three schools, in NY and Alabama, viewed the video. After viewing the video, 94 students participated in the mixed methods study, completing the brief, anonymous, online survey. The mean level of understanding about what palliative social workers do, rated from 1 (no understanding) to 5 (very good understanding), was 2.96 (SD=.99) before viewing the video and 4.31 (SD=.61) after, for an increase of 1.35 points (95% CI=1.14, 1.55) (p<.001). The mean level of interest in a career in palliative care social work and working with seriously ill persons and their family members, rated from 1 (Not at all interested) to 5 (Extremely interested), was 2.52 (SD=.99) before viewing the video and 3.45 SD=.80) after, for an increase of .91 points (95% CI=.79, 1.07) (p<.001). Qualitative data supporting the quantitative findings will be presented. This study suggests that a video intervention may be an effective tool to increase knowledge and interest in palliative and end-of-life care among social work students.

Mental healthcare and palliative care: barriers

2020 ◽  
pp. bmjspcare-2019-001986 ◽  
Author(s):  
Kelly O'Malley ◽  
Laura Blakley ◽  
Katherine Ramos ◽  
Nicole Torrence ◽  
Zachary Sager
Keyword(s):  
Mental Health ◽  
Palliative Care ◽  
Psychological Symptoms ◽  
Mental Healthcare ◽  
Well Being ◽  
Psychological Needs ◽  
Treatment Team ◽  
Advanced Illness ◽  
Palliative Care Teams ◽  
The Usa

ContextPsychological symptoms are common among palliative care patients with advanced illness, and their effect on quality of life can be as significant as physical illness. The demand to address these issues in palliative care is evident, yet barriers exist to adequately meet patients’ psychological needs.ObjectivesThis article provides an overview of mental health issues encountered in palliative care, highlights the ways psychologists and psychiatrists care for these issues, describes current approaches to mental health services in palliative care, and reviews barriers and facilitators to psychology and psychiatry services in palliative care, along with recommendations to overcome barriers.ResultsPatients in palliative care can present with specific mental health concerns that may exceed palliative care teams’ available resources. Palliative care teams in the USA typically do not include psychologists or psychiatrists, but in palliative care teams where psychologists and psychiatrists are core members of the treatment team, patient well-being is improved.ConclusionPsychologists and psychiatrists can help meet the complex mental health needs of palliative care patients, reduce demands on treatment teams to meet these needs and are interested in doing so; however, barriers to providing this care exist. The focus on integrated care teams, changing attitudes about mental health, and increasing interest and training opportunities for psychologists and psychiatrists to be involved in palliative care, may help facilitate the integration of psychology and psychiatry into palliative care teams.

How to better help cancer patients face their coming death?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21505-e21505 ◽  
Author(s):  
Francois-Xavier Goudot ◽  
Milena Maglio ◽  
Sandrine Bretonniere
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Disease Duration ◽  
Hospice Care ◽  
Good Practice ◽  
Terminal Phase ◽  
Palliative Care Teams ◽  
Short Disease Duration ◽  
Impending Death ◽  
The Mean

e21505 Background: According to literature and medical experience, the doctor-patient relationship becomes strained when oncologists tell their patients that they have no more curative treatments to offer them. Patients often resist when they are told that it is in their best interest to meet with the palliative teams. Little is known about how to meet patients’ expectations at this advanced stage. Methods: We conducted a multicenter qualitative research in an oncology department, a hospital at home service and in an inpatient hospice care center. We met 47 patients (M = 21, F = 27, mean age = 65 yrs, mean disease duration = 5 yrs) for in-depth face to face interviews performed by a multi-disciplinary ethics team. Interviews were carried out between 1 and 3 months before death. Results: Qualitative analysis revealed 4 main results. 1/ For respondents, palliative care introduction meant impending death. 2/ Palliative care introduction meant loss of hope. Without hope, the cancer trajectory is impossible to sustain, they said. 3/ Hope was intricately interwoven with the request for more chemotherapy, even if doctors had clearly refused to provide it. 4/ The oncologist remained the referent physician, even for patients in hospice care. Patients for which the mean duration between cancer diagnosis and interview was 5 years or more, were more willing to talk about death and better accepted palliative care than patients for which the mean duration of cancer was inferior to 3 yrs. For patients with fast progressing cancer (n = 11), 10 were not willing to talk about death and 7 strongly resisted palliative care introduction. There was no difference between patients according to age, sex, type of cancer or center of inclusion. Conclusions: In the terminal phase of cancer, patients are unwilling to talk about death and are reluctant to meet with palliative care teams. Short disease duration strongly reinforces this attitude. If patients resist discussions about their impending death, should physicians continue to consider it good practice to introduce such discussions? Is it beneficent for patients?

scholarly journals Palliative Care Consult for Clinician Distress Through the Philosophical Lenses of Gender Norms and Phenomenology

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 245-245
Author(s):  
Anessa Foxwell ◽  
Salimah Meghani ◽  
Connie Ulrich
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Gender Norms ◽  
Well Being ◽  
Future Research ◽  
Post Traumatic Stress ◽  
Social Construct ◽  
The Social ◽  
Palliative Care Teams ◽  
Seriously Ill

Abstract The National Academy of Medicine has raised significant concerns on clinician health and well-being as many experiencing burnout, post-traumatic stress, and depression. Indeed, clinicians experience a range of human emotions when caring for older adults with severe, life-limiting illnesses. These emotions may manifest in multiple ways and from various sources. Uncertain of how to attend to such distress, clinicians may consult a trusted resource, including the palliative care team. Palliative care specialists are trained to support the complexities and needs of patients and families; increasingly, however, palliative care consults are rooted in clinician distress. This session uses clinical case examples to explore the palliative care consult for distressed clinicians from two different philosophical perspectives: (1) phenomenology and (2) the social construct of gender norms. A phenomenological lens respects the unique, subjective lived experience of each individual in their day-to-day interactions with patients, families, and health care systems. Therefore, when caring for seriously ill older adults, clinicians may bring their own subjective experiences to the patient encounter and react differently to ethical dilemmas and conflicts that arise. The social construct of gender norms asks us to examine clinician distress from a different perspective. Here, the postmodern rejection of gender binarism allows clinicians to experience a spectrum of emotions and distress regardless of gender. Exploration through clinical cases will highlight the unique, varied experience of clinician distress and offer opportunities for future research into the role of palliative care teams in supporting distressed clinicians who care for seriously ill older adults.

scholarly journals Whole Person Team Care

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Glen Komatsu ◽  
Denise Hess
Keyword(s):  
Palliative Care ◽  
Identity Formation ◽  
Mindfulness Meditation ◽  
Meaning Making ◽  
Interdisciplinary Team ◽  
Well Being ◽  
Interdisciplinary Teams ◽  
Self Awareness ◽  
Palliative Care Teams ◽  
Whole Person

In the rapidly changing environment of 21st century healthcare, effective interdisciplinary team-based care is a key ingredient in providing whole person care across the continuum. Interdisciplinary teams face significant issues and challenges in providing whole person care given the boundaries that exist between various healthcare disciplines. Systemic institutional barriers and hierarchies commonly work against team communication, cooperation, and collaboration. These work environments contribute to work-related stress, staff turnover, inefficient, lower quality care, burnout, and compassion fatigue. Ultimately team environments that do not foster team member well-being are unlikely to find success in creating environments that foster whole person care. Given these realities, teams who hope to provide whole-person care need strategies for creating and sustaining a team environment of self-awareness, self-compassion, mindfulness and non-judgmental presence.This session will present the outcomes of three innovative approaches to interdisciplinary care team flourishing through case study analysis of hospital-based palliative care teams, and adult/pediatric hospice teams. The first intervention illustrates a process for developing and implementing a team retreat experience. Combining elements of team building, experiential learning and discussion of assigned readings, palliative care and hospice teams exhibit increased team trust, respect and communication across discipline boundaries. The second intervention demonstrates positive meaning-making through the use of a “spiritual narrative.” Through sustained reflection on a guiding metaphor, “spiritual narratives” enhance team identity formation, function, and sustainability. The third intervention outlines a model for group mindfulness meditation. Through regular practice of mindfulness meditation as an integrated component of the work day, team members sought to increase their self-awareness, presence, attunement and compassion in clinical interactions. Attendees of this workshop will be inspired and equipped to with new ways to enrich interdisciplinary team flourishing while providing excellent whole person care.

scholarly journals Coping Through COVID-19: A Mixed Method Approach to Understand How Palliative Care Teams Managed the COVID-19 Pandemic

2021 ◽  
pp. 104990912110456
Author(s):  
Kayla D. Finuf ◽  
Santiago Lopez ◽  
Maria T. Carney
Keyword(s):  
New York ◽  
Palliative Care ◽  
Physical Health ◽  
Coping Strategies ◽  
New York State ◽  
Supervisor Support ◽  
Well Being ◽  
Subjective Well Being ◽  
Positive Effects ◽  
Palliative Care Teams

Objective: While previous work documented a substantial increase in patient mortality consultations and workload for palliative teams, little is known about how these team members managed their mental and physical health during the COVID-19 pandemic. We investigated how job resources (coworker and supervisor support) and personal resources (coping strategies) reduced perceptions of burnout and increased perceptions of well-being. Method: An anonymous electronic survey was sent to all members ( N = 64) of the palliative medical team among 14 hospitals of a New York State health system. Data were collected between September 2020 to October 2020. Measures included validated scales for burnout (Oldenburg Burnout Inventory), coping strategies (Cybernetic Coping Scale), subjective well-being (BBC Subjective Well-being scale), and coworker/supervisor support (7 items from Yang et al). Results: Results indicated devaluation coping tactics were used to reduce perceptions of burnout and to increase perceptions of physical health. Higher burnout was identified when using avoidance coping techniques. Furthermore, coworkers and supervisor(s) support significantly reduced disengagement when compared to coworker support alone. Conclusion: COVID-19 exacerbated burnout experienced by palliative care teams, yet the use of coping behaviors (devaluation/avoidance) and external resources (coworker and supervisor support) utilized by these teams were found to have positive effects. Further research should investigate these antagonizing factors to help preventing and addressing burn out during times of crises and in the everyday of palliative care teams.

scholarly journals Associations Between The Spiritual Well-Being (EORTC QLQ-SWB32) and Quality of Life (EORTC QLQ-C30) of Patients Receiving Palliative Care for Cancer in Cyprus

2021 ◽  
Author(s):  
Maria Kyranou ◽  
Marianna Nicolaou
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Well Being ◽  
Cancer Data ◽  
Patients With Cancer ◽  
Spiritual Well Being ◽  
Eortc Qlq C30 ◽  
The Mean ◽  
Eortc Qlq

Abstract Background: Spiritual well-being is increasingly investigated in relation to patients’ perceived quality of life and is generally thought as having the potential to support patients with cancer who receive palliative care. Until recently, questionnaires used to assess spiritual well-being were developed mainly in the US. The purpose of this study was to translate and use the EORTC- SWB32, a newly developed tool, validated recently in 4 continents, 14 countries, and in 10 languages, to explore relationships of spiritual well-being with quality of life in patients with cancer.Methods: One hundred four patients participated in this study with an average age of 59 years. Of those, 79% were dealing with metastatic cancer. Data collection took place in three oncology centers from two large cities in Cyprus. The acceptability of the translated items was tested. Two questionnaires were employed for the assessment of quality of life and spiritual well-being, developed by the same organization: the EORTC QLQ-C30 and the EORTC QLQ-SWB32. The scores for each tool were analyzed separately and correlations between the two measures were explored. Results: Patients found the items of the SWB32 tool easy to understand and answer. They attested that filling the questionnaire prompted thoughts about their own spirituality. The mean score for Global Spiritual Well-Being was 60.4 (SD=23.7) and it was associated with the mean scores in the scales “Emotional functioning” and “Cognitive functioning” of the EORTC-QOL-C30 (0.42 and 0.40 respectively, p<0.01). The mean score for the “Relationship with God” scale (74.9, SD=29.7) reported by the Cypriot patients is high and compatible with the homogenous spiritual orientation of the island’s population.Conclusions: All subscales of the SWB32 tool demonstrated good internal consistency in this study. Significant associations were observed between dimensions of quality of life and spiritual well-being. Additionally, the participants found the items easy to answer consistent with the tool’s suggested clinical utility which lays the ground for the application of targeted interventions to enhance spiritual well-being.

scholarly journals Associations between the spiritual well-being (EORTC QLQ-SWB32) and quality of life (EORTC QLQ-C30) of patients receiving palliative care for cancer in Cyprus

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Maria Kyranou ◽  
Marianna Nicolaou
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Well Being ◽  
Cancer Data ◽  
Patients With Cancer ◽  
Spiritual Well Being ◽  
Eortc Qlq C30 ◽  
The Mean ◽  
Eortc Qlq

Abstract Background Spiritual well-being is increasingly investigated in relation to patients’ perceived quality of life and is generally thought as having the potential to support patients with cancer who receive palliative care. Until recently, questionnaires used to assess spiritual well-being were developed mainly in the US. The purpose of this study was to translate and use the EORTC- SWB32, a newly developed tool, validated recently in 4 continents, 14 countries, and in 10 languages, to explore relationships of spiritual well-being with quality of life in patients with cancer. Methods One hundred four patients participated in this study with an average age of 59 years. Of those, 79% were dealing with metastatic cancer. Data collection took place in three oncology centers from two large cities in Cyprus. The acceptability of the translated items was tested. Two questionnaires were employed for the assessment of quality of life and spiritual well-being, developed by the same organization: the EORTC QLQ-C30 and the EORTC QLQ-SWB32. The scores for each tool were analyzed separately and correlations between the two measures were explored. Results Patients found the items of the SWB32 tool easy to understand and answer. They attested that filling the questionnaire prompted thoughts about their own spirituality. The mean score for Global Spiritual Well-Being was 60.4 (SD = 23.7) and it was associated with the mean scores in the scales “Emotional functioning” and “Cognitive functioning” of the EORTC-QOL-C30 (0.42 and 0.40 respectively, p < 0.01). The mean score for the “Relationship with God” scale (74.9, SD = 29.7) reported by the Cypriot patients is high and compatible with the homogenous spiritual orientation of the island’s population. Conclusions All subscales of the SWB32 tool demonstrated good internal consistency in this study. Significant associations were observed between dimensions of quality of life and spiritual well-being. Additionally, the participants found the items easy to answer consistent with the tool’s suggested clinical utility which lays the ground for the application of targeted interventions to enhance spiritual well-being.

Fear, anxiety, and adjustment disorder in palliative care

2021 ◽  
pp. 756-763
Author(s):  
Kerry A. Sherman ◽  
Christopher J. Kilby
Keyword(s):  
Palliative Care ◽  
Information Provision ◽  
Well Being ◽  
Healthcare Team ◽  
Open Communication ◽  
Psychological Well Being ◽  
Difficult Time ◽  
Spiritual Well Being ◽  
Quality Of Death

Palliative care has major implications for the psychological well-being of not only the patient, but also family members and those close to them. Being offered palliative care can send a variety of signals to a patient, including a sense that the medical system has failed them and that their life is about to end, or maybe a sense of relief in knowing that their suffering will end soon. The family of the patient also experience a range of emotions associated with palliative care, often mimicking that of the patient. Although palliative care aims to minimize suffering and improve the quality of death for the patient, it is critical that the psychosocial well-being of the patient is addressed; neglect of these concerns will compromise the quality of palliative care, the quality of death, and overall psychological, emotional, and spiritual well-being of the patient, despite improvements in physical suffering. This chapter discusses the key importance of the need for reciprocal open communication and information provision during this difficult time between the patient, their family, and the palliative healthcare team. Ineffective communication can jeopardize the psychosocial well-being of the patient, with feelings of existential threat, isolation, depression, fear, anxiety, hopelessness, and wishing for a hastened death commonly reported. This chapter highlights these issues and provides an overview of evidence-based established approaches addressing the psychological well-being of both the patient and their family. An overarching theme across all intervention approaches is to maintain honest, open communication between medical staff, the patient, and their family.

scholarly journals Stakeholder Perspectives on the Biopsychosocial and Spiritual Realities of Living With ALS: Implications for Palliative Care Teams

2019 ◽  
Vol 36 (10) ◽  
pp. 851-857 ◽  
Author(s):  
Klaudia Kukulka ◽  
Karla T. Washington ◽  
Raghav Govindarajan ◽  
David R. Mehr
Keyword(s):  
Palliative Care ◽  
Family Caregivers ◽  
Health Care Providers ◽  
Quantitative Data ◽  
Well Being ◽  
Social Needs ◽  
Care Providers ◽  
Structured Interviews ◽  
Palliative Care Teams ◽  
The Impact

Context: Amyotrophic lateral sclerosis (ALS) is an all-encompassing, life-limiting disease, resulting in the eventual paralysis of all voluntary muscles and concurrent loss of independence. As the disease advances, both patients and their family caregivers develop complex biological, psychological, and social needs, leading to increasing calls for the involvement of palliative care teams in the management of ALS. Objective: The purpose of this study was to generate a rich description of the realities of living with ALS, equipping palliative care teams with an in-depth understanding of the experiences and needs of patients with ALS and their family caregivers. Methods: This study employed a mixed-methods design, with quantitative data supplementing a larger body of qualitative data. Semi-structured interviews with 42 key stakeholders, including patients, family caregivers, and health-care providers, were analyzed for themes essential for effective understanding of ALS. Results: Identified themes were organized into 2 broad categories: (1) biopsychosocial needs of patients with ALS and family caregivers and (2) the impact of ALS on spiritual and emotional well-being. Quantitative data supported the recognized themes, particularly with regard to challenges associated with preserving independence, securing sufficient social support, and managing the emotional complexities of the disease. Conclusion: Study findings illustrate the intricacies of living with ALS and the importance of eliciting individualized values when caring for patients with ALS and their families. The complex biopsychosocial needs experienced by patients and family caregivers suggest numerous opportunities for meaningful palliative care involvement.

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