2021; Volume 22, No 2, February

Promoting Resilience & Preventing Burnout: One size does not fit all

By Sharla Wells-Di Gregorio, PhD,
Assistant Professor of Psychology & Internal Medicine,

and IAHPC Board Member Steven “Skip” Radwany, MD, FACP, FAAHPM,
Professor of Medicine, Division of Palliative Medicine,

Department of Internal Medicine, The Ohio State University Wexner Medical Center, Ohio, USA

As palliative care providers, we confront suffering and loss daily in our work. Every team member bears some burden from these losses: from aides to advocates, from pharmacists to chaplains, from nurses to physicians. In addition, many of us feel overworked, inadequately resourced, and underappreciated by our parent institutions. No matter the setting, this has worsened dramatically with the COVID-19 pandemic having made death and isolation so prevalent. When these stresses manifest as burnout, our patients and their families may suffer the consequences, as may other team members. How can we alleviate these stresses? How do we prevent burnout and promote resilience, the process of adapting well in the face of adversity or stress?

Each of us can play a role. Furthermore, each program must take a unique approach based on local practices and resources. Finally, every team member has different needs in this regard; programs should offer a variety of different approaches to meet those needs.

Creating a culture of support

Leaders and team members must all work together diligently to create a culture of openness with one another and support for one another. Ask yourself if your colleagues feel free to express their concerns about workload and stress. Can they express their grief over patients who die; do they ask for help when they need it?

Most of us are drawn to this work by a sense of mission, by a desire to help those in the direst of situations, by a sense of duty to serve. However, these deeply felt obligations often prevent us from expressing the burdens that come with such service, as if to express stress or fatigue demeans the work itself. Challenge yourself and others with the idea that care for self and one another is not selfish, but essential to persevere in this work.

An organizational responsibility
to monitor & assess stress levels

Promoting resilience and preventing burnout must be seen as an organizational responsibility. Within our teams, we need to monitor workload and signs of stress while identifying existing resources for support. Do unsustainable patient volumes or bureaucratic demands burden team members with overwork? Many advocate for routinely measuring and reporting burnout among team members. Tools are widely available, some without cost, but any assessment must protect the confidentiality of those who respond. Even without sophisticated measures, a “Resilience Committee” of frontline workers can monitor and address stresses in real time. Assessments must be both targeted and result in practical action to not waste the limited time of clinicians for nonclinical tasks.

Ask for help, and take it when offered

Multiple sources of support are often available to palliative care teams. I have personally witnessed clergy, counselors, massage therapists, acupuncturists, cooks, musicians and others step up to offer or gladly participate when asked. When others offer support or ideas we must capitalize on these gifts. Creating protected time for team members is essential for clinicians with overloaded schedules.

Creating a variety of approaches

Once you’ve identified local resources and opportunities, recognize that not every team member may choose to participate. A variety of opportunities for them to participate offers the greatest chance of success. We’ve seen the following develop from the ground up in two organizations over 30 years:

Organizational Approaches

• Float teams or individuals to offload unexpected surges in demand
• Routine structured and informal assessment of wellness of team members and organizational adjustments based on this feedback
• Structured retreats for team building and planning

Team-Building Approaches

• Facilitated writing workshops
• Support or debriefing groups
• Regular organized bereavement sessions to honor patients, clinicians, and family members who have died
• Prayer groups
• Group meals during or after the workday, perhaps some with local cultural themes
• Activities or outings as a group, including group exercise outside of work
• Humor (especially if self-deprecating, from leaders)

Individual Approaches

• Special therapies for team members: massage, aromatherapy, music, or art therapy
• Meditation or yoga sessions
• Supportive counselling sessions or debriefings
• Opportunities to learn new skills to build resilience

In each case when the opportunity arose, leadership supported its development and flowering.

Thus, by creating a culture of support, identifying needs and opportunities, and capitalizing on a variety of approaches and gifts, palliative care organizations can preserve the emotional health and effectiveness of its team members. Using this “one size does not fit all” strategy increases your organization’s ability to successfully reduce burnout and promote resilience.

Resources:

1. Harrison KL, Dzeng E, Ritchie CS, Shanafelt TD, Kamal AH, et al. Addressing Palliative Care Clinician Burnout in Organizations: A workforce necessity, an ethical imperative. J Pain Symptom Manage 2017; 53(6): 1091-6.
2. Zanatta F, Maffoni M, Giardini A.Zanatta F, et al. Resilience in Palliative Healthcare Professionals: A systematic review. Support Care Cancer 2020; 28(3): 971-8.
3. Etkind SN, Bone AE, Lovell N, Cripps RL, Harding R, et al. The Role and Response of Palliative Care and Hospice Services in Epidemics and Pandemics: A rapid review to inform practice during the COVID-19 pandemic. J Pain Symptom Manage 2020; 60(1): e31-40.
4. Deodhar JK, Goswami SS. Structure, Process, and Impact of a Staff Support Group in an Oncology Setting in a Developing Country. Ind Psychiatry J 2017; 26: 194-200.
5. Shapiro J, McDonald TB. Supporting Clinicians during Covid-19 and Beyond—Learning from past failures and envisioning new strategies. NEJM 2020; 383(27).

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