Care for the Healthcare Professional Congrès de la Société Marocaine de Cancérologie Tangier Morocco, April 27-29, 2018 Care for the Healthcare Professional Joe El Khoury, MD

Overall Message… Avoiding burnout and building resilience is critical to personal health, strong teamwork, and provision of excellent patient care Burnout = epuisement professionnel

“ I just don’t know how much longer I can do this… ” “…staying til 8 every night ” “…being the only one around who can facilitate a family meeting ” “ I just don’t know how much longer I can do this… ” “…talking to the daughter from Jordan ( again ) ” “…convincing my colleagues that I don’t take away hope” “…seeing another 30-year old patient dying of melanoma”

Quality of Professional Life Progression of feelings Work-life Satisfaction Burnout Compassion fatigue 10 Work relationship(s) Lack of admin support Burden of charting

Prevalence of Burnout 62 % US Oncologists 62 % US Palliative Care Clinicians Higher rates in non-physicians Compassion fatigue common Allegra CJ J Onc Pract. 2005;1(4):140-147 Kamal AH JPSM. 2016; 51(4): 690-696

Compassion Fatigue vs Burnout Arises from the relationship between the clinician & the patient Burnout Arises from interaction with the work environment

Compassion Fatigue “Cost of Caring” Similar to PTSD Applies to those emotionally affected by the trauma of another Kearney M. JAMA 2009;301(11):1155-1164

Burnout Progressive loss of idealism, energy, and purpose experienced by people in the helping professions as a result of work conditions Kearney M. JAMA 2009;301(11):1155-1164

Identifying Progression to Burnout Others often see warning signs first

What are the signs?

Compassion Fatigue Symptoms Hyperarousal Disturbed Sleep Irritability Hypervigilance Avoidance

Characteristics of Burnout Emotional exhaustion Clinicians distance themselves emotionally & cognitively from work Cynicism Depersonalization Negative, callous & detached response to aspect(s) of work Sense of ineffectiveness Sanchez-Reilly S. J Supp Onc 2013; 11(2): 75-81

Physical pain Conflicts with family Feeling anxious, fearful, helpless …

Why should leaders care about burnout? Strong predictor for Depression  Satisfaction with career choice Association with Poor physical health Suboptimal patient care practices Medical errors Lower patient satisfaction scores Longer post discharge recovery by patients

What are some causes or risk factors for Burnout?

Risk Factors for Burnout Younger age More responsibility for dependents Being single Being highly motivated with intense investment in profession Working longer hours Working weekends

Possible causes Social Institutional Patients/Family Personal

Prescription for Burnout Prevention Building Resilience & Strategies for Self-Care

Compassion Satisfaction Pleasure experienced by facilitating positive changes in others Compassion satisfaction is defined as the pleasure derived from helping others.22 It is associated with an increased sense of connection to others, both to coworkers and to those receiving care, in addition to a palpable sense of meaning. Providers who are asked to describe their experience of compassion satisfaction o􀁸en describe a kind of flow state, or a state of easeful focus on their patient, free from concerns about time, resources, or other distractors. Compassion satisfaction is negatively correlated with burnout and compassion fatigue, and appears to be protective against these states.

Strategies to Facilitate Resilience

Negotiate Objectives For life For treatment Who makes decisions – change who is responsible Clinician – Paternalism Patient / family share decision-making

Change Your Perspective Their story / not my story Projection Transference Everyone will die Historically died quickly / often badly Many successes with health care Share the process with members of the interdisciplinary team

Rethink ‘ Failure ’ I did the best I could to treat the illness The illness is not responsive to the treatments we have Don’t abandon patients and families Teamwork Always care to offer – early palliative care is better

Possible Ingredients for Your ‘ Recipe ’ for Resilience Mindfulness practice Prayer, meditation, yoga Pause to ‘ smell the flowers ’ Present in the moment Reflection Journaling  Team relationships  Team / peer support Express gratitude Rituals Exercise Snuggle time with family / pets

Conclusion… Compassion fatigue that becomes burnout is frequent Be aware of signs and symptoms Pay attention to concerns raised by your health care team Change your behaviors to build resilience Change your work culture as possible

What is your ‘ recipe ’ for resilience…