Poetry at the Bedside: the poetics of palliative care Patrick L. Clary, MD Hospice involvement since 1988 Hospice Medical Director since 1993 Board certified palliative care physician since 1999

SPIKES protocol (after Buckman) Setting Perception Invitation

Preventing Burnout Mindfulness Meditation Reflective Writing Adequate supervision and mentoring Sustainable workload Promotion of choice and control Appropriate Recognition and Reward Supportive work community Fairness and justice in the workplace

Preventing Burnout Training in communications skills Development of self-awareness skills Practice of self-care activities Continuing education Participation in research Mindfulness-based stress reduction for team Meaning-centered intervention for team

Recognizing Burnout Physical and emotional exhaustion Feelings of detachment from the job Sense of ineffectiveness and lack of accomplishment Overidentification or overinvolvement Hyperirritability or hypervigilance Sleep problems including nightmares Social withdrawal Boundary violations Poor judgment

Recognizing Burnout Perfectionism and rigidity Questioning meaning of life Questioning prior religious beliefs Interpersonal conflicts Avoidance of emotionally difficult clinical situations Addictive behaviors Numbness and detachment Difficulty concentrating Frequent illnesses

SPIKES Protocol (after Buckman) Setting Perception Invitation Knowledge

SPIKES Protocol (after Buckman) Setting Perception Invitation Knowledge Empathy

Expressing Empathy and connection Naming the emotion Understanding the emotion Respect – often praise Support – “I think I can help” Explore – “tell me more”

Nonverbal indications of Empathy and connection Squarely face the patient (at the patient’s level) Open body position Lean toward the patient Eye contact maintained Relaxed posture

SPIKES Protocol (after Buckman) Setting Perception Invitation Knowledge Empathy Summary and plan

4 Practices to sustain Community Gratitude Promise-keeping Truthfulness Hospitality