1. 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

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

3. “ 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”

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

5. 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):
Kamal AH JPSM. 2016; 51(4):

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

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

8. 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):

9. Identifying Progression to Burnout
Others often see warning signs first

10. What are the signs?

11. Compassion Fatigue Symptoms Hyperarousal Disturbed Sleep Irritability
Hypervigilance
Avoidance

12. 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

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

14. 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

15. What are some causes or risk factors for Burnout?

16. 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

17. Possible causes
Social
Institutional
Patients/Family
Personal

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

19. 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.

20. Strategies to Facilitate Resilience

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

22. 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

23. 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

24. 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

26. 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

27. What is your ‘ recipe ’ for resilience…