5. Compassion Fatigue in Physicians Compassion Fatigue in Physicians: predictive and preventative processes Peter Huggard MPH MEd Senior Lecturer & Academic Advisor Department of General Practice and Primary Health Care Faculty of Medical and Health Sciences University of Auckland New Zealand

6. Invitation to engage in the process as the discussion develops As you do so, you may recall some of your own experiences that have relevance to you – think about why these memories have re-surfaced, and the significance of them for you. Later, as we discuss support, think of your own support systems

7. Compassion Fatigue in Physicians “You had better prepare yourself for what you will hear” (Professor of Medicine) “My God, I know exactly what you are talking about” (Senior Pediatrician) “I’ve become increasingly concerned by the number of unhappy junior doctors in hospitals, these being the doctors I have most contact with. I believe we handle issues around stress, looking after ourselves, and issues of (our) mental health, rather poorly” (Geriatrician)

8. Compassion Fatigue in Physicians “Ha! We had a group session and talked about this stuff, and decided it wouldn’t affect us” (Medical Student) “When I finished, after doing five years of that work (pediatric oncology), it was two and a half years before I could cry in the soppy movies” (Nursing Lecturer) “Compassion fatigue! Those ‘First-Years’ enter the Hospital and by the end of the year we’ve knocked every bit of compassion out of them” (Physician)

9. Compassion Fatigue in Physicians A search for the 3 P’s of compassion fatigue P revalence P redictive factors P reventative factors

10. Compassion Fatigue in Physicians... the natural consequent behaviours and emotions resulting from knowing about a traumatizing event experienced by a significant other. Charles Figley (1995)

11. Compassion Fatigue in Physicians You can’t wipe the tears from someone’s face without getting your hands wet

12. Compassion Fatigue in Physicians

13. Which words to use? Compassion fatigue is often used interchangeably with Secondary Traumatic Stress and Vicarious Traumatisation Several other terms have used: emotional contagion peripheral victims secondary survivor counter-transference proximity stress effects

14. Compassion Fatigue in Physicians “the transformation that occurs in the inner experience of the therapist that comes about as a result of empathic engagement with clients trauma material” Pearlman &Saakvitne, 1995

15. Compassion Fatigue in Physicians Compassion Fatigue Self Test for Psychotherapists 40 item instrument Scales for burnout and compassion fatigue Asked questions about: –emotional exhaustion –sense of failure –PTSD symptoms

16. A.The person has been exposed to a traumatic event in which both of the following were present: (1)the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2)the person's response involved intense fear, helplessness, or horror DSM IV-TR (2000) PTSD intrusive thoughts avoidance hypervigilance

17. Compassion Fatigue in Physicians Compassion Satisfaction Beth Stamm Idaho State University an expression of the positive aspects of care-giving

18. Compassion Fatigue in Physicians ProQOL (Professional Quality of Life) Instrument 30 items 10 each for CF, BO, and CS

19. Compassion Fatigue in Physicians Managing Compassion Fatigue: implications for medical education

20. Compassion Fatigue in Physicians Resiliency Social support Locus of control Personality traits Emotional regulation and coping Burnout COMPASSION FATIGUE Empathy Compassion satisfaction

21. Compassion Fatigue in Physicians compassion fatigue burnout compassion satisfaction Predictive & Preventative Factors: Resilience: Connor-Davidson Resilience Scale (Connor & Davidson, 2003) Empathy: Jefferson Scale of Physician Empathy (Hojat, 2001) Spirituality: Ryff's Scales of Psychological Well-being (van Dierendonck, 2003) Emotional Regulation & Support Seeking: (Huggard, 2003) Prevalence: Compassion Fatigue, Burnout & Compassion Satisfaction: Professional Quality of Life Scale (Stamm, 2002)

22. Compassion Fatigue in Physicians Research Methods Quantitative: Anonymous questionnaire distributed to RMOs in four District Health Boards Qualitative: Opportunity on the questionnaire to write comments Focus groups

23. Compassion Fatigue in Physicians Socio-demographic data n253 Male40% Female60% New Zealand Pakeha53% Mean age31 years Mean time since finishing medical school 6.5 years

24. Compassion Fatigue in Physicians Compassion SatisfactionBurnout Compassion Fatigue N (valid) 230226222 Mean 292413 Range 343840 Minimum value 1030 Maximum value 444140 Percentiles: 25 75 25 34 20 28 8 17 Reference values: Mean 372313 Percentiles: 25 75 31 42 18 29 7 18

25. Compassion Fatigue in Physicians Compassion SatisfactionBurnout Compassion Fatigue N (valid) 230226222 Mean 292413 Range 343840 Minimum value 1030 Maximum value 444140 Percentiles: 25 75 25 34 20 28 8 17 Reference values: Mean 372313 Percentiles: 25 75 31 42 18 29 7 18

26. Compassion Fatigue in Physicians Compassion SatisfactionBurnout Compassion Fatigue N (valid) 230226222 Mean292413 Range 343840 Minimum value 1030 Maximum value 444140 Percentiles: 25 75 25 34 20 28 8 17 Reference values: Mean 372313 Percentiles: 25 75 31 42 18 29 7 18

27. Compassion Fatigue in Physicians Compassion SatisfactionBurnout Compassion Fatigue N (valid) 230226222 Mean292413 Range 343840 Minimum value 1030 Maximum value 444140 Percentiles: 25 75 25 34 20 28 8 17 Reference values: Mean 372313 Percentiles: 25 75 31 42 18 29 7 18

28. Compassion Fatigue in Physicians Compassion Fatigue (STS) Compassion Satisfaction Burnout ProQOL Empathy Spirituality Emotional Regulation Resilience

29. Compassion Fatigue in Physicians Compassion Fatigue (STS) Compassion Satisfaction Burnout ProQOL Empathy Spirituality Emotional Regulation Resilience + sig.

30. Compassion Fatigue in Physicians Compassion Fatigue (STS) Compassion Satisfaction Burnout ProQOL Empathy Spirituality Emotional Regulation Resilience + sig. - sig.

31. Compassion Fatigue in Physicians Compassion Fatigue Compassion Satisfaction Burnout ProQOL Empathy Spirituality Emotional Regulation Resilience + sig. - sig. Spiritual Beliefs Relationship with a Higher Power + sig.

32. Compassion Fatigue in Physicians 32%

33. Compassion Fatigue in Physicians 88%

34. Compassion Fatigue in Physicians 79%

35. Compassion Fatigue in Physicians 70%

36. Compassion Fatigue in Physicians 20%

37. Compassion Fatigue in Physicians Prediction of compassion fatigue Personal Strengths and Resilience Emotional Competence and Confidence These two subscales were the most strongly, and negatively, associated with CF

38. Compassion Fatigue in Physicians Personal Strengths and Resilience I can deal with whatever comes up I believe that past success gives confidence for new challenge I see the humour side of things I believe that coping with stress strengthens I tend to bounce back after illness or hardship I believe I give my best effort no matter what I believe I should act on a hunch

39. Compassion Fatigue in Physicians Emotional Competence and Confidence I feel confident in my ability to care for patients exhibiting strong emotional distress I am aware of my emotions as I experience them I feel confident in my ability to understand my own emotional responses to my patients’ distress I feel competent in my ability to understand the reasons for patient’s strong emotional distress I feel confident in my ability to care for the emotional as well as the physical needs of my patients I feel able to initiate access to additional support, if required, to help me to understand and manage my emotions in relation to my patients

40. Compassion Fatigue in Physicians Contribution of this information to training and support interventions Personal Strengths and Resilience Emotional Competence and Confidence

41. Compassion Fatigue in Physicians Thank you for your attention