Mary L. S. Vachon

Self-care of Physicians Caring for Patients at the End of Life : Being Connected ... A Key to My Survival

Physicians providing end-of-life care are subject to a variety of stresses that may lead to burnout and compassion fatigue at both individual and team levels. Through the story of an oncologist, we discuss the prodromal symptoms and signs leading to burnout and compassion fatigue and present the evidence for prevention. We define and discuss factors that contribute to burnout and compassion fatigue and consider factors that may mitigate burnout. We explore the practice of empathy and discuss an approach for physicians to maximize wellness through self-awareness in the setting of caring for patients with end-stage illness. Finally, we discuss some practical applications of self-care in the workplace.

Staff stress in hospice/palliative care: a review.

A review of the research in the area of staff stress in hospice/palliative care since the start of the modern hospice movement shows that, while high stress was identified as a problem in the early days of the movement, later studies have shown that stress and burnout in palliative care are by no means universal. Staff stress and burnout in hospice/palliative care has been demonstrated to be less than in professionals in many other settings. However, other studies have noted suicidal ideation, increased alcohol and drug usage, anxiety, depression, and difficulty in dealing with issues of death and dying. It is hypothesized that part of the reason that stress may be lower than expected in some settings was the early recognition of the potential stress inherent in this field and the development of appropriate organizational and personal coping strategies to deal with the identified stressors. Staff in hospice/palliative care have been found to have increased stress when mechanisms such as social support, involvement in work and decision-making, and a realistic work-load are not available. The stress that exists in palliative care is due in large measure to organizational and societal issues, although personal variables were also found to have an influence. Suggestions are given for the direction of future research in the field.

Measurement and management of stress in health professionals working with advanced cancer patients.

Abstract Staff working with advanced cancer patients may experience considerable stress but there have been few attempts to measure such stress systematically. This paper presents preliminary studies of staff stress in two cancer centers. Nurses in an active treatment cancer hospital were found to focus on problems with dying patients as a displacement for their feelings of personal inadequacy in stressful situations. Major problems with the work situation and with staff communications were cited just as often as problems in watching patients suffer and die. A series of discussion groups lasting eight sessions was held with the nurses to facilitate communication with other staff and patients to promote understanding of the problems of dealing with life-threatening illnesses and death. Staff on a newly opened palliative care unit were found to experience only slightly less stress than a group of newly widowed women. While the stress decreased over time, indications are that some staff working in newly deve...

Meaning, Spirituality, and Wellness in Cancer Survivors

OBJECTIVES To explore the concepts of meaning, spirituality, and wellness in cancer survivors. DATA SOURCES Review and research articles, books, and personal experience as a nurse psychotherapist and as a cancer survivor. CONCLUSION Cancer survivors often rely on their religious and spiritual beliefs as a way of deriving meaning during their illness experience and survivorship, as well as a way of coping with and coming to terms with the concept of death. The measurement of religion and spirituality in health and cancer survivorship is challenging because of the difficulty in defining terms and in developing ways of measuring the concepts. IMPLICATIONS FOR NURSING PRACTICE Nurses have the opportunity to explore the meaning of cancer and spirituality in the lives of their patients. Such discussions can allow for the introduction of concepts of wellness including changes in lifestyle habits and social support that may improve quality of life for cancer survivors.

Caring for the caregiver in oncology and palliative care

OBJECTIVES To review the stressors and manifestations of stress present in oncology and palliative care settings and elucidate successful coping strategies. DATA SOURCES Review articles and research reports. CONCLUSIONS Professional care of advanced cancer patients and their families confronts nurses with a variety of challenges and stressors. Multiple strategies have been described in the literature to assist professionals to cope with stressful aspects of clinical practice. Research is needed to test the efficacy of these strategies. IMPLICATIONS FOR NURSING PRACTICE Personal coping strategies and the development of supportive collaborative relationships within the work environment are essential to the enhancement of self-esteem and professional effectiveness.

Motivation and stress experienced by staff working with the terminally ill

Abstract Concern with needs of dying patients too often leads to neglect of corresponding needs of staff members who work with them. This paper describes how motivation of staff to work with dying patients can effect the job stress they encounter. It is suggested that staff often choose to work with the dying for one of six reasons: accident or convenience, a desire to do the “in thing” or to affiliate with a charismatic leader, intellectual appeal and a desire for mastery over pain and death, a sense of “calling,” previous personal experience, and a suspicion that one might some day develop the disease. Each motivation may lead to its own particular forms of stress. In addition, constant exposure to the dying can effect ones personal life and relationships with family members and friends. A number of suggestions are given for coping with job stress including: understanding ones own limits, maintaining a balanced personal life, and developing effective support systems on and off the job.

Prospective Assessment of Symptom Palliation for Patients Attending a Rapid Response Radiotherapy Program: Feasibility of Telephone Follow-Up

Clinical trials generally include motivated patients with relatively good performance status. This can result in an overestimation of the effectiveness of an intervention. Clinic follow-up protocols for outcome assessment after palliative treatments suffer from high attrition rates. In this study, the feasibility of telephone follow-up for the assessment of symptom palliation in patients receiving outpatient palliative radiotherapy as a tool to evaluate outcome was examined. Patients referred for palliative radiotherapy were asked to rate their symptom distress using the modified Edmonton Symptom Assessment System (ESAS) at initial consultation. Patient demographics and analgesic consumption were collected. For those who received radiotherapy, follow-up was conducted through telephone interviews at week 1, 2, 4, 8, and 12 post-treatment using the same modified ESAS and analgesic diary. One hundred ninety patients received radiotherapy to 256 sites from January to August 1999. Seventy-eight patients (41%) died during the 12-week follow-up period. The percentage of surviving patients responding to the telephone interview ranged from 63% to 68% during the 12-week study. Telephone follow-up is a feasible tool for the prospective outcome assessment of symptom palliation in this population. It compares well to clinic visits or mailed questionnaires. However, to improve the follow-up rates, other modalities may also need to be implemented.

A Psychosocial Analysis of Risk of Psychological Impairment Following Bereavement

A multiple regression analysis was used to investigate the explanatory potential of a multidimensional approach to risk of psychological impairment. Information from a study of bereavement in Canadian women included meaning of the event to the individual, personality attributes, social supports available following bereavement and sociodemographic data. Risk of psychological impairment was estimated by score on the General Health Questionnaire (GHQ). Sixty-four per cent of the variance in GHQ scores at one month postbereavement was accounted for. The authors hypothesize that the addition of a measure of coping styles and more comprehensive measures of the other dimensions studied would increase the power of the technique. It seems critical to take into account the possible large effects of sociodemographic factors.

The Use of Group Meetings with Cancer Patients and Their Families

A diagnosis of cancer confronts the patient and his family with a major life crisis. With few exceptions, an extended period of uncertainty follows the initial treatment while all await the eventual outcome of the disease. Some authors have documented this period of uncertainty (1–3) but only a few attempts have been made to intervene in a systematic manner with groups of patients and family members to provide support and improve coping techniques during this period (4–7) Still less systematic research has been attempted with patients and family members who are living with the knowledge that the cancer is disseminated and therefore control of the disease is the best that can be hoped for. (8)

Reflections on Compassion, Suffering and Occupational Stress

In dealing with people with life threatening illness, whether in the context of early diagnosis, palliative or end of life care, professional caregivers are witness to considerable suffering. Such suffering can lead to distress in caregivers, which may be manifest in burnout, compassion fatigue, moral distress or vicarious traumatization. It is proposed that through understanding the concepts of suffering and compassion and practicing self-awareness, self-care, mindfulness and other reflective practices, self-compassion, exquisite empathy, and a sense of meaning and connectedness, caregivers may be better able to care both for patients and themselves.