Complexity of Palliative Care Work and Supporting of PC Teams

For palliative care (PC) clinicians, the daily work alongside end-of-life patients may be particularly demanding. In addition to being confronted to the suffering of patients and their families on a daily basis, PC staff also face frequent ethical, moral and interpersonal conflicts, complexification and technologization of care as well as a constantly-escalating workload. Considering the ageing population and the increasing chronicity of life-threatening illnesses such as cancer, the workload in PC, where understaffing already constitutes an important source of stress for the medical teams, is at risk of intensification.

The heavy demands of working in PC are sources of stress on emotional, professional and organizational levels.  In fact, it is estimated that nearly 50% of PC clinicians may experience distress as a consequence of workplace adversity. These professionals are at particular risk of developing burn out, compassion fatigue and secondary traumatic stress. Moreover, recent data indicates that the burnout rates are rising in this population, affecting 62% of the members of the American Academy of Hospice and Palliative Medicine. This represents a historic high and one superior to the other medical specialties. The deleterious effects of stress on PC staff’s health and well-being are likely to negatively affect the quality of care offered by them. The high prevalence of burnout may also lead to issues in retention and absenteeism which, in turn, further pressure PC teams.

Over the past decade, initiatives promoting support of PC staff and their resilience to stress have multiplied. Resilience is most often conceptualized as the capacity to respond to stressors in a healthy way and cope effectively with adversity. It may also be defined as the capacity to return to a zone of stability in the midst of challenging circumstances. Building resilience in PC may imply both individual and organizational/systemic factors. Interventions aimed at building resilience and preventing burnout among PC clinicians are still at an early phase of development. These past few years, systematic literature reviews have been completed in the hope of determining the effectiveness of interventions aimed at promoting resilience among PC staff. These interventions may fall into five categories: support groups, stress management, education, meaning-centered interventions and mindfulness. To this day, it is impossible to determine which of the aforementioned would most efficiently prevent burnout among PC clinicians and support their resilience to stress. Most of the intervention programs include one or more of the listed strategies, but the integration of organizational and institutional components remains limited.

The most recent recommendations state that, in order to build and support PC staff’s resilience to stress, interventions should: include personal and organizational components; be developed in collaboration with teams to root the interventions in their needs; stem from strong theoretical roots; and be implement with well-designed research, following Medical Research Council (MRC) guidelines. The present study directly result from these recommendations.