76 million Baby Boomers are aging and most will need palliative, end-of-life (EOL) or hospice care in the next few decades. Demand for palliative and EOL is exploding. A new Institute of Medicine report on “Dying in America” finds that wider access to palliative and EOL care could improve patient outcomes and could also lower healthcare spending in the US. But for palliative and EOL caregivers, stress, secondary trauma and burnout are constant occupational hazards, causing attrition rates of up to 50% and affecting patient care.
There’s a debate underway over how our healthcare system handles the end of life. Until 1950, almost all Americans who weren’t indigent died at home. Today almost all Americans die in a clinical setting. Demand for palliative and EOL care is exploding, and is increasingly covered by Medicare and private insurance. Studies show palliative and EOL care can improve quality of life, understanding, communication, and symptom burden, and may also lower healthcare spending in the US.
But for palliative and EOL caregivers, stress, secondary trauma and burnout are constant occupational hazards, and can affect patient care. Caregivers need intimate contact with patients on the threshold of the end of life. Being the bridge to what’s next demands unflinching presence in the face of death. It requires bearing witness without being able to fix the problem, bringing one’s whole self to the clinical encounter and maintaining authentic connection and communication despite caring for many dying patients. Such skills are rarely taught in medical or nursing schools, and working without them can be frustrating and draining for the clinician as well as the patient. Attrition rates for EOL and palliative clinicians (nurses and physicians) are surprisingly high — 30 – 50%.
Neuroscience research has demonstrated the effectiveness of contemplative approaches like meditation and mindfulness in patient healing and caregiver self-care, and many institutions are starting to integrate them into their standards of practice. The emerging field of “contemplative care” uses contemplative-based approaches to support doctors, nurses, social workers, family members and others involved in palliative or EOL care.
Palliative and end-of-life care are rapidly expanding fields, and contemplative care is an emerging field, but there is already a body of evidence pointing to their importance and efficacy. Here’s a brief sampling:
- Palliative and EOL Care Could Improve Patient Outcomes and Lower Healthcare Costs — According to a new consensus report from the Institute of Medicine entitled “Dying in America,” “Palliative care is associated with a higher quality of life, including better understanding and communication, access to home care, emotional and spiritual support, well-being and dignity, care at the time of death, and lighter symptom burden… Improving the quality and availability of medical and social services for patients and their families…may also contribute to a more sustainable care system.” Other studies show EOL and palliative care can improve outcomes including for patients and their families – for example metastatic lung cancer patients who received early palliative care had a better quality of life and even longer median survival. Communicating fully about what matters most to patients can also improve their sense of dignity, meaning and purpose, ameliorate suffering and depression and enhance their will to live (Chochinov et al, 2005).
- Stress and Burnout Rates Are High — The stresses of palliative and EOL care takes a toll on caregivers. Absenteeism and effectiveness of interpersonal communication and patient-centered care can decline along with clinicians’ sense of well-being, leading to compassion fatigue and burnout (Kearney et al, 2009). Attrition rates for EOL and palliative clinicians are 30% for nurses, 30 – 50% overall for physicians, including 50% for oncologists.
- Contemplative-Based Techniques Can Help — Programs designed to help clinicians be more present to themselves and to patients on the job are rare, but contemplative-based interventions have been formulated to maximize wellness for clinicians in EOL settings, ranging from empathy and self-awareness (Kearney et al, 2009), to compassionate silence (Back et al, 2009). A study of one such program for primary care physicians demonstrated improvements in mindfulness; burnout (sense of emotional exhaustion, depersonalization and personal accomplishment); empathy, conscientiousness and emotional stability (Krasner et al, 2010).
To further share the research a symposium, entitled “Communication and the Interpersonal Relationship Within Palliative and End-of-Life Care” will explore these issues and evidence that contemplative-based techniques can help physicians, nurses, social workers, patients and families. It features pioneers and leading practitioners of palliative and EOL care.