Strategies for Promoting High-Quality Care and Personal Resilience in Palliative Care

Abstract

Palliative care (PC) clinicians are faced with ever-expanding pressures, which can make it difficult to fulfill their duties to self and others and lead to moral distress. Understanding the pressures that PC clinicians face and the resources that could be employed to ease their moral distress is crucial to maintaining a healthy PC workforce and to providing necessary PC services to patients. In this paper, we discuss recommendations related to two promising pathways for supporting PC clinicians in providing high-quality PC: (1) improving systemic PC delivery and (2) strategies to promote ethical practice environments and individual resilience. Enacting these recommendations holds promise for sustaining higher-quality and accessible PC and a more engaged PC workforce. IntroductionPalliative care (PC) clinicians are faced with ever-expanding pressures, which can make it difficult to fulfill their duties to self and others. In 2008, more than 90 million Americans were living with serious illness, and this number was projected to double in 25 years [1]. PC clinicians are tasked with reducing the suffering of these patients and face daily challenges, such as treating patients with intractable pain, facilitating end-of-life (EOL) decision making, and collaborating with other health care specialists to ensure that PC is sufficiently integrated [2]. A recent survey found that PC physicians who were planning to leave the profession commonly cited burnout or dissatisfaction with their organization or practice as the reason [3], and another study found that high moral distress is linked to clinicians' intentions to leave their current position [4].

Systematic scoping review on moral distress among physicians

“…MD often manifests as anger, frustration, sadness, depression or guilt 1 89 90 94 97 104–107 113 115 119 120 122 123 136 137 143 151 154 157 160 164 168 173 188. A sense of powerlessness and the erosion of individual values and moral integrity may culminate in the intention or act of leaving one’s job,1 94 107 113 121 129 141 143 154 164 168 189 medical errors,1 2 88 89 96 98 99 101 107 108 112 113 115–117 119–126 136 148 151 155 159 161 164 167 168 170 176 190 191 a compromise in patient care1 34 90 111 112 116 119 120 122 124 144 151 159 160 165 169 192 or the transfer of the physician’s emotions onto patients 1 85 97 102 112 119 122 129 137 141 147 149 161 164 168. Multiple unresolved episodes of MD may lead to more severe consequences 85 86…”

“…Organisational interventions include team-based discussions,2 88 95 97 100 104 105 119 120 124 127 129 132 135 139 144 creating a conducive environment,158 196 increasing education and counselling,4 88–90 104 105 151 175 191 and providing an MD consultation service have been suggested 105 150…”

Lots of little ones: Analysis of charitable donations to a hospice and palliative care unit in Taiwan

“…Meanwhile, we have also launched various educational programs to increase HPC knowledge across the health care workforce, which can improve communication between clinicians and patients, boost the number of patients who receive the appropriate range of HPC services, and decrease both misconceptions about HPC and the moral distress associated with terminal care. 21 A proportion of the donations was applied to disadvantaged patients for indigent care. One of the core values of HPC is caring for dying patients with a financial barrier to health care services.…”