The emotional difficulties of caring for the gravely ill were not a surprise to Tom Miller, MD, MFA, a fellow in the University of Wisconsin Hospice and Palliative Medicine (HPM) Fellowship, but that does little to lessen the burden. “Difficult cases are difficult cases.” Miller says. “Young patients or patients with young families are the toughest. How do you put that aside and go home to your own family?”

As caregivers for the sickest of the sick, palliative care providers are in a unique position to make patients’ experiences with serious illnesses more tolerable while ensuring they receive the most appropriate care given the ultimate prognosis.

However, this work comes at a price for the providers: according to a 2015 survey, 62 percent of palliative care providers reported burnout, placing it among the top of all subspecialties for burnout.

Aware of the unique mental and emotional burden palliative care providers face, Sara Johnson, MD, assistant professor (CHS), Hematology, Oncology and Palliative Care, and director of the HPM Fellowship, set out to incorporate activities throughout the formal fellowship curriculum that helps trainees navigate that balance of patient and self-care while maintaining identity and perspective.

Processing emotions through shared experiences

Each week, inpatient palliative care teams gather to acknowledge any deaths and process the loss. The program also makes therapists or mental health providers available for fellows throughout their time in the program.

The monthly Reflection Conference connects fellows with a wide range of people involved in the end-of-life care process. Connecting with physicians, chaplains, and social workers, for example, allows shared experiences to build bridges and a sense of community while offering different perspectives and ways of processing emotion.

Writing exercises have long been a processing tool for health care providers, and this has been formalized into the HPM Fellowship’s monthly Writing Workshop. Toby Campbell, MD, MS, associate professor (CHS), Chief of Palliative Medicine, Hematology, Medical Oncology and Palliative Care, created the narrative medicine component of the workshop, one of the first in the nation to use the tool focusing on caregivers’ perspective.

Narrative medicine draws on the study of art and literature to enhance students’ listening and observation skills, and promotes humanistic characteristics that expand their view of patients to encompass more than just medical histories. By flipping the script, these exercises allow practitioners to process the wide-ranging and often highly emotional events that fill their days, both the challenging moments and the joys.

Although participants share their writing and hold an end-of-year reading, Liana Eskola, DO, clinical assistant professor, Hematology, Medical Oncology and Palliative Care, and the current Writing Workshop Coordinator, explains, “The writing is not the point; it’s about helping our providers survive and thrive.”

Miller concurs, adding that writing adjusts the way he sees details when interacting with patients and their families, gathering stories and information about when the patient was well. “It’s a point of connection that makes it all possible.”

Resources:

• Kamal AH, Bull JH, Wolf SP. Prevalence and predictors of burnout among hospice and palliative care clinicians in the US. J Pain Symptom Manage. 2016; 51: 690–696.
• "Narrative Medicine for Doctors." Poets & Writers, November/December 2019. Accessed February 18, 2020.

Banner photo: Dr. Tom Miller participates in the Hospice and Palliative Care Medicine Fellowship Program’s Writing Workshop. Photo credit: Clint Thayer/Department of Medicine.