Compassion Fatigue in Physicians Compassion Fatigue in Physicians: predictive and preventative...
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Transcript of Compassion Fatigue in Physicians Compassion Fatigue in Physicians: predictive and preventative...
Compassion Fatigue in Physicians
Compassion Fatigue in Physicians:predictive and preventative processes
Peter Huggard MPH MEdSenior Lecturer & Academic Advisor
Department of General Practiceand Primary Health Care
Faculty of Medical and Health SciencesUniversity of Auckland
New Zealand
Invitation toengage in the processas the discussion develops
As you do so, youmay recall some ofyour own experiencesthat have relevanceto you – think aboutwhy these memorieshave re-surfaced,and the significanceof them for you.
Later, as we discusssupport, think of yourown support systems
Compassion Fatigue in Physicians
“You had better prepare yourself for what you will hear” (Professor of Medicine)
“My God, I know exactly what you are talking about”(Senior Pediatrician)
“I’ve become increasingly concerned by the number of unhappy junior doctors in hospitals, these being the doctors I have most contact with. I believe we handle issues around stress, looking after ourselves, and issues of (our) mental health, rather poorly” (Geriatrician)
Compassion Fatigue in Physicians
“Ha! We had a group session and talked about this stuff, and decided it wouldn’t affect us” (Medical Student)
“When I finished, after doing five years of that work (pediatric oncology), it was two and a half years before I could cry in the soppy movies” (Nursing Lecturer)
“Compassion fatigue! Those ‘First-Years’ enter theHospital and by the end of the year we’ve knockedevery bit of compassion out of them” (Physician)
Compassion Fatigue in Physicians
A search for the 3 P’s of compassion fatigue
Prevalence
Predictive factors
Preventative factors
Compassion Fatigue in Physicians
. . . the natural consequent behaviours
and emotions resulting from knowing
about a traumatizing event experienced
by a significant other .
Charles Figley (1995)
Compassion Fatigue in Physicians
You can’t wipe the tears from
someone’s face without
getting your hands wet
Compassion Fatigue in Physicians
Which words to use?
Compassion fatigue is often used interchangeably with Secondary Traumatic Stress and Vicarious Traumatisation Several other terms have used:• emotional contagion• peripheral victims• secondary survivor • counter-transference• proximity stress effects
Compassion Fatigue in Physicians
“the transformation that occurs in the
inner experience of the therapist that
comes about as a result of empathic
engagement with clients trauma material”
Pearlman &Saakvitne, 1995
Compassion Fatigue in Physicians
Compassion Fatigue Self Test for Psychotherapists
• 40 item instrument
• Scales for burnout and compassion fatigue
• Asked questions about:– emotional exhaustion– sense of failure– PTSD symptoms
A.The person has been exposed to a traumatic event in which both of the following were present: (1) the person experienced,
witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a
threat to the physical integrity of self or others
(2) the person's response involved intense fear, helplessness, or horror
DSM IV-TR (2000)
PTSDintrusive thoughtsavoidancehypervigilance
Compassion Fatigue in Physicians
Compassion Satisfaction
Beth Stamm
Idaho State University
an expression of the positive aspects of
care-giving
Compassion Fatigue in Physicians
ProQOL (Professional Quality of Life)
Instrument
• 30 items
• 10 each for CF, BO, and CS
Compassion Fatigue in Physicians
Resiliency•Social support•Locus of control•Personality traits•Emotional regulation and copingBurnout
COMPASSIONFATIGUEEmpathy
Compassion satisfaction
Compassion Fatigue in Physicians
compassionfatigue
burnout compassionsatisfaction
Predictive & Preventative Factors:
Resilience:Connor-Davidson Resilience Scale(Connor & Davidson, 2003)
Empathy:Jefferson Scale of Physician Empathy(Hojat, 2001)
Spirituality:Ryff's Scales of Psychological Well-being (van Dierendonck, 2003)
Emotional Regulation & Support Seeking:(Huggard, 2003)
Prevalence:
Compassion Fatigue, Burnout &Compassion Satisfaction:Professional Quality of Life Scale(Stamm, 2002)
Compassion Fatigue in Physicians
Research Methods
Quantitative:• Anonymous questionnaire distributed to RMOs
in four District Health Boards
Qualitative:• Opportunity on the questionnaire to write comments• Focus groups
Compassion Fatigue in Physicians
Socio-demographic data
n 253
Male 40%
Female 60%
New Zealand Pakeha 53%
Mean age 31 years
Mean time since finishing medical school
6.5 years
Compassion Fatigue in Physicians
Compassion Satisfaction Burnout
CompassionFatigue
N (valid) 230 226 222
Mean 29 24 13
Range 34 38 40
Minimum value 10 3 0
Maximum value 44 41 40
Percentiles: 25 75
2534
2028
817
Referencevalues: Mean 37 23 13
Percentiles: 25 75
3142
1829
718
Compassion Fatigue in Physicians
Compassion Satisfaction Burnout
CompassionFatigue
N (valid) 230 226 222
Mean 29 24 13
Range 34 38 40
Minimum value 10 3 0
Maximum value 44 41 40
Percentiles: 25 75
2534
2028
817
Referencevalues: Mean 37 23 13
Percentiles: 25 75
3142
1829
718
Compassion Fatigue in Physicians
Compassion Satisfaction Burnout
CompassionFatigue
N (valid) 230 226 222
Mean 29 24 13
Range 34 38 40
Minimum value 10 3 0
Maximum value 44 41 40
Percentiles: 25 75
2534
2028
817
Referencevalues: Mean 37 23 13
Percentiles: 25 75
3142
1829
718
Compassion Fatigue in Physicians
Compassion Satisfaction Burnout
CompassionFatigue
N (valid) 230 226 222
Mean 29 24 13
Range 34 38 40
Minimum value 10 3 0
Maximum value 44 41 40
Percentiles: 25 75
2534
2028
817
Referencevalues: Mean 37 23 13
Percentiles: 25 75
3142
1829
718
Compassion Fatigue in Physicians
CompassionFatigue(STS)
CompassionSatisfaction
Burnout
ProQOL
Empathy
Spirituality
Emotional Regulation
Resilience
Compassion Fatigue in Physicians
CompassionFatigue(STS)
CompassionSatisfaction
Burnout
ProQOL
Empathy
Spirituality
Emotional Regulation
Resilience
+ sig.
+ sig.
+ sig.
+ si
g.
Compassion Fatigue in Physicians
CompassionFatigue(STS)
CompassionSatisfaction
Burnout
ProQOL
Empathy
Spirituality
Emotional Regulation
Resilience+ sig.
- sig.
- sig.
- sig.
- sig.
Compassion Fatigue in Physicians
CompassionFatigue
CompassionSatisfaction
Burnout
ProQOL
Empathy
Spirituality
Emotional Regulation
Resilience+ sig.
- sig.
- sig.
- sig.
Spiritual Beliefs
Relationship witha Higher Power
+ sig.
+ sig.
Compassion Fatigue in Physicians
Prediction of compassion fatigue
Personal Strengths and Resilience
Emotional Competence and Confidence
These two subscaleswere the most strongly,
and negatively,associated with CF
Compassion Fatigue in Physicians
Personal Strengths and Resilience
• I can deal with whatever comes up• I believe that past success gives confidence for new challenge• I see the humour side of things• I believe that coping with stress strengthens• I tend to bounce back after illness or hardship• I believe I give my best effort no matter what• I believe I should act on a hunch
Compassion Fatigue in Physicians
Emotional Competence and Confidence
• I feel confident in my ability to care for patients exhibiting strong emotional distress• I am aware of my emotions as I experience them• I feel confident in my ability to understand my own emotional responses to my patients’ distress• I feel competent in my ability to understand the reasons for patient’s strong emotional distress• I feel confident in my ability to care for the emotional as well as the physical needs of my patients• I feel able to initiate access to additional support, if required, to help me to understand and manage my emotions in relation to my patients
Compassion Fatigue in Physicians
Contribution of this information to training
and support interventions
Personal Strengths and Resilience
Emotional Competence and Confidence