compassion fatigue in physicians compassion fatigue in physicians: predictive and preventative...

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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


“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)


“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)


A search for the 3 P’s of compassion fatigue

Prevalence

Predictive factors

Preventative factors


. . . the natural consequent behaviours

and emotions resulting from knowing

about a traumatizing event experienced

by a significant other .

Charles Figley (1995)


You can’t wipe the tears from

someone’s face without

getting your hands wet


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


“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 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 Satisfaction

Beth Stamm

Idaho State University

an expression of the positive aspects of

care-giving


ProQOL (Professional Quality of Life)

Instrument

• 30 items

• 10 each for CF, BO, and CS


Managing Compassion Fatigue:

implications for medical education


Resiliency•Social support•Locus of control•Personality traits•Emotional regulation and copingBurnout

COMPASSIONFATIGUEEmpathy

Compassion satisfaction


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)


Research Methods

Quantitative:• Anonymous questionnaire distributed to RMOs

in four District Health Boards

Qualitative:• Opportunity on the questionnaire to write comments• Focus groups


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 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


CompassionFatigue(STS)

CompassionSatisfaction

Burnout

ProQOL

Empathy

Spirituality

Emotional Regulation

Resilience




Burnout

ProQOL

Empathy

Spirituality


Resilience

+ sig.

+ sig.

+ sig.

+ si

g.




Burnout

ProQOL

Empathy

Spirituality


Resilience+ sig.

- sig.

- sig.

- sig.

- sig.


CompassionFatigue


Burnout

ProQOL

Empathy

Spirituality


Resilience+ sig.

- sig.

- sig.

- sig.

Spiritual Beliefs

Relationship witha Higher Power

+ sig.

+ sig.


32%


88%


79%


70%


20%


Prediction of compassion fatigue

Personal Strengths and Resilience

Emotional Competence and Confidence

These two subscaleswere the most strongly,

and negatively,associated with CF



• 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



• 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


Contribution of this information to training

and support interventions




Thank you for your attention

compassion fatigue in physicians compassion fatigue in physicians: predictive and preventative...

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