Self-care: how good are we at actually doing it?

This is likely due, in part, to managing the clinical demands of complex patients in combination with the many challenging ethical situations that can present at the end-of-life. The burden of stress can be reflected in health care providers’ physical and psychological health. It is important to realize that accompanying patients on their illness journeys may also trigger our own responses of suffering. Unfortunately, many providers, both in palliative and other areas of practice, do not recognize the signs of their own suffering and therefore do not seek the appropriate help.

Many factors contribute to the experience of caregiver fatigue and burnout. Among them may be a lack of confidence in one’s own abilities to communicate sensitive issues that must be addressed in patients approaching the end-of-life, demands on health care provider time, systematic constraints, and lack of resources to effectively deliver palliative services – especially in remote and rural areas. This can create a syndrome of exhaustion and moral distress, and lead to increased vulnerability of the provider as well as the patient.

Given the ever increasing complexity of caring for patients at the end-of-life, we must remain aware of the importance of maintaining our own well-being in order to properly care for patients dealing with life threatening illnesses. It is important to optimize the interprofessional structure of palliative care delivery, so that all providers feel valued and can contribute to the overall well-being of the patient. We must look for strategies that allow us to spend sufficient time with patients and families so that their concerns may be appropriately addressed. Those who care for patients during a life-threatening illness and at the end-of-life benefit from achieving communication competency, through a combination of continuing education and practical clinical experience of handling challenging end-of-life situations. This increases job confidence and satisfaction. Strategies of prevention that combine reflection and developing satisfactory interpersonal relationships with team members and colleagues have also been shown to be effective in preventing burnout in palliative, oncologic and other settings.

Having a good death is as important as having a happy and healthy life. Those privileged to work with patients at various stages of their illness have a responsibility to their patients to provide excellent standards of care as well as a responsibility to themselves to identify stressors and sources of strain, and take appropriate measures to counter them. These measures may then lead to a healthy processing of experiences that helps to develop resiliency in palliative care providers.