Grief over patients, compassion fatigue, and the role of social acknowledgment among psycho-oncologists

Describing Remembrance & Renewal: A Holistic Self-Care Program

Background: Holistic care interventions include support for healthcare worker grief in a relationship-based care paradigm. Few programs support oncology healthcare worker grief and renewal prior to and during the COVID-19 pandemic. Objective: Describe "knowledge of" and "engagement with" a program about grief and resilience, Remembrance & Renewal (R&R). Method: An anonymous, electronic survey was available to healthcare workers at an academic, comprehensive cancer center. Demographic questions were analyzed against "knowledge of" and "engagement with." Results: Of 105 responding to "awareness of," 81 knew about R&R and 48 had "engaged with" the program. Statistically significant relationships between a characteristic and awareness were found for education (p  =  .03), setting (p < .01), and the frequency of learning about a death (p  =  .04). Statistically significant relationships between a characteristic and level of participation were found for profession (p  =  .02) and length of time in job (p  =  .03). Open-ended questions asked about impact of patient death (n  =  93), barriers to participation (n  =  54), and feelings after "engagement with" (n  =  45). Responses to impact, barriers, and feelings were respectively: sadness (75.3%); time (77.8%); and calm (75.6%). Conclusion: This study describes "knowledge of" and "engagement with" a holistic grief and renewal program. Further study will add to healthcare worker holistic self-care.

A Continuing Educational Program Supporting Health Professionals to Manage Grief and Loss

Health professionals working in oncology face the challenge of a stressful work environment along with impacts of providing care to those suffering from a life-threatening illness and encountering high levels of patient loss. Longitudinal exposure to loss and suffering can lead to grief, which over time can lead to the development of compassion fatigue (CF). Prevalence rates of CF are significant, yet health professionals have little knowledge on the topic. A six-week continuing education program aimed to provide information on CF and support in managing grief and loss and consisted of virtual sessions, case-based learning, and an online community of practice. Content included personal, health system, and team-related risk factors; protective variables associated with CF; grief models; and strategies to help manage grief and loss and to mitigate against CF. Participants also developed personal plans. Pre- and post-course evaluations assessed confidence, knowledge, and overall satisfaction. A total of 189 health professionals completed the program (90% nurses). Reported patient loss was high (58.8% > 10 deaths annually; 12.2% > 50). Improvements in confidence and knowledge across several domains (p < 0.05) related to managing grief and loss were observed, including use of grief assessment tools, risk factors for CF, and strategies to mitigate against CF. Satisfaction level post-program was high. An educational program aiming to improve knowledge of CF and management of grief and loss demonstrated benefit.

Grief as a mediator of the relationship between empathy and compassion fatigue

OBJECTIVE

Oncology nurses are at high risk of developing compassion fatigue (CF) because of the persistent exposure to patients' suffering and death. Empathy is a prerequisite cognitive reaction for CF. Nurses with greater empathy levels are more prone to develop an emotional connection with patients. However, it is this kind of close bonds that led nurses to experience a deep sense of grief. Cumulative grief may eventually develop into CF. This study examined the levels of grief, empathy and CF, evaluated the correlation among empathy, grief and CF, and verified the role grief as a mediator of the relationship between empathy and CF.

METHODS

Participants were 794 Chinese oncology nurses in a cross-sectional study. We measures consisted a demographic questionnaire, the Interpersonal Reactivity Index, the Texas Revised Inventory of Grief-Present, and the Professional Quality of Life Scale.

RESULTS

Oncology nurses showed moderate levels of empathy and grief, moderate to high levels of CF. Perspective taking was negatively related to grief and secondary traumatic stress (STS). Empathic concern was negatively related to burnout (BO). Personal distress was positively related to grief, STS and BO. Grief was positively related to STS and BO. Grief played a partial mediating role between empathy and STS.

CONCLUSIONS

Oncology nurses commonly experience CF. There is a need to provide interventions and effective supports for oncology nurses to improve their empathy ability, and help them cope with grief and CF.