Reflection & Resilience’: A Structured Team-Based Intervention to Address Compassion Fatigue and Burnout

Key Message: Palliative care teams nationwide are experiencing growing demands, contributing to diminished compassion satisfaction and increased burnout. There is an unprecedented need to develop team practices to support resilience. One strategy is developing structured processing of deaths and difficult encounters within the interdisciplinary team.

Abstract:

Background/Purpose:
Due to frequent exposure to patient and family distress, pediatric palliative care (PPC) clinicians have a unique risk for compassion fatigue and burnout (1), negatively impacting wellbeing and professional performance (2). A reflective ritual is a strategy to mitigate this and foster compassion satisfaction and resilience (3). We describe the development, implementation and effectiveness of an interdisciplinary structured intervention for our PPC team to process deaths and difficult encounters.

Approach:
We developed and implemented Reflection & Resilience (R & R); a structured processing intervention guided by our interdisciplinary team. R&R was facilitated weekly by the different members of our interdisciplinary team using a structured template. We designed a 5-question survey to evaluate workplace satisfaction and burnout and we aimed to improve our PPC team’s compassion satisfaction scores, by 10% in three months. Team members assisted in face validation of the survey prior to use. Surveys were completed prior to the initiation of R&R to collect baseline data and at 3 months and 6 months after implementation to assess the perceived impact. Iterative modifications to R&R were guided by Plan-Do-Study-Act cycles.

Implications/Lessons learned:
Over a 6-month period (phase 1), survey responses at 3 time periods demonstrated significant improvement in emotion and team-based domains. Participants reported greater connection to the multidisciplinary team (+33%), enhanced workplace resilience (+35%), and improved capacity to process difficult encounters (+56%). Notably, self-reported symptoms of burnout decreased by 13%. Data collection is ongoing for a second 6-month period (phase 2).

This low cost, adaptable intervention, now a routine part of team culture, enhanced emotional resilience and team connection through a structured processing ritual. This model offers a reproducible framework for PC teams seeking to improve workplace sustainability in an emotionally demanding specialty.

References: (1) Kase SM, Waldman ED, Weintraub AS. A cross-sectional pilot study of compassion fatigue, burnout, and compassion satisfaction in pediatric palliative care providers in the United States. Palliat Support Care. 2019 Jun;17(3):269-275. doi: 10.1017/S1478951517001237. Epub 2018 Feb 5. PMID: 29397055.

(2) Koh MYH, Gallardo MD, Khoo HS, Hum A. Burnout in Palliative Care - Difficult Cases: Qualitative Study. BMJ Support Palliat Care. 2024 Jan 8;13(e3):e1383-e1389. doi: 10.1136/bmjspcare-2021-003347. PMID: 35332027.

(3) Montross-Thomas LP, Scheiber C, Meier EA, Irwin SA. Personally Meaningful Rituals: A Way to Increase Compassion and Decrease Burnout among Hospice Staff and Volunteers. J Palliat Med. 2016 Oct;19(10):1043-1050. doi: 10.1089/jpm.2015.0294. Epub 2016 Jun 23. PMID: 27337055; PMCID: PMC6453491.