ABSTRACT
Introduction Burnout is a psychological syndrome affecting over 50% of the clinician workforce, leading to job dissatisfaction, workplace turnover, and increased clinician error. Strategies to prevent burnout are critical among palliative care providers. Methods Canadian national postgraduate burnout/wellness core competencies were used to revamp a year-long Palliative Care postgraduate wellness curriculum at the University of Toronto during COVID-19. Learners were introduced to theory as well as practical tools to implement in their daily practice. The course included a virtual trip to the Art Gallery of Ontario to enhance observation, reflection and communication skills. Results 23 learners have completed the course to date;14 have completed anonymous surveys (5 males and 9 females). All reported greater comfort recognizing signs of burnout following course completion, and would recommend it to future learners. A majority (93%) agreed that the course provided them with enhanced skills to manage burnout, and skills to assist with managing pandemic-related stressors at work and at home. The open and protected learning environment, situated outside of clinical work, and the opportunity to link with a formal 'buddy' for additional support, were valued. Conclusions Relentless clinical and pandemic-related demands highlight an urgent need to equip palliative care providers with skills to prevent burnout. Novel longitudinal curricula appear to be beneficial and can likely also be adapted to promote faculty wellness.
ABSTRACT
Background: Little is known on what palliative care (PC) has been provided to patients with COVID-19. Aims: To understand what PC was provided nationwide to patients with COVID-19 and strategies implemented to overcome barriers during the pandemic. Methods: Semi-structured interviews were conducted with physicians across Canada about their experiences providing PC to patients with COVID-19. Thematic analysis was used to describe and interpret overarching themes. Results: Twelve specialized PC (SPC) and 11 primary PC (PPC) were interviewed. Interim analysis of 16 coded interviews demonstrated SPC and PPC physicians used traditional strategies (such as opioids, oxygen and serious illness conversations) to manage symptoms, support end of life, and engage patients and families in goals of care conversations (GOC). Neither SPC nor PPC indicated strong adoption of GOC and symptom management tools circulated early in the pandemic. Both SPC and PPC indicated a shift to virtual communication due to restrictive visitor policies, highlighting the need for distanced support and planned communication. Care coordination for PC patients was challenged by a lack of community resources, family infected with COVID-19, prolonged hospital stays, and increased number of PC patients discharged to rehabilitation services. New PC structures included;GOC teams that functioned in the emergency department and medicine floors, integrated clinical rounding by non-PC clinicians with PC teams, and hospital-based PC outreach to long term care. Strategies to improve PC implementation included: virtual technologies, team collaboration, patient and family engagement tools, and symptom management and GOC conversations tools. Conclusions: While PC management approaches to support patients with COVID-19 were mostly unchanged, new structures and strategies were developed to ensure patients and their families were provided with support.