Oral Papers: Palliative Care & Oncology II
Oral Paper
Nithya Ravindran, DO
Chief Resident
Tulane Department of Psychiatry
New Orleans, LA
Rachel Hammer, MD
Chief Resident Physician
Tulane Psychiatry and Medicine
New Orleans, Louisiana
Background/Significance: Death Cafés are non-profit social franchises that arise in communities to serve as informal forums on death. Spreading in a volunteer-based, grassroots fashion, there are thousands of Death Cafes taking place (www.deathcafe.com) in over 65 countries internationally. A great need exists within the medical community for the kind of conversations that Death Cafés foster: open, unstructured, spontaneous, and interdisciplinary dialogue on death and dying. Burnout is a prevalent global crisis in healthcare, due, in part, to the vicarious trauma from our work with the dying. While open-forum community-based Death Cafes exist widely, we found no evidence in the literature to suggest that healthcare settings have adapted this model for fostering debriefings among hospital employees. This work could be one future domain of the C-L subspecialty.
Methods: In an effort to study healthcare worker burnout, we piloted a hospital-exclusive Death Café, sponsored by a hospital wellness committee in a large, public, urban, Level I Trauma center. Quarterly, we offered voluntary sessions in a private space to hospital employees. We advertised by internal email. The sessions were facilitated by psychiatrists who have two years of experience hosting community-based Death Cafés and also work in C-L psychiatry. Participants completed surveys after each session to examine anxiety, moral distress, avoidance, fear, intrusive thoughts and dysphoria as related to death. Qualitative attitudes and feedback was also collected.
Results/Discussion: In our presentation, we will introduce the concept and practice of hospital-based Death Cafes. We can share complete survey results aggregated over one year. Our interim results show 60% of our attendees self-report burnout symptoms. Our sample (n= 35) includes physicians (intensive care, internists, palliative specialists, specialty and trauma surgeons, residents, trauma psychologists, social workers, hospital technicians (autopsy and phlebotomy), nurses (outpatient, ICU and med-surg), and students of medicine, psychology and nursing. Other interim results demonstrate 62% of participants reporting moral distress related to patient care within the last month. 94% of our attendees believe that regular attendance of Death Cafés can positively affect burnout and depersonalization.
Conclusions/Implication: From our experience, hospital-based Death Cafes are a feasible and effective tool to address burnout. Perhaps these safe spaces can be fostered as a natural extension of the inherent role of the C-L psychiatrist within hospitals—to be a liaison, a facilitator of tough conversations. Should the phenomenon of Death Cafés take off in hospitals as it has in communities internationally, we propose that this intervention be studied for its effect on healthcare worker burnout.
References:
Death Café. “What is Death Cafe?” Accessed March 26, 2019. https://deathcafe.com/what/.
Shanafelt, Tait. “Enhancing meaning in work: a prescription for preventing physician burnout and promoting patient-centered care.” JAMA, 302, no 12 (2009): 1338–1340.