A high level of burnout has been demonstrated in oncologists, nurses, and other health professionals. Interventions developed in response demonstrate mixed results. Wellspring, a community cancer support organization, has developed a 1-day session called Care for the Professional Caregiver Program (CPCP) and has delivered it to over 700 healthcare workers. The present study assessed the effects of the CPCP on three groups of oncology nurses (pediatric, surgical, and general oncology staff) and one group of nurse managers. Subjects completed the Maslach burnout inventory (MBI), the General health questionnaire (GHQ) and the short form of the Marlowe-Crowne social desirability scale (M-C) prior to receiving the intervention. They then completed the MBI and GHQ at 1-month and 7-month follow-ups. Six months after the original session, a small subset of subjects was randomly selected to participate in a 1-day CPCP booster session. At baseline, one third of the nurses showed high burnout on the MBI. The nurses demonstrated a significant decrease in emotional exhaustion and an improvement on the GHQ, at the 1-month follow-up testing (p = 0.003 and 0.001, respectively) and 7-month follow-up testing (p = 0.002 and 0.001). The booster session proved difficult to deliver because of institutional scheduling problems due to nurse shortages, so only a small percentage (22%) of the sample participated; however, it was well received. Thus, the CPCP is effective in ameliorating emotional exhaustion, an intrinsic aspect of burnout.
Background
Continuity of care is important to patients and is a key factor in providing good end of life care. Relational continuity describes the continuity of care provided by seeing the same doctor. This can facilitate difficult conversations regarding preferences for future care. A previous study of palliative care patients examined the number of doctors encountered. Since then there have been changes to medical training, limits on working hours and increased flexible working. This presents new challenges to continuity of care.
Aims
To study relational continuity for patients who received end of life care in the hospice setting. To assess the number of doctors encountered in the last 6 months of life.
Methods
A retrospective case note review was carried out for consecutive patients who died in a hospice over a 4 month period. A standardised data collection sheet was used and the number of doctors encountered noted. Encounters were identified by review of the hospital notes and documentation of a doctor's signature or an entry confirming which doctors the patient saw.
Results
Sixty-five patients were identified and of these 41 case notes were available. In the last 6 months of life, the minimum number of doctors met was 2 and the maximum 57, mean 19.Of the total number of encounters one third were with a doctor they had not met before. Patients saw more foundation doctors and consultants than speciality trainees.
Discussion
These results are highly likely to underestimate the actual number of doctors patients saw. It does not include encounters in primary care or the continuity provided by other health professionals. Some patients encounter a large number of doctors in the months preceding death. With reduced working hours for doctors, attention has focused on handover for informational continuity and patient safety; less attention may have been given to relational continuity.
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