Impact of structured debriefing sessions on residents rotating on inpatient oncology.

Abstract

11018 Background: Participating in end-of-life (EOL) care may lead to physician distress and burnout. Residents rotating on inpatient oncology services often care for patients and families nearing the EOL. There is no standardized resident training for EOL care nor are there standardized methods to assist with resultant emotional distress. Studies have demonstrated that residents on hematology/oncology rotations experience acute empathy decline, which can lead to cynicism and depersonalization, contributing to burnout (McFarland, 2016). Our objective was to prospectively evaluate the impact of a structured debriefing session during a 4-week inpatient oncology rotation on residents' concerns about death and rotation satisfaction. Methods: During week 1, residents completed a 10-item Concerns about Dying (CAD) instrument (Mozer, 2004). During week 3, residents participated in a structured 60-minute debriefing session with a clinical psychologist or licensed social worker specializing in hematology-oncology. During week 4, residents completed the CAD and an end-of-rotation self-assessment. Results: 58 individual residents rotated through inpatient oncology at Loyola University Medical Center from 7/2020 – 1/2022. 15 residents were excluded as they did not complete both the pre and post surveys. Trainees had a lower CAD score at the end of their oncology rotation, indicating a more positive attitude towards death and dying. PGY1s had the greatest decrease in CAD score over 4 weeks. Anxiety (70%), relief (70%), satisfaction/pride (63%) and sadness (58%) were the most common emotions residents felt while providing EOL care. 42/43 (98%) residents were comfortable discussing EOL topics with a licensed counselor and 40/43 (93%) felt the debriefing had a positive impact on their rotation. 38/43 residents (88%) believed the debriefing reduced sentiments of cynicism and dissatisfaction caused by emotional distress related to EOL care. Conclusions: Resident concerns about death decreased during a 4-week inpatient oncology rotation in which a structured debriefing program occurred during week 3. Although the study protocol does not provide causation, it suggests the debriefing allowed residents to reflect on EOL care and enhance their ability to cope with distress. The favorable feedback from this pilot led to a permanent curricular change for the inpatient oncology rotation. Strategies to assess and manage emotional strain among residents providing EOL care remain limited and warrant further investigation.[Table: see text]