34 The education and practice of self-care in palliative medicine trainees, a qualitative study

Abstract

Context The emotional burden of regularly confronting suffering when caring for dying patients can affect the well-being of palliative care clinicians. Experienced clinicians recommend self-care strategies as a way of sustaining this work. There is increasing evidence for the effective use of self-care strategies in other caring professions who face similar challenges. Little is known about how doctors-in-training learn such skills. The aim of this study was to explore how trainees in palliative medicine learn and practice self-care strategies. Methods Eight palliative trainees in one region in England participated in a qualitative study using semi-structured interviews. An inductive thematic approach was used to analyse the data. Results Five closely linked themes are described detailing the perspectives of the trainees. Self-care was recognised as being integral to their identity as a palliative medicine clinician, even though it was not openly discussed. Trainees were keen for self-care to be recognised as an accepted part of providing holistic patient care in a sustainable manner. Strategies needed to be integrated into the working day to be most useful and were mostly learnt through personal experience. Explicit training or guidance from seniors on self-care strategies was rare but non-hierarchical relationships with peers enabled and motivated shared learning. Training in communication skills and Psychosocial care were also identified as important in improving their sense of work-related competency and hence well-being. Conclusions Denying the deeply emotional nature of this work does not equip trainees with the skills they need to thrive in this field. Supporting and guiding trainees in developing their self-care skills is an occupational responsibility and will benefit patient care in many ways. Collaborative peer learning shows promise for developing self-care strategies.