Abstract

Protecting the mental health of healthcare workers is an urgent global public health priority. Healthcare workers, especially those immersed in palliative care, are prone to burnout due to the intense emotions associated with end-of-life caregiving. This study examines the efficacy of a novel, multimodal, and group-based Mindful-Compassion Art-based Therapy (MCAT) that integrates reflective self-awareness with creative emotional expression for protecting healthcare workers’ mental health. A dual-arm open-label waitlist randomized controlled trial was conducted. A total of 56 healthcare workers were recruited from the largest homecare hospice in Singapore and randomized to the immediate-treatment condition of a standardized 6-week, 18-hours MCAT intervention (n=29), or the waitlist-control condition (n=27). Self-administered outcome measures on burnout, resilience, emotional regulation, self-compassion, death attitudes, and quality of life were collected at baseline, post-intervention/second-baseline at 6weeks, and follow-up/post-intervention at 12weeks. Results from mixed model ANOVAs reveal that treatment group participants experienced significant reduction in mental exhaustion, as well as significant improvements in overall emotional regulation, nonreactivity to intrusive thoughts, approach acceptance of death, and afterlife belief as compared to waitlist-control immediately after MCAT completion. Effect sizes of these impacts ranged from medium to large (η2=0.65 to 0.170). Results from one-way ANOVAs further reveal that the treatment gains of reduced mental exhaustion and increased emotional regulation were maintained among treatment group participants at 12-weeks follow-up compared to baseline, with new benefits identified. These include increased ability to observe and describe one’s experiences, elevated overall self-compassion, greater mindful awareness, enhanced common humanity, and better quality of life. Effect sizes of these impacts were large (η2=0.128 to 0.298). These findings reflect the robust effectiveness and positive residual effects of MCAT for reducing burnout, building resilience, nurturing compassion, fostering collegial support, and promoting mental wellness among healthcare workers. The clinical model and applicability of MCAT in larger and more diverse caregiving contexts, such as family dementia care, are discussed.Clinical Trial Registration: ClinicalTrials.gov # NCT03440606, #NCT04548089.

Highlights

  • Healthcare workers, especially those immersed in palliative care, engage with life and death situations and dilemmas on a day-to-day basis and are exposed to the immense stress of end-of-life caregiving

  • Mindful-Compassion Art-based Therapy (MCAT) aims to mitigate the detrimental effects of burnout and to foster psychological resilience among the healthcare workers immersed in the field of palliative end-of-life care

  • Utilizing a robust waitlist RCT design, the overall quantitative findings revealed that MCAT was effective in reducing mental exhaustion, enhancing emotional regulation and nonreactivity to intrusive thoughts, and fostering positive death attitudes among immediate-treatment group participants when compared to waitlist control across time

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Summary

Introduction

Healthcare workers, especially those immersed in palliative care, engage with life and death situations and dilemmas on a day-to-day basis and are exposed to the immense stress of end-of-life caregiving. Amidst these challenges, they are expected to provide unwavering compassionate care to dying patients and their families with immediate responsiveness (Vachon, 1995). They are expected to provide unwavering compassionate care to dying patients and their families with immediate responsiveness (Vachon, 1995) They receive minimal support for the mental, emotional, and spiritual strains that result from the intense nature of their work, as they often suffer in silence from the vicarious trauma of witnessing the sufferings and deaths of their patients. There is clearly an urgent need to develop an effective mental health self-care program for professional careers, as protecting their mental health is an urgent global public health priority (World Health Organization, 2016)

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