Abstract
IntroductionEnd-of-life (EoL) care professionals are prone to burnout given the intense emotional nature of their work. Previous research supports the efficacy of art therapy in reducing work-related stress and enhancing emotional health among professional EoL caregivers. Integrating mindfulness meditation with art therapy and reflective awareness complementing emotional expression has immense potential for self-care and collegial support. Mindful-compassion art therapy (MCAT) is a novel, empirically informed, and highly structured intervention that aims to reduce work-related stress, cultivate resilience, and promote wellness. This study aims to assess the potential effectiveness of MCAT for supporting EoL care professionals in Singapore.MethodsThis is an open-label waitlist randomized controlled trial. Sixty EoL care professionals, including doctors, nurses, social workers, and personal care workers, are randomly allocated to one of two groups: (i) an intervention group that receives MCAT immediately and (ii) a waitlist-control group that receives MCAT after the intervention group completes treatment. Face-to-face self-administered outcome assessments are collected at three different time points—baseline (T1) for both groups, post-intervention (T2), and 6-week follow-up (T3) for intervention group—as well as pre-intervention (T2) and post-intervention (T3) for the waitlist-control group. The primary outcome measure is burnout, and secondary measures include emotional regulation, resilience, compassion, quality of life, and death attitudes. Between- and within-participant comparisons of outcomes are conducted, and the appropriate effect size estimates are reported. An acceptability and feasibility study is to be conducted by using a triangulation of qualitative data with framework analysis.DiscussionThe outcomes of this study will contribute to advancements in both theories and practices for supporting professional EoL caregivers around the world. It will also inform policy makers about the feasibility, acceptability, and effectiveness of delivering a multimodal psycho-socio-spiritual intervention within a community institutional setting. The study has received ethical approval from the institutional review board of Nanyang Technological University.Trial registrationClinicalTrials.gov Identifier: NCT03440606. Retrospectively registered February 21, 2018.
Highlights
End-of-life (EoL) care professionals are prone to burnout given the intense emotional nature of their work
Burnout combined with the vicarious trauma experienced by professional EoL caregivers through the deaths of their patients can further result in compassion fatigue, “an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper” [5]
A waitlist randomized control trial (RCT) is chosen on the basis of the ethical principle of justice as the research team hypothesizes and anticipates Mindful-compassion art therapy (MCAT) to be an effective intervention for reducing burnout and promoting wellness on the basis of previous research on the subject [19,20,21]
Summary
End-of-life (EoL) care professionals are prone to burnout given the intense emotional nature of their work. Previous research supports the efficacy of art therapy in reducing work-related stress and enhancing emotional health among professional EoL caregivers. Mindful-compassion art therapy (MCAT) is a novel, empirically informed, and highly structured intervention that aims to reduce work-related stress, cultivate resilience, and promote wellness. This study aims to assess the potential effectiveness of MCAT for supporting EoL care professionals in Singapore. Professional caregivers working in the fields of end-oflife (EoL), palliative, and bereavement care are regularly exposed to immense stress from intense emotional engagements with dying patients and bereaved families [1]. Burnout and compassion fatigue can be detrimental to the physical and mental health of professional EoL caregivers, and effects can trickle down to patients, colleagues, family, and friends and pose threats to quality of patient care and quality of personal life. Of particular importance is establishing a communal platform for EoL care professionals to periodically reflect on their own attitudes, feelings, and anxieties related to death and loss [10] while being able to express their thoughts to team members for building mutual respect, understanding, and communal support [11]
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