P-37 Death and dying: let’s talk about it. a study of improving junior doctors’ wellbeing by talking about the ‘D’ word

Abstract

<h3>Background</h3> Delivery of good palliative care is a vital skill for medical trainees. Research identifies psychological burdens associated with managing dying patients, with up to 12% of junior doctors reporting features of Post-traumatic Stress Disorder. Contributing factors include unpreparedness and insufficient support. <h3>Methods</h3> This project looks at talking about dying and how this impacts junior doctor wellbeing and palliative care delivery. Data were collected via questionnaires validated in the undergraduate population: Self Efficacy in Palliative Care Scale (SEPC) and Thanatophobia Scale. These were distributed to Core/Internal Medicine Trainees (n = 19). Phase 1 involved distribution of a book aimed at normalising dying (With the End in Mind, Kathryn Mannix); accompanied by a bookmark signposting to additional resources, including local (WMPCP) guidelines. In Phase 2, wellbeing workshops were held. Plan-Do-Study-Act cycles were implemented. A repeat questionnaire was distributed in January (n = 12) and March 2020 (n = 13). <h3>Results</h3> By March 2020, 69% (n = 9) had read the book and 85% (n = 11) were aware of WMPCP guidelines, compared to 5% (n = 1) and 47% (n = 9) at baseline. Of those that read the book, 100% of documented (n = 8) responses indicated positive/very positive impact on their practice and wellbeing in relation to managing dying patients. Across all questions in the SEPC, there was improvement in mean self-perceived management of dying patients. Across six of seven questions in the Thanatophobia Scale, there was a small reduction in mean scores (−0.28 to −0.85), a higher score indicating greater fear of managing dying. <h3>Conclusions</h3> Results suggest that narrative medicine may be an effective approach to support palliative care training in trainee doctors. More research is needed to explore this further in a larger cohort and in different staff groups. <h3>References</h3> Linane H, Connolly F, <i>et al</i>. Disturbing and distressing: a mixed methods study on the psychological impact of end of life care on junior doctors. <i>Irish Journal of Medical Science</i> 2019; 188:2, p633–639. Mason S, Ellershaw J. Assessing undergraduate palliative care education: validity and reliability of two scales examining perceived efficacy and outcome expectancies in palliative care. <i>Medical Education</i> 2004;<b>38</b>:1103–1110, Appendix 1–2. With the End in Mind: Dying, Death, and Wisdom in an Age of Denial. Kathryn Mannix, 2017. West Midlands Palliative Care Physicians Guidelines. Available from URL: https://www.westmidspallcare.co.uk/wmpcp/