Patient-Clinician Boundaries in Palliative Care Training: Identifying and Managing Boundary Crossings (517)

Abstract

1.Discuss the concept of boundaries, boundary crossings, and boundary violations within the patient-clinician relationship in palliative care.2.Discuss the importance of identifying boundary crossings and how they can be helpful or harmful to the patient-clinician relationship.3.Develop a framework for recognizing, interpreting, and managing boundary crossings and violations when they occur. The subject of patient-clinician boundaries has been most extensively explored in the psychiatric literature, but the recognition of boundary issues may be particularly relevant to the practice of palliative care. The relationship between a palliative care clinician and a patient at the end of life, can reach a level of intensity and intimacy that is commonly found in psychotherapy. Palliative care clinicians are trained to address various types of suffering— including physical, spiritual, and psychological distress. In facing suffering and death, patients often express their emotions more easily and authentically than is typical for the usual patient-clinician interactions. In the presence of such emotionality and intimacy, palliative care clinicians may experience a particular sense of closeness to their patients, which can increase the chances that boundary crossings may occur. Palliative care clinicians, especially those early in training or lacking specific psychological education, may be particularly susceptible to boundary crossings and violations. Utilizing both psychiatric and palliative care perspectives, this session will address the concept of patient-clinician boundaries. Clinicians will have the opportunity to reflect on potential boundary issues in clinical practice in general and palliative care specifically. We will explore the nature of the patient-clinician relationship within the context of the sociological model of role theory. Using the psychological concept of dual relationships, we will distinguish between neutral or therapeutic boundary crossings and harmful boundary violations. We will discuss why some palliative care practitioners and trainees are particularly vulnerable to boundary crossings and violations. Attendees will be provided with a framework for identifying and managing boundary crossings and violations when they occur. Structure and Processes of Care