COMMENTARY

Compassion Fatigue: A Multidisciplinary Concern

Betty R. Ferrell, PhD, RN

Disclosures

December 26, 2014

Viewpoint

In the field of palliative of care, there is ever-increasing interest in the concept of compassion fatigue. Related topics include stress, burnout, self-care, and work-life balance. Little attention has been given to the core concept of compassion, however, which is fundamental in understanding the related terms. This article addresses compassion specifically as it relates to physicians, although the important conceptual work described here is relevant to other professions as well. The authors distinguish compassion from empathy in that compassion goes beyond empathy to a desire to relieve the suffering of another.

The authors provide the historical basis of the concept of compassion fatigue first used by Johnson in 1992 in observing nurses in emergency rooms who were "burned out."[1] Subsequent literature has identified many professional groups and settings where compassion fatigue is common.[2,3,4,5,6] They also report on the many consequences of compassion fatigue to the individual experiencing it as well as for their institution and for patient care.

The authors propose a Transactional Model of Physician Compassion in which physician factors overlap with patient and family factors, with a common ground of clinical factors. Various physician factors such as communication skills, life experience, age, and sensitivity to suffering will create unique responses to the patient situation. Similarly, the diversity of clinical factors, including patient personality or health behaviors, will influence the physician response. The last element, environment, is described as often impeding compassionate responses, because rushed environments, a lack of privacy, noise, and other factors that often are out of the physician's control can greatly diminish the capacity for compassion.

As the authors suggest, compassion fatigue is the endpoint. Important questions exist as to the process to that endpoint. A few models are emerging, offering examples of interventions to promote compassion, such as mindfulness, self-awareness, and communication training, as well as processes to create environments more conducive to compassionate encounters. This conceptual model and discussion can be further extended to two areas of palliative care. First, this model could be equally applied to other professionals beyond physicians. A hallmark of palliative care is its interdisciplinary nature. In addition, the need for compassion as well as the endpoint of compassion fatigue are also worthy of study in nurses, chaplains, social workers, and such unlicensed personnel as nursing assistants.. Is compassion similar across professions?

A second observation in reviewing this model is a potentially missing element of the model: the interaction between physicians and other professionals. How do the relationships and interactions between physicians and colleagues influence compassion and the endpoint of compassion fatigue? Although palliative care discussions always emphasize the necessity of compassion offered to patients, what do we know of the compassion for our colleagues? Could team interventions promote compassion? Would training to prepare teams in mindfulness or to foster compassionate responses toward each other affect the endpoint of compassion fatigue? Perhaps an additional circle should be added to the Transactional Model of Physician Compassion to note the interprofessional dimension. This would be a circle of the relationship with colleagues.

The authors have identified well the factors that involve patients, environments, and physicians. In reality, most of the factors cited—workloads, strained environments, patients, and families—will only become more strained and complex in the years ahead.

Abstract

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