Chronic exposure to distress in patients and families puts pediatric critical care physicians at risk for compassion fatigue, according to the authors of a recent study.1

“Compassion fatigue, burnout, and compassion satisfaction can have a significant impact on the personal well-being and professional performance of healthcare providers,” says Jeanie Gribben, the study’s lead author and a medical student at Icahn School of Medicine at Mount Sinai.

There has been much attention paid to burnout in physicians; in contrast, less attention has been paid to compassion fatigue and compassion satisfaction, Gribben notes. “Given their chronic exposure to patient and family distress among pediatric critical care providers, we were motivated to study this population to assess the prevalence and predictors of compassion fatigue,” says Samuel Kase, also a medical student at Mount Sinai and another of the study’s authors.

The researchers had positive professional experiences with pediatric critical care colleagues, who appeared to have high levels of job satisfaction. Thus, they were interested in assessing compassion satisfaction as well as compassion fatigue.

Of 252 pediatric critical care physicians, 21% reported severe burnout; about 90% of this group considered leaving their practice, according to the results of a recent survey.2 The prevalence of burnout in pediatric critical care providers has been reported in various studies at between 39% and 50%.3,4

“At 23.2%, the prevalence of burnout in our study population was appreciably lower,” Kase reports. The prevalence of compassion satisfaction was only 16.8%. “This is significantly lower than what was found in other pediatric subspecialists,” Kase adds.5,6

Higher compassion satisfaction scores were associated with:

  • prayer or meditation practiced as a means of self-care;
  • the presence of a chaplain when delivering bad news.

“It is not clear why the presence of a chaplain, as opposed to another supportive ancillary staff member, augments a provider’s compassion satisfaction,” says Andrea Weintraub, MD, the study’s senior author and an associate professor at the Icahn School of Medicine and neonatologist in the Mount Sinai Health System.

The researchers speculated that the chaplain may provide a unique layer of emotional and spiritual support to the pediatric critical care provider. Asking students to be present when delivering bad news also was associated with higher compassion satisfaction scores. This could be because it allows the provider to “transform difficult experiences into rewarding teaching and mentoring opportunities,” Weintraub offers.

Ethicists in the hospital setting may face a similar emotional toll as their pediatric critical care colleagues, Weintraub says. Both groups are constantly exposed to challenging clinical scenarios, moral distress, and ethical dilemmas. Weintraub suggests asking a chaplain to be readily available for debriefing and discussion.

“It may be a tangible way to promote emotional processing and protect ethicist well-being.”

REFERENCES

  1. Gribben JL, Kase SM, Waldman ED, Weintraub AS. A cross-sectional analysis of compassion fatigue, burnout, and compassion satisfaction in pediatric critical care physicians in the United States. Pediatr Crit Care Med 2019;20:213-222.
  2. Shenoi AN, Kalyanaraman M, Pillai A, et al. Burnout and psychological distress among pediatric critical care physicians in the United States. Crit Care Med 2018;46:116-122.
  3. Garcia TT, Garcia PC, Molon ME, et al. Prevalence of burnout in pediatric intensivists: An observational comparison with general pediatricians. Pediatr Crit Care Med 2014;15:e347-e353.
  4. Larson CP, Dryden-Palmer KD, Gibbons C, Parshuram CS. Moral distress in PICU and neonatal ICU practitioners: A cross-sectional evaluation. Pediatr Crit Care Med 2017;18:e318-e326.
  5. Weintraub AS, Geithner EM, Stroustrup A, Waldman ED. Compassion fatigue, burnout and compassion satisfaction in neonatologists in the US. J Perinatol 2016;36:1021-1026.
  6. Kase SM, Waldman ED, Weintraub AS. A cross-sectional pilot study of compassion fatigue, burnout, and compassion satisfaction in pediatric palliative care providers in the United States. Palliat Support Care 2018:1-7.