Pereira Anne G, Linzer Mark, Berry Leonard L
Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA.
Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Palliat Med Rep. 2023 Feb 16;4(1):24-27. doi: 10.1089/pmr.2022.0062. eCollection 2023.
Palliative care clinicians (PCCs) in the United States face the combination of increasing burnout and a growing need for their services based on demographic changes and an increasing burden of serious illness. In addition to efforts to increase the number of PCCs and to train other clinicians in "primary palliative skills," we must address the burnout in the field to address the growing gap between need for this care and capacity to provide it. To address burnout in PCCs, we must develop solutions with the unique contributors to burnout in this field in mind. PCCs are particularly susceptible to moral distress and moral injury faced by all clinicians, and these states are inextricably linked to burnout. We propose three solutions to address moral distress and moral injury in PCCs to reduce burnout. These solutions are grounded in the dilemmas particular to palliative care and in best evidence: first, to create space for PCCs to confront moral challenges head-on; second, to integrate ethics consultations into care of some patients cared for by PCCs; and third, to reassess care models for PCCs. These approaches can mitigate burnout and thus address the growing gap in our ability to provide high-quality palliative care for those patients in need.
美国的姑息治疗临床医生面临着职业倦怠加剧的问题，同时，由于人口结构变化和严重疾病负担的增加，对他们服务的需求也在不断增长。除了努力增加姑息治疗临床医生的数量，并培训其他临床医生掌握“初级姑息治疗技能”外，我们还必须解决该领域的职业倦怠问题，以应对这种护理需求与提供能力之间日益扩大的差距。为了解决姑息治疗临床医生的职业倦怠问题，我们必须在制定解决方案时考虑到导致该领域职业倦怠的独特因素。姑息治疗临床医生特别容易受到所有临床医生都会面临的道德困扰和道德伤害，而这些状态与职业倦怠有着千丝万缕的联系。我们提出了三种解决方案，以解决姑息治疗临床医生的道德困扰和道德伤害问题，从而减少职业倦怠。这些解决方案基于姑息治疗特有的困境和最佳证据：第一，为姑息治疗临床医生创造直面道德挑战的空间；第二，将伦理咨询纳入部分由姑息治疗临床医生护理的患者的治疗过程中；第三，重新评估姑息治疗临床医生的护理模式。这些方法可以减轻职业倦怠，从而解决我们为有需要的患者提供高质量姑息治疗的能力方面日益扩大的差距。
