title: Promoting resiliency among palliative care clinicians: stressors, coping strategies, and training needs.
abstract: BACKGROUND
  Palliative care clinicians (PCCs) are susceptible to burnout, as they regularly witness immense patient and family suffering; however, little is known about their specific challenges and training needs to enhance their long-term sustainability.
  
  
  OBJECTIVE
  The purpose of this qualitative study was to explore common stressors, coping strategies, and training needs among PCCs in efforts to inform the development of a targeted Resiliency Program.
  
  
  METHODS
  Utilizing a semistructured interview guide, we conducted a series of in-depth interviews with 15 PCCs at the Massachusetts General Hospital.
  
  
  RESULTS
  Content analysis highlighted three main areas of stressors: (1) systematic challenges related to managing large, emotionally demanding caseloads within time constraints; (2) patient factors, such as addressing patients' mutable needs, managing family dynamics, and meeting patient and family demands and expectations; and (3) personal challenges of delineating emotional and professional boundaries. Engaging in healthy behaviors and hobbies and seeking emotional support from colleagues and friends were among the most common methods of coping with stressors. In terms of programmatic topics, PCCs desired training in mind-body skills (e.g., breathing, yoga, meditation), health education about the effects of stress, and cognitive strategies to help reduce ruminative thoughts and negative self-talk. A majority of clinicians stressed the need for brief strategies that could be readily integrated in the workplace.
  
  
  CONCLUSIONS
  These results suggest that an intervention aimed to enhance PCC sustainability should focus on utilizing a skill-building approach to stress reduction that imparts strategies that can be readily utilized during work hours.
authors.affiliation: 1 Mongan Institute for Health Policy, Massachusetts General Hospital , Boston, Massachusetts.
authors.forename: Giselle K
authors.initials: GK
authors.lastname: Perez
authors.forename: Vivian
authors.initials: V
authors.lastname: Haime
authors.forename: Vicki
authors.initials: V
authors.lastname: Jackson
authors.forename: Eva
authors.initials: E
authors.lastname: Chittenden
authors.forename: Darshan H
authors.initials: DH
authors.lastname: Mehta
authors.forename: Elyse R
authors.initials: ER
authors.lastname: Park
mesh_terms: D000328:Adult; D002055:Burnout, Professional / Q000209:etiology / Q000517:prevention & control / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D020380:Needs Assessment; D010166:Palliative Care / Q000458:organization & administration / Q000523:psychology*; D065126:Palliative Medicine / Q000193:education* / Q000379:methods / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D010561:Personnel Staffing and Scheduling; D010865:Pilot Projects; D011368:Professional-Family Relations; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012064:Relaxation Therapy / Q000379:methods*; D055500:Resilience, Psychological; D012944:Social Support; D013997:Time Factors; D000078329:Workforce