Developing Cross-Cultural Empathy through Mindfulness

INTRODUCTION: The murder of George Floyd sparked international movements to address racial inequality. These movements have prompted critical conversations about medical racism, bias, and social determinants of health. These events have caused us to turn inwardly and question what we know, the limits of our understanding, and the role of medical training in developing the skills and perspectives needed to address racial inequality in health care systems. The purpose of this session is to share the design and preliminary outcomes of a curricular intervention that aims to train pediatrics residents to use mindful reflective practice to develop cross-cultural empathy and engage with anti-racist ideas. STUDY OBJECTIVE: To develop and implement a curriculum that teaches mindful reflective practice as a tool for developing cross-cultural empathy and advancing diversity, equity, inclusion, and justice in healthcare. METHODS: Pediatrics and combined medicine-pediatrics residents participated in four 90-minute small group sessions: (1) cultivating critical awareness of racism in medicine, (2) unpacking bias, microaggressions, and coded language, (3) exploring personal identity and intersectionality, and (4) committing to action and curriculum reflections/feedback. Each session was co-led by 3 facilitators (LB, JL, FW) and structured to provide opportunities for learners to engage, explore, explain, and elaborate on the content presented. Each session began with a guided mindfulness activity and concluded with individual written reflection. Participants completed the Maslach Burnout Inventory, Mindful Attention Awareness Scale, Empathy Quotient, and Stanford Professional Fulfillment assessments prior to session 1, following session 4, and 3 months after completion of the curriculum. Participants also completed the Social Justice and Empathy Assessment following session 4, and 3 months post-curriculum. Quantitative data was analyzed for pre-post changes using t-tests. Curriculum acceptability, facilitator effectiveness, and perceived benefit of each portion of session content was reviewed. Participants engaged in a brief audio-recorded focus group at the end of session 4. The transcribed focus groups and participants’ written reflections following each session were qualitatively analyzed to identify common themes. RESULTS: Preliminary results from first two cohorts (N=9) indicate that all residents found the course to be sufficiently challenging and that it helped them to pursue growth. The majority of participants expressed increased understanding of curriculum domains; mindfulness (77.8%), medical racism (88.9%), bias/coded language/microaggressions (100%), and identity/oppression/intersectionality (88.9%) and rated the overall course as excellent (88.9%). All residents endorsed agreement for facilitator’s content expertise and excellence in teaching skills. Qualitative analysis of focus groups is ongoing at this time. Preliminary review suggests that participants enjoyed the curriculum, found it to be unique in their residency experience, and desire more opportunities to discuss DEIJ issues in small groups. We expect full quantitative an qualitative analysis of all 6 cohorts in this pilot study will be completed and available for presentation at IU Education Day

Advice to clinicians on communication from adolescents and young adults with cancer and parents of children with cancer

Effective communication is integral to patient and family-centered care in pediatric and adolescent and young adult (AYA) oncology and improving healthcare delivery and outcomes. There is limited knowledge about whether AYAs and parents have similar communication preferences and needs. By eliciting and comparing communication advice from AYAs and parents, we can identify salient guidance for how clinicians can better communicate. We performed secondary analysis of semi-structured interviews from 2 qualitative communication studies. In one study, 80 parents of children with cancer during treatment, survivorship, or bereavement were interviewed. In the second study, AYAs with cancer during treatment or survivorship were interviewed. We asked AYAs and parents to provide communication advice for oncology clinicians. Using thematic analysis, we identified categories of advice related to three overarching themes: interpersonal relationships, informational preferences, and delivery of treatment, resources, and medical care. AYAs and parents provided similar advice about the need for compassion, strong connections, hopefulness, commitment, and transparent honesty However, AYAs placed additional emphasis on clinicians maintaining a calm demeanor

Developing Cross-Cultural Empathy through Mindfulness

INTRODUCTION: The murder of George Floyd sparked international movements to address racial inequality. These movements have prompted critical conversations about medical racism, bias, and social determinants of health. These events have caused us to turn inwardly and question what we know, the limits of our understanding, and the role of medical training in developing the skills and perspectives needed to address racial inequality in health care systems. The purpose of this session is to share the design and preliminary outcomes of a curricular intervention that aims to train pediatrics residents to use mindful reflective practice to develop cross-cultural empathy and engage with anti-racist ideas. STUDY OBJECTIVE: To develop and implement a curriculum that teaches mindful reflective practice as a tool for developing cross-cultural empathy and advancing diversity, equity, inclusion, and justice in healthcare. METHODS: Pediatrics and combined medicine-pediatrics residents participated in four 90-minute small group sessions: (1) cultivating critical awareness of racism in medicine, (2) unpacking bias, microaggressions, and coded language, (3) exploring personal identity and intersectionality, and (4) committing to action and curriculum reflections/feedback. Each session was co-led by 3 facilitators (LB, JL, FW) and structured to provide opportunities for learners to engage, explore, explain, and elaborate on the content presented. Each session began with a guided mindfulness activity and concluded with individual written reflection. Participants completed the Maslach Burnout Inventory, Mindful Attention Awareness Scale, Empathy Quotient, and Stanford Professional Fulfillment assessments prior to session 1, following session 4, and 3 months after completion of the curriculum. Participants also completed the Social Justice and Empathy Assessment following session 4, and 3 months post-curriculum. Quantitative data was analyzed for pre-post changes using t-tests. Curriculum acceptability, facilitator effectiveness, and perceived benefit of each portion of session content was reviewed. Participants engaged in a brief audio-recorded focus group at the end of session 4. The transcribed focus groups and participants’ written reflections following each session were qualitatively analyzed to identify common themes. RESULTS: Preliminary results from first two cohorts (N=9) indicate that all residents found the course to be sufficiently challenging and that it helped them to pursue growth. The majority of participants expressed increased understanding of curriculum domains; mindfulness (77.8%), medical racism (88.9%), bias/coded language/microaggressions (100%), and identity/oppression/intersectionality (88.9%) and rated the overall course as excellent (88.9%). All residents endorsed agreement for facilitator’s content expertise and excellence in teaching skills. Qualitative analysis of focus groups is ongoing at this time. Preliminary review suggests that participants enjoyed the curriculum, found it to be unique in their residency experience, and desire more opportunities to discuss DEIJ issues in small groups. We expect full quantitative an qualitative analysis of all 6 cohorts in this pilot study will be completed and available for presentation at IU Education Day

Approaches for Discussing Clinical Trials with Pediatric Oncology Patients and Their Families

PURPOSE OF REVIEW: This manuscript aims to describe evidence-based best practices to guide clinicians in communicating with pediatric patients and their families about clinical trial enrollment. RECENT FINDINGS: The standard paradigm for discussing clinical trial enrollment with pediatric oncology patients and their families inconsistently enables or facilitates true informed consent. Evidence exists to suggest that adopting a shared decision-making approach may improve patient and family understanding. When navigating communication about clinical trials, clinicians should integrate the following evidence-based communication approaches: (1) extend dialogue about clinical trial enrollment across multiple conversations, allowing families space and time to process information independently; (2) use core communication skills such as avoiding jargon, checking for understanding, and responding to emotion. Clinicians should consider factors at the individual, team, organizational, community, and policy levels that may impact clinical trial communication with pediatric cancer patients and their families. This article reviews learnable skills that clinicians can master to optimize communication about clinical trial enrollment with pediatric cancer patients and their families

Communicating Effectively in Pediatric Cancer Care: Translating Evidence into Practice

Effective communication is essential to the practice of pediatric oncology. Clear and empathic delivery of diagnostic and prognostic information positively impacts the ways in which patients and families cope. Honest, compassionate discussions regarding goals of care and hopes for patients approaching end of life can provide healing when other therapies have failed. Effective communication and the positive relationships it fosters also can provide comfort to families grieving the loss of a child. A robust body of evidence demonstrates the benefits of optimal communication for patients, families, and healthcare providers. This review aims to identify key communication skills that healthcare providers can employ throughout the illness journey to provide information, encourage shared decision-making, promote therapeutic alliance, and empathically address end-of-life concerns. By reviewing the relevant evidence and providing practical tips for skill development, we strive to help healthcare providers understand the value of effective communication and master these critical skills

Advice to Clinicians on Communication from Adolescents and Young Adults with Cancer and Parents of Children with Cancer

Effective communication is integral to patient and family-centered care in pediatric and adolescent and young adult (AYA) oncology and improving healthcare delivery and outcomes. There is limited knowledge about whether AYAs and parents have similar communication preferences and needs. By eliciting and comparing communication advice from AYAs and parents, we can identify salient guidance for how clinicians can better communicate. We performed secondary analysis of semi-structured interviews from 2 qualitative communication studies. In one study, 80 parents of children with cancer during treatment, survivorship, or bereavement were interviewed. In the second study, AYAs with cancer during treatment or survivorship were interviewed. We asked AYAs and parents to provide communication advice for oncology clinicians. Using thematic analysis, we identified categories of advice related to three overarching themes: interpersonal relationships, informational preferences, and delivery of treatment, resources, and medical care. AYAs and parents provided similar advice about the need for compassion, strong connections, hopefulness, commitment, and transparent honesty However, AYAs placed additional emphasis on clinicians maintaining a calm demeanor

Don\u27t be afraid to speak up : Communication advice from parents and clinicians of children with cancer

BACKGROUND: Parents and clinicians of children with cancer can provide advice to improve communication that reflects lessons learned through experience. We aimed to identify categories of communication advice offered to parents of children with cancer from clinicians and other parents. PROCEDURE: (1) Semi-structured interviews with 80 parents of children with cancer at three sites; (2) single-item, open-ended survey administered following 10 focus groups with 58 pediatric oncology clinicians at two sites. We asked participants for communication advice to parents, and analyzed responses using semantic content analysis. RESULTS: Parents provided five categories of communication advice to other parents. Advocacy involved asking questions, communicating concerns, and speaking up for the child. Support involved pursuing self-care, seeking and accepting help, and identifying supportive communities. Managing information involved taking and organizing notes, remaining open to difficult truths, and avoiding inaccurate information. Partnership involved establishing open lines of communication with clinicians, making the family\u27s values and priorities known, and trusting the clinical team. Engaging and supporting the child involved, understanding and incorporating the child\u27s preferences and values, and creating a loving environment. Clinicians\u27 advice addressed similar categories, although only one clinician described engaging and supporting the child. Furthermore, parental advice expanded beyond interactions with the clinical team, whereas clinician advice focused more on the role of clinicians. CONCLUSIONS: Parents and clinicians of children with cancer provided five categories of communication advice. With these data, clinicians, health care organizations, support groups, and patient advocates could offer experience-informed advice to parents who are seeking information and support

Associations of job demands and patient safety event involvement on burnout among a multidisciplinary group of pediatric hematology/oncology clinicians

BACKGROUND: Workplace burnout can result in negative consequences for clinicians and patients. We assessed burnout prevalence and sources among pediatric hematology/oncology inpatient nurses, ambulatory nurses, physicians (MDs), and advanced practice providers (APPs) by evaluating effects of job demands and involvement in patient safety events (PSEs). METHODS: A cross-sectional survey (Maslach Burnout Inventory) measured emotional exhaustion, depersonalization, and reduced personal accomplishment. The National Aeronautics and Space Administration Task Load Index measured mental demand, physical demand, temporal demand, effort, and frustration. Relative weights analyses estimated the unique contributions of tasks and PSEs on burnout. Post hoc analyses evaluated open-response comments for burnout factors. RESULTS: Burnout prevalence was 33%, 20%, 34%, and 33% in inpatient nurses, ambulatory nurses, and MD, and APPs, respectively (N = 481, response rate 69%). Reduced personal accomplishment was significantly higher in inpatient nurses than MDs and APPs. Job frustration was the most significant predictor of burnout across all four cohorts. Other significant predictors of burnout included temporal demand (nursing groups and MDs), effort (inpatient nurses and MDs), and PSE involvement (ambulatory nurses). Open-response comments identified time constraints, lack of administrator support, insufficient institutional support for self-care, and inadequate staffing and/or turnover as sources of frustration. CONCLUSIONS: All four clinician groups reported substantial levels of burnout, and job demands predicted burnout. The body of knowledge on job stress and workplace burnout supports targeting organizational-level sources versus individual-level factors as the most effective prevention and reduction strategy. This study elaborates on this evidence by identifying structural drivers of burnout within a multidisciplinary context of pediatric hematology/oncology clinicians

Never Enough Time: Mixed Methods Study Identifies Drivers of Temporal Demand That Contribute to Burnout Among Physicians Who Care for Pediatric Hematology-Oncology Patients

Purpose: Burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment because of chronic occupational stress. Approximately one third of pediatric hematology-oncology physicians experience burnout. The goal of this mixed methods study was to determine the prevalence and drivers of burnout among physicians caring for pediatric hematology-oncology patients at our institution. Materials and methods: This mixed methods, cross-sectional study was conducted at a large academic cancer center. Validated survey instruments were used to measure burnout, job demands, experience with patient safety events, and workplace culture. Quantitative data informed development of a semistructured interview guide, and physicians were randomly selected to participate in individual interviews. Interviews were transcribed and analyzed via content analysis based on a priori codes. Results: The survey was distributed to 132 physicians, and 53 complete responses were received (response rate 40%). Of the 53 respondents, 15 (28%) met criteria for burnout. Experiencing burnout was associated with increased temporal demand. Twenty-six interviews were conducted. Qualitative themes revealed that frequent meetings, insufficient support staff, and workflow interruptions were key drivers of temporal demand and that temporal demand contributed to burnout through emotional exhaustion and reduced personal accomplishment. Conclusion: Nearly one-third of participating physicians met criteria for burnout, and burnout was associated with increased temporal demand. Qualitative interviews identified specific drivers of temporal demand and burnout, which can be targeted for intervention. This methodology can be easily adapted for broad use and may represent an effective strategy for identifying and mitigating institution-specific drivers of burnout