Improving self-compassion and reducing burnout with mindfulness for palliative care

Imogen Eastwood and Ivor Williams

Helix Centre
Jun 4 · 9 min read

Meeting people where they were

In September 2018, we began a new project to address people’s psychosocial (emotional, psychological and spiritual) care needs at end of life. We wanted to investigate therapeutic approaches that may benefit people living with life-limiting conditions. A clinical nurse specialist in palliative care in London, Imogen Eastwood, joined the team to help develop the project.

A prepared room, for a mindfulness session for patients, at a London hospice

Identifying the need for an inter-relational approach

Mindfulness has recently become a bit of a buzzword, found in fashion magazines and health websites alike. It’s being taught everywhere: from community halls to schools and workplaces. And there is no shortage of mindfulness apps on the market. Many are for general wellbeing, some for mental health and a few are targeted at those with chronic pain. But we didn’t find any that exist specifically for those facing the end of their lives.

It is difficult for professionals to advocate for something that’s perceived as non-essential

End-of-life care organisations are acutely aware of the pressures on their staff. Several hospices we spoke with were already running eight-week, mindfulness-based stress relief courses and drop-ins. But attendance was reported to be unreliable. In the presence of other colleagues, staff sometimes felt exposed during sessions which required them to open up emotionally. Despite interest, staff (and carers) frequently said they just didn’t have time to attend sessions and professionals weren’t given protected time to attend within working hours. It is difficult for professionals to advocate for something that’s perceived as non-essential, despite the evidence that mindfulness can benefit both staff and patients.

What we learned

Our prototype validated many assumptions. As expected, the most common barrier to fully engaging with the exercise was a lack of distraction-free time. Participants are immersed in a busy and changing work environment. Many were parents, so it was little surprise that finding the time was particularly difficult for those with children.

…by engaging in mindfulness practice with patients, something could be shared rather than just provided.

However, there was also a very positive realisation that by engaging in mindfulness practice with patients, something could be shared rather than just provided. One nurse felt that they had lost touch with the importance of one-to-one connection with their patients, due to the ‘task-orientated’ care that many feel is expected of them. Most participants felt that mindfulness provided an opportunity to encourage more meaningful professional/patient interaction.

To be viable in the long-term, we feel that any solution to this problem must cater to both the patient and the professional/carer.

Finally, we feel our investigations revealed a problem in the human-centred design methodology. If we place the patient at the centre, and design explicitly for their needs, then we will come up against issues we observed in our prototyping. The professionals and carers who support them will be ignored, and their needs placed secondary. We saw how palliative healthcare professionals were experiencing burnout and debilitating stress by having their own psychosocial needs put behind the needs of the system, in effect representing the patient. A great deal is demanded of doctors and nurses in this specialty that can leave little time for self-care. To be viable in the long-term, we feel that any solution to this problem must cater to both the patient and the professional/carer. A more systemic-approach to developing design solutions is needed, to better identify, acknowledge and respect the inter-relationships between people. We see this project as an opportunity to test this approach out. We are keen to think through these ideas with the wider design community.

Where this takes us

End-of-life care often forces patients, families and professionals alike to confront their own existential issues, which can sometimes be expressed as pain. Great care and sensitivity are therefore required to openly discuss death and dying. And our work has taught us that a mindfulness service in palliative care would need to be adaptable for the changing needs of patients, and for a variety of healthcare professionals.

Contact us

Ivor Williams
ivor@helixcentre.com
helixcentre.com

helixcentre

Helix Centre is an innovation lab working at the heart of healthcare. We translate research into products that improve health outcomes. We are part of Imperial College London and the Royal College of Art, and based in St Mary's Hospital, London.

Helix Centre

Written by

We are an innovation lab working at the heart of healthcare. We translate research into products that improve health outcomes. Based at St Mary’s Hospital.

helixcentre

Helix Centre is an innovation lab working at the heart of healthcare. We translate research into products that improve health outcomes. We are part of Imperial College London and the Royal College of Art, and based in St Mary's Hospital, London.