P2B343: Impact of Caring for Children with Life Limiting Illness on the Wellness of Pediatric Providers

Background: The literature on physician wellness in pediatric palliative care (PPC) focuses mainly on negative impacts such as compassion fatigue, burnout, and emotional distress. However, qualitative studies suggest that providers often derive personal and occupational meaning from caring for children with life limiting illness (CLLI). We aimed to characterize the perceived impact of caring for CLLI on the mental, physician, social, and integrated wellness of pediatric providers at a mid-sized academic institution.

Methods: We developed a 4-item survey to evaluate provider wellness based on the holistic conceptualization proposed by a 2018 systemic review by Brady et al which includes mental, physical, social, and integrated dimensions of wellness (Table 1). Respondents to this survey are asked to rank the perceived impact of their work on each dimension using a Likert Scale from 1 (Strongly Negative Impact) to 5 (Strongly Positive Impact). The survey was distributed to pediatric providers at an academic institution as part of a needs assessment for PPC services.

Results: Of the 112 providers invited, 56 (50%) responded, including resident physicians (n=20), attending physicians (n=30), and advanced practice providers (APPs) (n=6) from sub-specialties including primary care (n=7), hospital medicine (n=4), critical care (n=6), neonatology (n=9), pulmonology (n=3), genetics (n=1), and other (n=4). Most providers reported a positive perceived impact on social (41/56) and integrated (41/56) wellness (Figure 1). An equal number (20/56) reported that caring for CLLI had a positive and a negative impact on their mental wellness with 16/56 providers reporting a neutral impact. Most providers (45/56) reported a neutral perceived impact on their physical wellness.

Conclusion: Most pediatric providers at our institution self-reported that caring for CLLI positively impacted their social and integrated wellness and over one-third reported a positive impact on mental wellness. Although our study is limited as we used a non-validated survey tool at a single center, the findings challenge the pervading narrative that caring for CLLI has a wholly negative impact on providers’ wellness. Rather, characterizing wellness in multiple domains reveals that there are likely aspects of the PPC provider experience that can be leveraged to mitigate burn-out. Further work should be done to identify these factors to inform wellness promotion strategies and to develop a validated holistic model of provider wellness using this conceptualization.