Impact of a contemplative end-of-life training program: Being With Dying

Health care professionals report a lack of skills in the psychosocial and spiritual aspects of caring for dying people and high levels of moral distress, grief, and burnout. To address these concerns, the “Being with Dying: Professional Training Program in Contemplative End-of-Life Care” (BWD) was created. The premise of BWD, which is based on the development of mindfulness and receptive attention through contemplative practice, is that cultivating stability of mind and emotions enables clinicians to respond to others and themselves with compassion. This article describes the impact of BWD on the participants.

Methods: Ninety-five BWD participants completed an anonymous online survey; 40 completed a confidential open-ended telephone interview. Results: Four main themes—the power of presence, cultivating balanced compassion, recognizing grief, and the importance of self-care—emerged in the interviews and were supported in the survey data. The interviewees considered BWD’s contemplative and reflective practices meaningful, useful, and valuable and reported that BWD provided skills, attitudes, behaviors, and tools to change how they worked with the dying and bereaved.

Significance of results: The quality of presence has the potential to transform the care of dying people and the caregivers themselves. Cultivating this quality within themselves and others allows clinicians to explore alternatives to exclusively intellectual, procedural, and task oriented approaches when caring for dying people. BWD provides a rare opportunity to engage in practices and methods that cultivate the stability of mind and emotions that may facilitate compassionate care of dying patients, families, and caregivers.

The Power of Presence: Presence refers to the capacity to be fully therewith a quality of attention and authenticity that informs relationships and actions. A prominent theme in the interviews was the recognition that the mandate in modern medicine “to do” and “to fix” and hopefully cure may no longer be appropriate when people are dying and, in fact, may require balancing with the quality of being present with those who are suffering. Interviewees said that BWD had helped them realize that being present with dying patients and their families and bearing witness to suffering are healing acts in themselves and are often “enough.” This theme, illustrated by interview quotes in Table 4,

Table 4. The power of presence

A physician said: “[W]hat sticks with me most, and what has changed most in me since doing the training . . . is the comfort in witnessing. ‘I don’t have to fix anything here. I’m not expected to know the answers here. It’s enough just to witness.’”

Another physician noted: “I remember just completely breaking down . . . thinking . . . ‘there’s this whole other way to be with patients,’ rather than fixing things and testing them . . . and so it was like a . . . glimpse into possibly another way of doing things.. . . [T]hat moment stuck with me.”

A counselor said: “I think what has stayed with me the most, what was reinforced . . . because for me, this is one of the most important aspects of what I do, . . . was the concept of really being present. The art of being present, the art of listening, and bearing witness. And the sacredness of . . . doing this work.”

A chaplain, speaking of what had most helped her in her work, noted: “Basically, bearing witness to suffering and the relationship to pain and suffering, and mindfully being with someone. I mean it’s pretty simple, but if you can really be ’present,’ which isn’t always an easy thing to do, . . . but to really hone in on the skill of deep listening and being present and bearing witness. . . . Just being with someone in the moment . . . that you don’t have to do anything really, you just have to be.”

A nurse observed: “I’m not going to be able to fix everything. I know that . . . sometimes just simply the presence of a person who can be there in the midst of all this chaos and pain and suffering . . . and just ’be there,’ as a way to start. And . . . once you’ve . . . gotten yourself present in the situation, you can start looking around . . . and find what actually is important, which may not have been what you thought would be from your professional standpoint.”

Table 5. Cultivating balanced compassion

A physician attending BWD hoped to learn “how to take care of people who are this sick without hurting myself.” A social worker who trains many staff wanted to learn strategies and techniques to help her colleagues “open up their hearts and minds to being with patients in a more compassionate way.”

Another social worker said: “[Y]ou’re not there to change anyone, you’re there to really walk with folks through their own process.”

A physician reflected on the notion of “soft front, strong back” as “the ability . . . to have the softness to receive whatever it is and to experience even the pain that may be associated with it, [with] a strong back and equanimity to try to be present.”

A nurse said, “The core of the training . . . is to me the whole notion of cultivating equanimity and compassion; . . . that’s the core practice. In the end, that’s the nugget of it all. It’s just the internal cultivation of that, so that I can be more present with myself and more present with other people no matter what the situation is. . . . [W]hat [BWD] drills in . . . to me, the most . . . [is] both the equanimity and the compassion, and it’s not either/or, it’s both.”

Another nurse said: “[W]hat I came away with and I think a lot of people came away with [is] taking that step back. . . . being present, but being in a really grounded place in one’s self . . . in order to be that middle ground for a family that’s in conflict, or for a medical team that’s in conflict. . . . [T]he whole Buddhist approach of the middle way.”

http://www.upaya.org/roshi/writings.php#articles Copyright Cambridge University Press, 2009

 

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