End-of-life Care Clinical Trial
Official title:
Development and Evaluation of a Novel Mindful-Compassion Art Therapy (MCAT) Supervision for Self-Care and Collegial Support Among End-of-Life Care Professionals in Singapore
Background: The need for empathy and the difficulties of coping with morality when caring for
the dying and the bereaved pose great psychological and spiritual strains. End-of-Life (EoL)
care professionals including doctors, nurses and social workers are particularly prone to
burnout given the intense emotional and existential nature of their work. Supervision is one
important way to provide adequate support that focuses on both professional and personal
competencies in working with death and loss. Previous research has provided strong evidence
that support the inclusion of art therapy within supervision for it had effectively reduced
burnout and enhanced emotional regulation. Combining the practice of mindfulness in
art-therapy based supervision has immense potential to create a dynamic platform for
self-care and collegial support, of which could ultimately cultivate sustained resilience,
compassion and growth among those immersed the fields of hospice and palliative care.
Methods/Design: A randomized wait-list control trial design. 60 EoL care professionals were
randomly allocated into one of two groups: (i) Intervention group (MCAT Supervision), and
(ii) Control group (MCAT Supervision will be provided after the intervention group completed
all supervision sessions). Both quantitative and qualitative outcomes were assessed at
baseline, immediately after intervention, and four weeks post intervention. Primary outcome
measure included level of burnout. Secondary outcomes included death attitude and fear of
death, emotional awareness and regulation, resilience, compassion, and overall quality of
life. Qualitative data were analyzed using Framework method.
Discussion: The integration of art and mindfulness practice to process the needs of
professional EoL caregivers for self-care is a scarcely explored area in the field of hospice
and palliative care in Singapore and in the international context. This pilot study proposes
to develop and test a novel Mindful-Compassion Art Therapy (MCAT) Supervision for
professional EoL caregivers. The expected outcome would generate new knowledge contributing
to advancements in both theories and practice in hospice and palliative care for Singapore
and across the globe.
Study Design
Building on the established protocol of Art-Therapy based supervision together with the
additional elements of mindfulness practice, this study will adopt an randomized wait-list
control trial design comprising of two groups: (i) Intervention group (MCAT Supervision), and
(ii) Control group (MCAT Supervision will be provided after the intervention group completed
all supervision sessions).
Study Site
Participants will be recruited from a community-based collaborating partner, Hospice Care
Association (HCA), Singapore's largest home hospice care provider. Deputy Medical Director
and Programme Director of HCA Star PALs, together with his appointed staffs will provide
assistance in recruitment as well as tracking of participants, allowing for timely
intervention and efficient data collection.
Participants
The sample will comprise of 60 frontline EoL caregivers including doctors, nurses, social
workers and allied health professionals currently working in field of hospice and palliative
care (N=60).
Allowing for an attrition rate of 15% at follow-up, a sample of 60 will provide 80% power to
detect an effect size of 0.80 standard deviation units in the primary outcome measure of
Maslach Burnout Inventory-General Survey between the intervention and control group at the
(two-tailed test) 5% level of significance.
Recruitment, assessment, intervention, and follow up procedures
Upon informed consent and baseline assessment [T1] conducted via paper or electronic online
questionnaires, participants will be randomly assigned to either the intervention or waitlist
control group. Those assigned to in the intervention group will attend 6 weekly
Mindful-Compassion Art Therapy supervision led by a credentialed art therapist and an
experienced mindfulness practitioner at the training facilities of HCA. Each session will
last for 3 hours and each group will consists of 15 participants. Outcome assessments will be
conducted at two-time-points: immediately after intervention [T2] and four weeks post
intervention [T3]. Those assigned to the waitlist control group will receive no intervention
until approximately three month later; equivalent intervention and assessment procedures will
be administered. The 6-week 3-hour MCAT supervision will include elements of brief
psycho-education, weekly mindful mediation that serve as a foundation to foster art making,
reflective writing, group sharing and discussion.
Between and within participants comparisons of quantitative outcomes will be conducted and
the appropriate effect size estimates reported. The intervention group and control group will
be compared on the main outcome (i.e. burnout) and secondary outcomes (i.e. fear and negative
attitudes of death, emotional awareness and regulation, resilience, compassion, and overall
quality life). T2 and T3 assessments will be compared with baseline assessment. The
intervention and control groups will also be compared on demographic characteristics with
baseline measures; if necessary, they variables will be controlled in the analyses. The SPSS
statistical software package will be used to manage the data.
The Framework method of analysis will be used to analyze qualitative data. 28 Analyses will
be both deductive (from pre-set aims and objectives) and inductive (arising from participants
view). This method tends to be more structured than some other methods of qualitative
analysis and the process more explicit and more informed by a priori questions. It is
designed so that it can be more easily understood and assessed by people other than the
analyst, such as funding bodies, policy makers and participants. Throughout the analytical
process we will use strategies to maximize credibility, criticality, and authenticity. The
QSR NVIVO software package will be used to manage the data.
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