Clinicians, nurses, and trainees in critical care medicine report alarmingly high rates of burnout and professional distress due to constant exposure to patient deaths and other end-of-life issues—all in a rapid-pace environment that often presents challenges to adapt and cope with these situations.

To shed a light on these issues, CHEST 2023 will host The Intersection Between End-of-Life Care, Professional Burnout, and Team Engagement in Critical Care on Sunday, October 8, at 7 am HST, in Room 316C of the Hawaiʻi Convention Center. This session will discuss key aspects of integrating contemporary concepts about physician and nurse grieving, debriefing strategies to improve team engagement and prevent burnout, as well as controversies about end-of-life and advanced life support in the ICU settings.

“The first step is to acknowledge that we all grieve, and it is OK to do so. When we lose critically ill patients, it is important to create an environment that allows for sharing and accepting those feelings,” said Session Chair, Carlos L. Alviar, MD, Assistant Professor of Cardiovascular Medicine and Critical Care Cardiologist at New York University. “If we don’t have compassion for ourselves, we won’t have compassion toward others.”

The importance of mental health considerations in high-stress work environments has increasingly been in the national consciousness. One of the most visible examples occurred at the start of the year, during a primetime NFL game between the Buffalo Bills and Cincinnati Bengals, when Bills defensive back Damar Hamlin collapsed after completing a tackle. With the game temporarily suspended, Hamlin received CPR and other life-saving interventions on the field. Distraught players and a national TV audience watched for nearly 20 minutes before he was transported to the hospital. Reports suggested that the NFL initially explored restarting the game after a short delay, despite objections from both teams, but the remainder of the game was ultimately canceled.

Hamlin has since recovered, but in the days and weeks following his injury, many conversations centered around images of his traumatized teammates and opponents, who were uncertain if they would have to resume play. CHEST Critical Care Network Chair, Christopher Carroll, MD, FCCP, Medical Director of the Pediatric ICU at Wolfson Children’s Hospital, summed up his thoughts in a viral social media post.

“Much is being said of the NFL initially stating they would return to play after a 5-minute break. But I’m also saddened to recall the number of times that I also failed to protect my ICU team and allow them time to process after a traumatic event because the unit was busy,” Dr. Carroll wrote.

During the upcoming session at CHEST 2023, a panel of critical care experts will touch on similar conversations and experiences. Presenters will review recent data about clinician and nurse burnout in the ICU, the interaction with end-of-life issues, and strategies for debriefing after a patient’s death in order to improve team engagement and cope with loss.

They will also examine how decision-making while providing advanced life support in the ICU affects team engagement and burnout. Finally, speakers will discuss reckoning with futility in critical care settings when advanced therapies are considered for rapidly deteriorating patients.

“People often try to go around pain or avoid it in difficult situations, but psychology tells us we must go through pain to process it properly,” Dr. Alviar said.

The session will use a flipped classroom format to incorporate active audience participation and encourage a thorough discussion about these difficult conversations and challenging situations. 

“This is a session for the people,” Dr. Alviar said. “We want to create the kind of environment that we’re advocating for throughout the presentations, so people feel encouraged to share their personal experiences and challenges. This is a topic where we can all learn from each other.”