Background: For more than a decade, researchers and institutions have been exploring the phenomenon of “high utilizers” – a small percentage of the population that accounts for a disproportionate amount of healthcare spending, often through frequent and/or lengthy hospitalizations. There is very little information, however, on how this population’s needs affect those who provide care for them. This study examines the impact of caring for complex health and social needs patients (CHSNPs) on the professional identity and well-being of clinicians. CHSNPs include patients who are housing-insecure, elderly or frail and unable to access adequate care at home, unable to make their own medical or discharge decisions without a proxy decision maker available, and challenging to place because of behavior, legal histories, mental illness, or dementia.
Methods: This mixed-methods study collected survey responses from attending physicians, advanced practice providers, nurses, social workers, patient care technicians, and rehabilitation therapists who routinely care for CHSNPs. The survey captured demographics, experiential data about clinician perception and causes of the problem, ethical dilemmas encountered in the care of this patient population, and the impact on compassion, work satisfaction and meaning, and moral integrity. Data on overall compassion fatigue/satisfaction were collected through previously validated questions. Follow-up focus groups sought to further explore themes revealed in the survey.
Results: 386 participants were included in the survey and about 24 participants were included in the focus groups. 74% of participants felt CHSNPs have increased over recent years. Participants believed the top reasons for this increase to include patient non-adherence to plan and patient behavior or history limiting placement. The distress scores related to the care of CHSNPs were significantly higher, with 91.8% reporting moderate to high distress compared as compared to the compassion fatigue score, with 63.6% reporting moderate to high compassion fatigue. There was a correlation between the two scores. Respondents with less than 5 years of hospital medical experience had higher levels of compassion fatigue; these levels dropped with experience. 37% of the participants felt they were making a positive improvement in the care for CHSNPs whereas 41% felt helpless in taking care of this population. 75% felt at least somewhat drained and 64% had moral distress caring for CHSNPs. Distress was also expressed about discharging patients into unsafe environments or prolonging hospital stays due to resource limitations.
Conclusions: Overall, healthcare workers had higher distress scores related to caring for CHSNPs than compassion fatigue scores. Many experienced a loss of purpose, compromised moral integrity, and a sense of futility in caring for CHSNPs. However, some with more experience had been able to develop effective coping strategies. Suggestions were also made that may help clinicians at every stage manage the emotional challenges associated with caring for CHSNPs.