Interest in contemplative medicine may be rising in the palliative and end-of-life care communities as more practitioners realize the potential benefits for clinicians and patients.
The concept of contemplative medicine is rooted in the use of mindfulness, meditation and other practices designed to reduce clinician stress and help them embrace care for the whole patient — mind, body and spirit —which is also an integral aspect of palliative care.
To advance this approach, two Buddhist monks have developed an evidence-based contemplative medicine fellowship for clinicians through the New York Zen Center for Contemplative Care. The monks — Koshin Paley Ellison and Chodo Robert Campbell — have spent years working as health care chaplains and educators in medical schools around the world.
Paley Ellison is also co-author of the book, Awake at the Bedside: Contemplative Teachings on Palliative and End-of-Life Care.
“At medical schools and medical institutions, we kept hearing the same thing over and over again: ‘I’m so bad at self care,’” Paley Ellison told Palliative Care News. “And it was heartbreaking, because across cultures, across nations, the same problems exist. Everyone feels isolated. People felt disconnected. People are forgetting why they’re doing what they’re doing and not feeling supported.”
One of the potential benefits of these practices is helping to stave off burnout as well as fostering a more mindful approach to patient interactions amid the rush and bustle of modern health care.
“We really felt this major call to do what we could to actually respond to this call and this cry, because it’s also the vow that we have as monks, to serve,” Paley Ellison said.
The emotional toll of caring for the seriously ill contributes to high rates of burnout among palliative care workers, leading some to consider leaving the field.
A 2020 meta-analysis of 15 studies on burnout among palliative care nurses found a 24% prevalence for emotional exhaustion, 30% for depersonalization and 28% for feelings of low personal accomplishment.
Beyond potential staffing issues, burnout can lead to negative attitudes toward patients and cynicism towards providing care, leading to a lower quality of care, even if the nurse stays on. These are circumstances that practitioners of contemplative medicine hope to prevent.
“This can be applied anywhere that care is needed, one-on-one care with someone that’s really interested, because many doctors and nurses don’t have the time or don’t prioritize the time,” Campbell told Palliative Care News. “So our students, they’re there to be with the patient and to listen and to bear witness and give that extra layer of spiritual and emotional support.”
Campbell and Paley Ellison’s organization, the New York Zen Center for Contemplative Care, offers the first evidence-based contemplative medicine fellowship in the nation, which follows a Zen Buddhist approach.
The 12-month fellowship typically accepts cohorts of close to 30 participants annually, though the program does not limit the number of fellows. Currently, it focuses on the needs of physicians, advanced practice registered nurses and physician assistants. Many members of these cohorts continue to meet long after their time in the fellowship has ended in order to provide mutual support, according to Ellison.
“Each cohort creates this courageous, beautiful community they’ve never had before, being able to speak to other physicians about their challenges both at home and in the workplace and with friends,” Campbell said. “Through this training, these tools that they’re given, even just by simply pausing or taking a deep breath between each patient, they are at their entry into the relationship with the patient in a very different way.”
