the precarious nature of the team when challenges are faced …

Swetenham et al and Hegarty etal study the impact of refractory suffering on the interdisciplinary team.

“Refractory suffering – that is, suffering that persists unrelieved despite all attempts by an interdisciplinary team to ameliorate it, is one of the most difficult and challenging aspects of palliative care practice. Its effects on clinicians have been documented. Having been trained to treat pain and other symptoms, clinicians who find themselves unable to relieve suffering may feel that their sense of professional competence is being challenged. Clinical responses include avoidance (of the sufferer or of engagement with that person’s suffering), over-identification, or compassion fatigue. Such responses can fracture care teams … Yet this mutual suffering of patient, family, and clinician is rarely articulated within palliative care teams, nor are ways of living and working with refractory suffering widely discussed within the palliative care literature or taught within clinical services or educational programs … “ (Hegarty)

“The suffering of patients and their families affects clinicians, who grapple personally and professionally with their own suffering in the face of another’s distress. Clinicians also feel impotent and powerless when unable to relieve it. Yet this “mutual suffering” … is often not articulated within palliative care teams. Identification of specific skill sets required to manage a patient’s refractory suffering is absent in most of [hospice and palliative care]. While there is recognition that witnessing suffering affects the carer, identifying protective qualities remains the domain of the individual concerned. This identification requires self-reflection and insight, and often goes unrecorded or unnoticed because it is considered to be an inherent trait of the healthcare worker.” (Swetenham)