Nephrology Social Workers’ Opinions on the Use of Acceptable Humor in Conversations with Advanced Illness Patients: A National Survey

Abstract

In our everyday lives, no matter what field we are in, humor is ever present and no less true than working with patients in a palliative care program (Dean & Gregory, 2004). The use of humor with our patients should be selective, being mindful that some patients may not feel comfortable with its use.  If used correctly, humor can be a “valuable resource” (Linge-Dahl et al, 2018, p. 2) for both health care providers and for the patients being served. Our definition of acceptable humor is a smile, a laugh or a joke. Nephrology and kidney transplant social workers frequently encounter patients with advanced illness in the end stage kidney disease (ESKD) setting.  They have conversations with them and assess for depression, anxiety, pain, and suicidality.  Death is all too frequent with this ESKD population, and this can contribute to burnout.  In multiple studies on palliative care, the use of humor allows providers, patients, and caregivers to be connected, provide them hope, decrease their agitation, and improve their own unique perspectives. Humor is a tool to fend off the stress of dealing with death and dying.

This cross-sectional study implemented a 33-item anonymous online survey. It was sent out by the Executive Directors from the 18 ESRD Networks. We received permission to proceed with our survey from the Centers for Medicare & Medicaid Services (CMS) and from our Institutional Review Board. No identifiable information was collected, all questions were optional, and the survey could only be taken once.

Over 6,100 surveys were emailed with a rate of return of 21% (1,018) over three weeks in May-June 2022.  The survey used a Likert scale.  A majority of social workers (92%) strongly agreed or agreed that they engage in acceptable humor and (80%) use humor in their practice 26-100% of the time. These social workers experienced burnout (80%) and (67%) felt that humor decreased this burnout and enhanced their personal connection(s) (95%) with their patient.  Most did not use humor until the patient initiated (83%).  A majority (60%) felt that their cultural background influenced positively their ability to engage in humor. Humor was also a positive communicative tool (96%).  Humor was advantageous in allowing for the patient to cope with grief (72%), emotional distress (84%) and their overall well-being (95%). The respondents used humor during advance care planning discussions and felt it helped the patient dialog their personal end-of-life journey (75%). They believed that the patient’s caregiver (89%) also benefited from the use of humor. There was no difference in the use of acceptable humor by gender, ethnicity, or region of the country.  However, it appears the use of acceptable humor slightly increased as the provider’s age and the number of years in practice increased.