July 2, 2026
The Hidden Cost of Championing Palliative Care
Clinical champions are dedicated individuals driving new palliative care services, training programs, facilities, or processes. They promote, protect, and troubleshoot efforts to improve care through influence, advocacy, and persistence. They are the people others turn to when things become complex or systems fail to adapt.
Many will recognize this picture. In palliative care, we tend to call these people colleagues; sometimes, they are ourselves. In primary care, nurse champions have been shown to be pivotal in successfully integrating palliative care into routine practice.1 In hospital oncology services, systematic reviews highlight clinical advocates and champions as key to successful program implementation.2
Burnout is a real risk for champions
Yet the qualities that make champions effective—such as credibility, clinical expertise, strong relationships and personal investment—are the very ones that put them at risk of burnout.3 In a field already defined by emotional intensity and the tension between what people need and what systems can deliver, this risk is amplified.
Palliative care consistently relies on champions to drive change, but the emotional and values-driven nature of the work means the personal cost is often invisible. Champions understand the positive impact of good palliative care to patients, families, staff, and communities. However, quality improvement in end-of-life care involves significant, often unrecognized emotional labor.4
The ‘champion paradox’
Each small compromise or missed opportunity accumulates emotionally,5 particularly for the champion of change. One study of experienced oncology and palliative care professionals found that moral distress is directly linked to workforce attrition.6 In other words, the people most likely to be a palliative care champion are the people weighing up whether they can keep going.
Stark and Page7 describe this as the “champion paradox,” where the individuals best placed to drive change can become the system’s workaround when adequate support is lacking. Without sufficient authority, staffing or resources, pressure concentrates on the champion, resulting in longer hours, heightened vigilance, and increasing emotional burden that gradually becomes normalized.
Sustainable systems cannot depend on just 1 person
A system that depends on individual dedication to function is not sustainable. A more sustainable model positions champions as transition leads, building team capability, documenting practice and distributing knowledge so that quality care is not dependent on any one person's endurance. Success would be measured not by whether a service is running, but by whether it can continue if the champion steps back.
Based on Stark H & Page J. (2026) The champion paradox: the dual effects of implementation champions on the sustainment of evidence-based practices. Implementation Science Communications. doi:10.1186/s43058-026-00959-2
6 Ways to Harness Your Powers
Here are some ways you can harness your powers as a champion for yourself and your fellow champions.
- Deliberately and intentionally implement a succession plan from the start. State clearly when your tenure will end and start thinking about what your legacy will be for the person who will follow you.
- Explicitly document the expertise that is accrued over the life course of the project and pass it on, rather than it being implicitly held by one person.
- Document unambiguously that your role is to work with others to distribute knowledge, build capability, and embed processes that reduce reliance on any one person. Make these areas the framework for meetings and reports, and regularly check your team’s performance against these areas. If need be, remind everyone when your tenure will end.
- Remind yourself that you are enough. Champions do not have super powers: do not be beguiled by silver-tongued managers suggesting otherwise.
- Be clear to yourself—and anyone else who needs to hear it—that the goal was never to build a system that depends on champions. That is too risky. The goal is to build systems that don’t need champions at all.
- Finally, find structured spaces for connection and reflection with others. At times, being a champion can be a lonely place. Nothing is better at reminding you why you answered the call to improve than being with other people. Listen to each other with an open heart and an open mind. This is where you’ll find your why.
References
- Langley et al. BMJ Open 2024; 14(1): E079234. Barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices: a mixed methods study.
- Rizvi et al. Palliat Med 2023 37(9): 1326-1344. An evidence-base for the implementation of hospital-based palliative care programs in routine cancer practice: A systematic review.
- Bonawitz et al, 2020 Implement Sci 2020; 15(1): 62. Champions in context: which attributes matter for change efforts in healthcare?
- Boulton and Boaz, 2019 BMC Health Serv Res 2019; 19: 923. The emotional labour of quality improvement work in end of life care: a qualitative study of Patient and Family Centred Care (PFCC) in England.
- Maunder et al, 2023. BMC Nurs 2023; 22(1): 243. The relationship between moral distress, burnout, and considering leaving a hospital job during the COVID-19 pandemic: a longitudinal survey.
- Ratcliffe et al, 2024. J Psycho Oncol Res Pract 2024; 6(4): 150. Experiences of moral distress among health care professionals in oncology and palliative care in Australia: a qualitative investigation.
- Stark, Page. Implement Sco Commun 2026; doi.org/10.1186/s43058-026-00959-2. The champion paradox: the dual effects of implementation champions on the sustainment of evidence-based practices.
Read Victoria Hewitt’s bio.
Read more of this week's issue of Pallinews
Plus
SWANA: A new regional association A webinar being held on Tuesday, July 7, at 2 p.m. Cairo time, will introduce the emerging framework for a regional palliative care association for South-West Asia and North Africa (SWANA). This is an opportunity for colleagues working in all disciplines related to palliative care in the region, as well as health ministry officials, to contribute their perspectives and help shape the association’s future direction. Register here.
Abstract deadlines
- August 10, 2026 is the deadline to submit your abstract for the combined Asia Pacific Hospice Conference and Oceanic Palliative Care Conference taking place in April 2027 in Adelade, Australia. The theme is “Stronger Together: Humanity at the Heart of Palliative Care.”
- August 31, 2026 is the deadline to submit your abstract for a conference hosted by the Research Institute for Hospice/Palliative Care at the Catholic University of Korea. Taking place on October 30, 2026, the conference theme is “Futuristic Evolution in Palliative Care: Harmonizing Policy, Technology, and Equity.”
Also… Barry Ashpole’s monthly compilations of articles and reports about end-of-life care in prisons are freely available.
IAHPC Resources
Free for everyone
In October 2024, Pallinews ran an article worth repeating: “Palliative Care, Sepsis & Antimicrobial Resistance: Shared problems, shared solutions.”
Free for members
Pain management for patients with cancer or HIV is the focus of Module 7 of IAHPC’s Comprehensive Basic Pain Assessment and Management Course. Not yet a member? Join us!
Upcoming Events in the Calendar
Explore the IAHPC calendar of events to find educational events, conferences, and congresses to expand and improve your palliative care skills and knowledge.