“It Is Like Heart Failure. It Is Chronic … and It Will Kill You”: A Qualitative Analysis of Burnout Among Hospice and Palliative Care Clinicians

Abstract

Context Although prior surveys have identified rates of self-reported burnout among palliative care clinicians as high as 62%, limited data exist to elucidate the causes, ameliorators, and effects of this phenomenon. Objectives We explored burnout among palliative care clinicians, specifically their experiences with burnout, their perceived sources of burnout, and potential individual, interpersonal, organizational, and policy-level solutions to address burnout. Methods During the 2014 AAHPM/HPNA Annual Assembly, we conducted 3 focus groups to examine: personal narratives of burnout; how burnout differs within hospice and palliative care; and, strategies to mitigate burnout. Two investigators independently analyzed data using template analysis, an inductive/deductive qualitative analytic technique. Results We interviewed 20 palliative care clinicians (14 physicians, 4 advanced practice providers, 2 social workers). Common sources of burnout included: increasing workload, tensions between non-specialists and palliative care specialists, and regulatory issues. We heard grave concerns about the stability of the palliative care workforce, and concerns of providing, high-quality palliative care in light of a distressed, overburdened discipline. Participants proposed anti-burnout solutions including: promoting the provision of generalist palliative care, frequent rotations on-and-off service, and organizational support for self-care. We observed variability in sources of burnout between clinician type and by practice setting, such as role monotony among full-time clinicians. Conclusion Our results reinforce and expand upon the severity and potential ramifications of burnout on the palliative care workforce. Future research is needed to confirm our findings and to investigate interventions to address or prevent burnout.

Burnout and resilience among Canadian palliative care physicians

“…Further illuminated in our open-text review, specific participants commented on the meaningful and sustaining work of delivering palliative care while also directly acknowledging the personal costs, accumulated stressors in delivering care with limited time, resources and support, and the persistent conflicts in advocating for the legitimacy and importance of providing palliative care. These findings, echo the importance of examining individual (personal and coping strategies), interpersonal and organizational (systemic stressors) effects of burnout and protective factors that raised in other studies with hospice and palliative care clinicians [ 35 , 50 ]. Further, as demonstrated in previous studies [ 41 , 42 ], there was a strong association between burnout and resilience: respondents reporting lower levels of resilience had higher levels of burnout.…”

“…Further identified were personal and professional comments about present-day stress, fatigue, and burnout, in addition to past experiences of burnout and how some participants were building resilience into their lives. Many of these issues have been identified in other studies [ 50 , 64 , 65 ], and further research using mixed-methods approaches is needed to better understand what contributes and mitigates experiences of burnout and resilience and importantly, what system-wide changes and potential interventions are required, to best support physicians across specialities [ 56 , 61 , 66 ]. Most importantly, it is critical that research in this area is integrated into policy and practice, to ensure that palliative care physicians are supported to provide compassionate, competent, comprehensive care.…”

Empowering the Health and Well-Being of the Palliative Care Workforce: Evaluation of a Weekly Self-Care Checklist

“…( 14 , 15 , 16 ) In healthcare, burnout is associated with increases in depression, medical errors, chemical coping, suicidal ideation, poor physical health, and many other adverse effects for personnel. ( 2 , 3 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ) Burnout hurts organizations and the healthcare system, as personnel increase their rates of absenteeism and leave their jobs through career changes or early retirement. ( 24 ) Attrition from the palliative care workforce is particularly dire in a time when demand exceeds supply.…”

Social capital and burnout among mental healthcare providers

“…Up to 67% of mental health providers are estimated to experience high levels of burnout (Rohland, 2000;Morse et al, 2012). This rate ranks among the highest compared to other health specialties, such as palliative care clinicians that report a 62% rate of burnout (Shanafelt et al, 2015;Kavalieratos et al, 2017;Westwood, et al, 2017). Burnout has also been associated with physical and mental health problems in providers (Halbesleben, et al, 2008;Peterson et al, 2008;Acker, 2010;Pompili et al, 2010;Fridner et al, 2011;Welp, Meier, & Manser, 2014).…”