COMMENTARY

Burnout: Like a Chronic Disease?

Betty R. Ferrell, PhD, RN

Disclosures

August 01, 2017

Burnout in Palliative Care Clinicians

Burnout—a negative psychological state characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment[1]—can result in harm to healthcare professionals, patients, and organizations.[2] Previous surveys have identified rates of self-reported burnout among palliative care clinicians as high as 62%, although data to elucidate the causes, ameliorators, and effects of this phenomenon are limited.[3]

A recent study by Kavalieratos and colleagues[4] explored burnout among 20 palliative care clinicians (physicians, physician assistants, nurses, and social workers) attending a national conference. Interviews focused on the personal experiences of these clinicians with burnout; perceived sources of burnout; and potential individual, interpersonal, organizational, and policy-level solutions to address burnout in the field of hospice and palliative care.

These interviews provided a rich description of the phenomenon of burnout in this profession, captured well by the study report's title, taken verbatim from a participant: "It's like heart failure. I think it's chronic, and it's there, and if you do not take care of it, it will kill you."

Sources of burnout described through the qualitative analysis included individual factors (eg, a lack of boundaries), interpersonal factors (eg, interspecialty conflict), organizational/system stress, and policy issues. In the discussion of their findings, the investigators integrated previous work by Back and colleagues[5] on resilience and the fact that attention to burnout and promotion of resilience require organizational support.

Viewpoint

The field of palliative care has now matured to a point of having a critical mass of dedicated professionals with a history of clinical experience. Kavalieratos' group's study is a thoughtful exploration of burnout in these professionals at a time of awareness of their critical role in healthcare delivery juxtaposed with significant workforce shortages. The study authors provide insight on potential features of burnout in palliative care and critical issues that should be addressed.

A very interesting finding from this study is the need for workforce development through the promotion of primary palliative care. As the study participants described, too few healthcare professionals are specializing in palliative care currently. A key strategy to avoid burnout of the limited workforce is to have the burden of care shared by more clinicians.

Emotional strain is, of course, expected in a specialty devoted to compassionate care of the seriously ill.[6,7] There is also insightful discussion through this focus-group analysis of the urgency to provide attention to burnout in palliative care to sustain this new field.

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