OpenLB
Open Library of Bioscience
Advanced Search
Journal of the American Association of Nurse Practitioners
Nov 01, 2023;35 (11): 676-681.

Burnout among palliative care providers.

Colleen Borden Zogby
Author Information
  1. Colleen Borden Zogby: St. Joseph Hospital, Syracuse, New York. ORCID
PMID: 37395681 DOI: 10.1097/JXX.0000000000000912

Abstract

BACKGROUND: Burnout among health care professionals contributes to high job turnover. Within the United States, burnout among specialty palliative care (PC) providers will accentuate provider shortage problems.
OBJECTIVES: This systematic review was conducted to answer the question "what is known about burnout among specialty PC providers practicing in the United States?" More specifically, it was designed to identify the rate of burnout and factors that influence or mitigate it among PC nurse practitioners (NPs), physician assistants (PA), and physicians and to inform future research.
DATA SOURCES: An electronic literature search of studies conducted in the United States between 2012 and September 2022 was completed in Embase, PubMed, CINAHL, and PsycINFO.
CONCLUSIONS: Analysis of 14 studies showed that there are five primary themes related to burnout among PC providers: (1) the rate of burnout, (2) the physical, psychological, and clinical manifestations of burnout, (3) predictors of burnout, (4) factors of resiliency, and (5) interventions piloted to decrease burnout. The majority of studies have delineated the physician role but have failed to determine the rate and factors of burnout among PC NPs and PAs.
IMPLICATIONS FOR PRACTICE: As NPs and PAs are integral to the PC provider workforce, future research should be designed to understand more clearly how burnout affects these two PC roles to inform efforts to sustain the PC workforce.

References

  1. Back A. L, Steinhauser K. E., Kamal A. H., Jackson V. A. (2016). Building resilience for palliative care clinicians: An approach to burnout prevention based on individual skills and workplace factors. Journal of Pain and Symptom Management, 52(2), 284–291. https://doi.org/10.1016/j.jpainsymman.2016.02.002
  2. Beresford L. (2021, April 19). Physician assistants pursue larger roles in hospice and palliative care. CSU Shiley Haynes Institute for Palliative Care. https://csupalliativecare.org/physician-assistants-pursue-larger-roles-in-hospice-and-palliative-care/
  3. Center to Advance Palliative Care (n.d.). About palliative care. https://www.capc.org/about/palliative-care/
  4. Collins C. M., Small S. P. (2019). The nurse practitioner role is ideally suited for palliative care practice: A qualitative descriptive study. Canadian Oncology Nursing Journal, 29(1), 4–9. https://doi.org/10.5737/2368807629149 [DOI: 10.5737/2368807629149]
  5. Dahlin C., Coyne P. (2019). The palliative APRN leader. Annals of Palliative Medicine, 8(S1), S30–S38. https://doi.org/10.21037/apm.2018.06.03 [DOI: 10.21037/apm.2018.06.03]
  6. Gerhart J., O'Mahony S., Abrams I., Grosse J., Greene M., Levy M. (2016). A pilot test of a mindfulness-based communication training to enhance resilience in palliative care professionals. Journal of Contextual Behavioral Science, 5(2), 89–96. https://doi.org/10.1016/j.jcbs.2016.04.003 [DOI: 10.1016/j.jcbs.2016.04.003]
  7. Granek L., Buchman S. (2019). Improving physician well-being: Lessons from palliative care. Canadian Medical Association Journal, 191(14), E380–E381. https://doi.org/10.1503/cmaj.190110 [DOI: 10.1503/cmaj.190110]
  8. Hotchkiss J. T. (2018). Mindful self-care and secondary traumatic stress mediate a relationship between compassion satisfaction and burnout risk among hospice care professionals. American Journal of Hospice and Palliative and Care, 35(8), 1099–1108. https://doi.org/10.1177/1049909118756657 [DOI: 10.1177/1049909118756657]
  9. Kamal A. H., Bull J. H., Swetz K. M., Wolf S. P., Shanafelt T. D., Myers E. R. (2017). Future of the palliative care workforce: Preview to an impending crisis. The American Journal of Medicine, 130(2), 113–114. https://doi.org/10.1016/j.amjmed.2016.08.046 [DOI: 10.1016/j.amjmed.2016.08.046]
  10. Kamal A. H., Bull J. H., Wolf S. P., Swetz K. M., Shanafelt T. D., Ast K., Kavalieratos D., Sinclair C. T. (2020). Prevalence and predictors of burnout among hospice and palliative care clinicians in the U.S. Journal of Pain and Symptom Management, 59(5), e6–e13. https://doi.org/10.1016/j.jpainsymman.2019.11.017 [DOI: 10.1016/j.jpainsymman.2019.11.017]
  11. Kamal A. H., Bull J., Wolf S., Samsa G. P., Swetz K. M., Myers E. R., Shanafelt T. D., Abernethy A. P. (2016). Characterizing the hospice and palliative care workforce in the U.S.: Clinician demographics and professional responsibilities. Journal of Pain and Symptom Management, 51(3), 597–603. https://doi.org/10.1016/j.jpainsymman.2015.10.016 [DOI: 10.1016/j.jpainsymman.2015.10.016]
  12. Kamal A. H., Wolf S. P., Troy J., Leff V., Dahlin C., Rotella J. D., Handzo G., Rodgers P. E., Myers E. R. (2019). Policy changes key to promoting sustainability and growth of the specialty palliative care workforce. Health Affairs (Project Hope), 38(6), 910–918. https://doi.org/10.1377/hlthaff.2019.00018 [DOI: 10.1377/hlthaff.2019.00018]
  13. Kavalieratos D., Siconolfi D. E., Steinhauser K. E., Bull J., Arnold R. M., Swetz K. M., Kamal A. H. (2017). ““It Is Like Heart Failure. It Is Chronic … and It Will Kill You”: A Qualitative Analysis of Burnout Among Hospice and Palliative Care Clinicians, and it will kill you”: A qualitative analysis of burnout among hospice and palliative care clinicians. Journal of Pain and Symptom Management, 53(5), 901–910.e1. https://doi.org/10.1016/j.jpainsymman.2016.12.337 [DOI: 10.1016/j.jpainsymman.2016.12.337]
  14. Lawton A. J., Lawton C. W., Dietz S. S. B., Stevens E. E., Weis J. M. (2020). Exploring and managing the impostor phenomenon in palliative care: A case series. Journal of Palliative Medicine, 23(4), 586–590. https://doi.org/10.1089/jpm.2019.0094 [DOI: 10.1089/jpm.2019.0094]
  15. Marchalik D., Rodriguez A., Namath A., Krasnow R., Obara S., Padmore J., Groninger H. (2019). The impact of non-medical reading on clinician burnout: A national survey of palliative care providers. Annals of Palliative Medicine, 8(4), 428–435. https://doi.org/10.21037/apm.2019.05.02 [DOI: 10.21037/apm.2019.05.02]
  16. Maslach C., Jackson S. E. (1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2(2), 99–113. https://doi.org/10.1002/job.4030020205 [DOI: 10.1002/job.4030020205]
  17. Maslach C., Schaufeli W. B., Leiter M. P. (2001). Job burnout. Annual Review of Psychology, 52, 397–422. https://doi.org/10.1146/annurev.psych.52.1.397
  18. Maunder R. G., Heeney N. D., Strudwick G., Shin H. D., O'Neill B., Young N., Jeffs L. P., Barrett K., Bodmer N. S., Born K. B., Hopkins J., Jüni P., Perkhun A., Price D. J., Razak F., Mushquash C. J., Mah L. (2021). Burnout in hospital-based healthcare workers during COVID-19. Ontario COVID-19 Science Advisory Table. https://doi.org/10.47326/ocsat.2021.02.46.1.0
  19. Mehta D. H., Perez G. K., Traeger L., Park E. R., Goldman R. E., Haime V., Chittenden E. H., Denninger J. W., Jackson V. A. (2016). Building resiliency in a palliative care team: A pilot study. Journal of Pain and Symptom Management, 51(3), 604–608. https://doi.org/10.1016/j.jpainsymman.2015.10.013 [DOI: 10.1016/j.jpainsymman.2015.10.013]
  20. Moola S., Munn Z., Tufanaru C., Aromataris E., Sears K., Sfetcu R., Currie M., Qureshi R., Mattis P., Lisy K., Mu P-F. (2020). Chapter 7: Systematic reviews of etiology and risk. In Aromataris E., Munn Z. (Eds.). JBI manual for Evidence Synthesis. JBI. https://synthesismanual.jbi.global
  21. O'Mahony S., Ziadni M., Hoerger M., Levine S., Baron A., Gerhart J. (2018). Compassion fatigue among palliative care clinicians: Findings on personality factors and years of service. The American Journal of Hospice and Palliative Care, 35(2), 343–347. https://doi.org/10.1177/1049909117701695 [DOI: 10.1177/1049909117701695]
  22. Page M. J., McKenzie J. E., Bossuyt P. M., Boutron I., Hoffmann T. C., Mulrow C. D., Shamseer L., Tetzlaff J. M., Akl E. A., Brennan S. E., Chou R., Glanville J., Grimshaw J. M., Hróbjartsson A., Lalu M. M., Li T., Loder E. W., Mayo-Wilson E., McDonald S., McGuinness L. A., Moher D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71 [DOI: 10.1136/bmj.n71]
  23. Podgurski L., Greco C., Croom A., Arnold R., Claxton R. (2019). A brief mindfulness-based self-care curriculum for an interprofessional group of palliative care providers. Journal of Palliative Medicine, 22(5), 561–565. https://doi.org/10.1089/jpm.2018.0550 [DOI: 10.1089/jpm.2018.0550]
  24. Reddy S. K., Yennu S., Tanco K., Anderson A. E., Guzman D., Ali Naqvi S. M., Sadaf H., Williams J., Liu D. D., Bruera E. (2020). Frequency of burnout among palliative care physicians participating in a continuing medical education course. Journal of Pain and Symptom Management, 60(1), 80–86.e2. https://doi.org/10.1016/j.jpainsymman.2020.02.013 [DOI: 10.1016/j.jpainsymman.2020.02.013]
  25. Reddy S. K., Yennurajalingam S., Tanco K., Anderson A. E., Guzman D., Williams J., Liu D., Bruera E. (2022). Frequency and prediction of burnout among physicians who completed palliative care fellowship training—A 10 year survey. Journal of Pain and Symptom Management, 64(1), e15–e21. https://doi.org/10.1016/j.jpainsymman.2022.02.009 [DOI: 10.1016/j.jpainsymman.2022.02.009]
  26. Reith T. P. (2018). Burnout in United States healthcare professionals: A narrative review. Cureus, 10(12), e3681. https://doi.org/10.7759/cureus.3681 [DOI: 10.7759/cureus.3681]
  27. Soper K. (2022). Reducing burnout and promoting professional development in the palliative care service. Journal of Hospice & Palliative Nursing, 24(3), 181–185. https://doi.org/10.1097/NJH.0000000000000847 [DOI: 10.1097/NJH.0000000000000847]
  28. Sorenson C., Bolick B., Wright K., Hamilton R. (2017). An evolutionary concept analysis of compassion fatigue. Journal of Nursing Scholarship, 49(5), 557–563. https://doi.org/10.1111/jnu.12312 [DOI: 10.1111/jnu.12312]
  29. Whitebird R. R., Asche S. E., Thompson G. L., Rossom R., Heinrich R. (2013). Stress, burnout, compassion fatigue, and mental health in hospice workers in Minnesota. Journal of Palliative Medicine, 16(12), 1534–1539. https://doi.org/10.1089/jpm.2013.0202 [DOI: 10.1089/jpm.2013.0202]
  30. World Health Organization. (2019, May 28). Burn-out an “occupational phenomenon”: International Classification of Diseases. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases
  31. Yoon J. D., Hunt N. B., Ravella K. C., Jun C. S., Curlin F. A. (2017). Physician burnout and the calling to care for the dying: A national survey. The American Journal of Hospice & Palliative Care, 34(10), 931–937. https://doi.org/10.1177/1049909116661817 [DOI: 10.1177/1049909116661817]

MeSH Term

Humans
United States
Palliative Care
Nurse Practitioners
Burnout, Professional
Workforce
Physicians
Physician Assistants
Systematic Review Journal Article

Word Cloud

Created with Highcharts 10.0.0burnoutPCamongcareUnitedprovidersratefactorsNPsstudiesBurnoutStatesspecialtypalliativeproviderconducteddesignedphysicianinformfutureresearchPAsworkforceBACKGROUND:healthprofessionalscontributeshighjobturnoverWithinwillaccentuateshortageproblemsOBJECTIVES:systematicreviewanswerquestion"whatknownpracticingStates?"specificallyidentifyinfluencemitigatenursepractitionersassistantsPAphysiciansDATASOURCES:electronicliteraturesearch2012September2022completedEmbasePubMedCINAHLPsycINFOCONCLUSIONS:Analysis14showedfiveprimarythemesrelatedproviders:12physicalpsychologicalclinicalmanifestations3predictors4resiliency5interventionspiloteddecreasemajoritydelineatedrolefaileddetermineIMPLICATIONSFORPRACTICE:integralunderstandclearlyaffectstworoleseffortssustain

Similar Articles

Cited By