Scientific Papers

Burnout and quality of life in Portuguese healthcare professionals working in oncology and palliative care—a preliminary study | BMC Palliative Care

Palliative care (PC), carried out by a multidisciplinary team, should be provided on the basis of patients’ needs, such as the high suffering associated with the disease, and not on the basis of diagnosis [31].

Working in a specialized service as oncological PC, has specificities and needs that impose and require professionals an increased dedication and effort, compared to other health contexts [31].

So, these professionals are exposed to pain and suffering, as well as complex and advanced health problems, sometimes with difficult decisions to make, namely with ethical implications [31].

For this reason, these professionals constitute a population more vulnerable to Burnout syndrome [31]. Burnout syndrome is related to experiences of stress at work, when the individual is faced with a mismatch between expectations and personal / professional motivations, and the resources that work offers to satisfy them [31].

In the present study, the authors tried to evaluate the risk of burnout and quality of life of health professionals working in cancer PC, in hospital context.

After the evaluation of the dimensions of Burnout, it was observed that most of professionals in this study presented moderate to high levels of “Emotional exhaustion” and “Depersonalization”, as well as, low levels of “Personal achievement”. So, at the time of the study, these professionals presented high risk of Burnout. These results, although the sample is small, are in agreement with the literature.

According to the different professional groups, it was found that, for the dimension “Emotional exhaustion”, higher levels were identified in physicians and nurses. In the group of nurse assistant, the levels of this dimension were low to moderate. In the group designated as “others” (that included social worker and psychologists) the levels were low.

For the dimension “Depersonalization”, only the group “others” showed low levels, while physicians, nurses and nurse assistants had moderate levels. However, the group of nurses presented the highest scores, with statistical significance, compared to the others. In the dimension “Personal achievement”, there were small differences between professional groups (physicians – moderate levels; nurses—moderate to high levels; nurse assistants- high levels; “other” – moderate levels).

Gómez—Urquiza et al. analize the levels and prevalence of burnout’s dimensions in PC nurses [32]. The results of this review and meta-analysis have shown that between 24 and 30% of PC nurses were suffering one of the burnout dimensions [32]. “Depersonalization” was the most affected dimension, because working conditions were harsh and it ends up producing exhaustion and inefficiency with the patient [32].

The results indicate that in the different dimensions of burnout in the group of PC professionals, the scores are relatively high in emotional exhaustion (55.9% had a high score). This can be explained by the fact that, PC professionals are exposed to crisis situations as the transmission of bad news, confrontation with death and suffering, dealing with ambivalent families and the need to deal with their own emotions to help others.

In this study, relatively high levels of depersonalization (75.8%) and low to moderate levels of personal achievement (63.6%) were also observed. Both Metha and Garcia et al. found that nurses working in PC had a reduced personal achievement [33,34,35]. However, Emold et al. observed that, about 80% of health professionals in cancer units had very satisfactory levels of personal fulfillment [34].

In the study, there was a trend of similar levels in the dimensions of burnout between physicians, nurses and nurse assistants. However, in the group “others”, there was an inverse trend (low emotional exhaustion and depersonalization score and moderate personal achievement).

We know that the practice of medicine, particularly in this area, can provide opportunities to develop a career with huge meaning and satisfaction [35,36,37,38]. Taking into account the service provided, which requires a different involvement with work and with patients, especially because of the life/death limit situation they experience, it is important to design strategies capable of promoting the development of personal and situational resources capable of facilitating stress management, minimizing their effect on the health status of individuals and their work. These strategies may include meditation and mindfulness, training of effective communication techniques and self-care [39, 40].

Regarding QoL, the results showed that, this was not influenced by the high burnout rates. Although 19 individuals in the sample presented a high burnout score in the dimension “Emotional exhaustion”, the perception of quality of life in the different dimensions varied between 13.6 and 19 (scale of 4–20). Regarding “Depersonalization”, 25 individuals presented a high score, but their perception of QoL in the various dimensions was from 13.7 to 15.6 on the same scale. In the “Personal achievement”, 21 of the elements presented a low score (i.e., a low personal achievement), but the level of QoL perception varied between 14.2 and 15.9. The same trend was observed in quality of life in general (4, i.e., Good) and in health-related conditions in which most individuals felt quite satisfied.

These results may seem contradictory. However, it can be explained by the fact that, these professionals are part of a cohesive team, with solid personal relationships. Furthermore, they have a long and extensive care experience, which may have facilitated the development of mechanisms of inter-help and coping, and thus prevent the high levels of Burnout, experienced by professionals, have a significant impact on QoL.

Pereira et al. developed a study in physicians and nurses who worked at palliative care units in Portugal [25]. This study showed a low risk of burnout (55%). These results were similar with the literature [41, 42].

Palliative medicine professionals are characterized by resilience, indispensable to face the challenges that are naturally associated with this area. Although curative therapeutic success is fruitful, “terminality” is naturally accepted, enjoying “small big” successes, such as controlled intense pain, a quiet and suffering-free death, reconciliation. Positive reinforcement of third parties (friends and family of patients) is part of the daily life of this team and helps make your path easier [43, 44].

Pereira et al. identified some protective factors to burnout, as religious and spiritual dimension, but also, training in palliative care [43, 44].

In this sample, there was a satisfactory perception of QoL. This means that these professionals have already developed the appropriate self-protection strategies, thus preventing their QoL from being affected by burnout. Thus, prevention, diagnosis and intervention at burnout level is an important measure to be taken in health organizations, since the consequences that come from the experiences experienced by professionals will be reflected both in the quality of services provided to patients and in the QoL and well-being of professionals.

The authors recognize some limitations of the present research. One of the limitations was the sample size. However, according to internal consistency, it is a robust sample. This study was carried out in the context of a PC team. Therefore, the sample is so heterogeneous, just like other teams in this area, which must be multidisciplinary. On the other hand, the presence of greater representation of certain professional groups allowed reaching more conclusions.

On the other hand, the fact that this study took place only in one institution, limited the sample size and the type of PC patients observed. The patients in palliative care observed in this study are only oncological patients, not considering non-cancer patients. This fact was explained by the target population of the hospital, where the study took place.

Further studies are needed to complement these results, for example, in the context of hospice and PC community teams. In the near future, it would be interesting to extend this study to other national units.

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