Kavalieratos Dio, Siconolfi Daniel E, Steinhauser Karen E, Bull Janet, Arnold Robert M, Swetz Keith M, Kamal Arif H
Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
J Pain Symptom Manage. 2017 May;53(5):901-910.e1. doi: 10.1016/j.jpainsymman.2016.12.337. Epub 2017 Jan 4.
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.
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.
During the 2014 American Academy of Hospice and Palliative Medicine/Hospice and Palliative Nurses Association Annual Assembly, we conducted three 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.
We interviewed 20 palliative care clinicians (14 physicians, four advanced practice providers, and two social workers). Common sources of burnout included increasing workload, tensions between nonspecialists and palliative care specialists, and regulatory issues. We heard grave concerns about the stability of the palliative care workforce and concerns about providing high-quality palliative care in light of a distressed and overburdened discipline. Participants proposed antiburnout 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.
Our results reinforce and expand on the severity and potential ramifications of burnout on the palliative care workforce. Future research is needed to confirm our findings and investigate interventions to address or prevent burnout.
尽管先前的调查显示，姑息治疗临床医生自我报告的职业倦怠率高达62%，但用于阐明这一现象的原因、缓解因素及影响的数据却很有限。
我们探讨了姑息治疗临床医生的职业倦怠情况，特别是他们的职业倦怠经历、感知到的职业倦怠来源，以及应对职业倦怠的潜在个人、人际、组织和政策层面的解决方案。
在2014年美国临终关怀与姑息医学学会/临终关怀与姑息护理护士协会年会上，我们开展了三个焦点小组讨论，以审视职业倦怠的个人叙述、临终关怀与姑息治疗中职业倦怠的差异，以及缓解职业倦怠的策略。两名研究人员使用模板分析法（一种归纳/演绎定性分析技术）独立分析数据。
我们采访了20名姑息治疗临床医生（14名医生、4名高级执业提供者和2名社会工作者）。职业倦怠的常见来源包括工作量增加、非专科医生与姑息治疗专科医生之间的紧张关系以及监管问题。我们听到了对姑息治疗劳动力稳定性的严重担忧，以及鉴于该学科面临困境和负担过重而对提供高质量姑息治疗的担忧。参与者提出了抗职业倦怠的解决方案，包括促进提供全科姑息治疗、频繁的轮班服务以及组织对自我护理的支持。我们观察到临床医生类型和执业环境之间职业倦怠来源的差异，例如全职临床医生中的角色单调问题。
我们的结果强化并扩展了职业倦怠对姑息治疗劳动力的严重性及潜在影响。需要未来的研究来证实我们的发现，并调查应对或预防职业倦怠的干预措施。
