Duke Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA; Duke Cancer Institute, Durham, North Carolina, USA.
Four Seasons Compassion for Life, Flat Rock, North Carolina, USA.
J Pain Symptom Manage. 2020 May;59(5):e6-e13. doi: 10.1016/j.jpainsymman.2019.11.017. Epub 2019 Nov 26.
Many clinical disciplines report high rates of burnout, which leads to low quality of care. Palliative care clinicians routinely manage patients with significant suffering, aiming to improve quality of life. As a major role of palliative care clinicians involves educating patients and caregivers regarding identifying priorities and balancing stress, we wondered how clinician self-management of burnout matches against the emotionally exhaustive nature of the work.
We sought to understand the prevalence and predictors of burnout using a discipline-wide survey.
We asked American Academy of Hospice and Palliative Medicine clinician members to complete an electronic survey querying demographic factors, job responsibilities, and the Maslach Burnout Inventory. We performed univariate and multivariable regression analyses to identify predictors of high rates of burnout.
We received 1357 responses (response rate 30%). Overall, we observed a burnout rate of 38.7%, with higher rates reported by nonphysician clinicians. Most burnout stemmed from emotional exhaustion, with depersonalization comprising a minor portion. Factors associated with higher odds of burnout include nonphysician clinical roles, working in smaller organizations, working longer hours, being younger than 50 years of age, and working weekends. We did not observe different rates between palliative care clinicians and hospice clinicians. Higher rated self-management activities to mitigate burnout include participating in interpersonal relationships and taking vacations.
Burnout is a major issue facing the palliative care clinician workforce. Strategies at the discipline-wide and individual levels are needed to sustain the delivery of responsive, available, high-quality palliative care for all patients with serious illness.
许多临床学科报告称存在较高的倦怠率，这导致医疗服务质量下降。姑息治疗临床医生通常会管理患有严重痛苦的患者，旨在提高生活质量。由于姑息治疗临床医生的主要职责之一是教育患者和护理人员如何确定优先事项和平衡压力，因此我们想知道临床医生自我管理倦怠与工作中情感疲惫的性质如何匹配。
我们使用全学科调查来了解倦怠的流行率和预测因素。
我们要求美国临终关怀和姑息医学医师协会的临床医生成员完成一份电子调查，询问人口统计学因素、工作职责和马斯拉赫倦怠量表。我们进行了单变量和多变量回归分析，以确定倦怠率高的预测因素。
我们收到了 1357 份回复（回复率为 30%）。总体而言，我们观察到的倦怠率为 38.7%，非医师临床医生的报告率更高。大多数倦怠源于情感疲惫，而去人性化仅占一小部分。与更高倦怠率相关的因素包括非医师临床角色、在较小的组织中工作、工作时间更长、年龄小于 50 岁以及在周末工作。我们没有观察到姑息治疗临床医生和临终关怀临床医生之间的差异。更高的自我管理活动评分可减轻倦怠，包括参与人际关系和休假。
倦怠是姑息治疗临床医生劳动力面临的主要问题。需要在学科层面和个人层面采取策略，以维持对所有患有严重疾病的患者提供响应迅速、可用且高质量的姑息治疗。
