Department of Medicine, Division of Palliative Care, University of Ottawa, 43 Bruyère St., Ottawa, ON, K1N 5C8, Canada.
School of Social Work, Carleton University, 1125 Colonel By Dr., Ottawa, ON, K1S 5B6, Canada.
BMC Palliat Care. 2020 Nov 6;19(1):169. doi: 10.1186/s12904-020-00677-z.
Physicians experience high rates of burnout, which may negatively impact patient care. Palliative care is an emotionally demanding specialty with high burnout rates reported in previous studies from other countries. We aimed to estimate the prevalence of burnout and degree of resilience among Canadian palliative care physicians and examine their associations with demographic and workplace factors in a national survey.
Physician members of the Canadian Society of Palliative Care Physicians and Société Québécoise des Médecins de Soins Palliatifs were invited to participate in an electronic survey about their demographic and practice arrangements and complete the Maslach Burnout Inventory for Medical Professionals (MBI-HSS (MP)), and Connor-Davidson Resilience Scale (CD-RISC). The association of categorical demographic and practice variables was examined in relation to burnout status, as defined by MBI-HSS (MP) score. In addition to bivariable analyses, a multivariable logistic regression analysis, reporting odds ratios (OR), was conducted. Mean CD-RISC score differences were examined in multivariable linear regression analysis.
One hundred sixty five members (29%) completed the survey. On the MBI-HSS (MP), 36.4% of respondents reported high emotional exhaustion (EE), 15.1% reported high depersonalization (DP), and 7.9% reported low personal accomplishment (PA). Overall, 38.2% of respondents reported a high degree of burnout, based on having high EE or high DP. Median CD-RISC resilience score was 74, which falls in the 25th percentile of normative population. Age over 60 (OR = 0.05; CI, 0.01-0.38), compared to age ≤ 40, was independently associated with lower burnout. Mean CD-RISC resilience scores were lower in association with the presence of high burnout than when burnout was low (67.5 ± 11.8 vs 77.4 ± 11.2, respectively, p < 0.0001). Increased mean CD-RISC score differences (higher resilience) of 7.77 (95% CI, 1.97-13.57), 5.54 (CI, 0.81-10.28), and 8.26 (CI, 1.96-14.57) occurred in association with age > 60 as compared to ≤40, a predominantly palliative care focussed practice, and > 60 h worked per week as compared to ≤40 h worked, respectively.
One in three Canadian palliative care physicians demonstrate a high degree of burnout. Burnout prevention may benefit from increasing resilience skills on an individual level while also implementing systematic workplace interventions across organizational levels.
医生的 burnout 发生率很高，这可能会对患者的护理产生负面影响。姑息治疗是一项情感要求很高的专业，之前来自其他国家的研究报告了较高的 burnout 发生率。我们旨在估计加拿大姑息治疗医生的 burnout 发生率和恢复力程度，并在全国调查中检查他们与人口统计学和工作场所因素的关联。
邀请加拿大姑息治疗医生学会和魁北克姑息治疗医生学会的医生成员参加一项关于他们的人口统计学和实践安排的电子调查，并完成 Maslach 职业倦怠量表（MBI-HSS（MP））和 Connor-Davidson 恢复力量表（CD-RISC）。使用 MBI-HSS（MP）评分定义 burnout 状态，检查分类人口统计学和实践变量与 burnout 状态的关联。除了双变量分析外，还进行了多变量逻辑回归分析，报告了优势比（OR）。使用多变量线性回归分析检查 CD-RISC 得分的平均差异。
165 名成员（29%）完成了调查。在 MBI-HSS（MP）上，36.4%的受访者报告情绪耗竭高（EE），15.1%报告去人格化高（DP），7.9%报告个人成就感低（PA）。总体而言，根据 EE 或 DP 高，38.2%的受访者报告高度 burnout。CD-RISC 韧性得分中位数为 74，处于正态分布的第 25 百分位数。与 40 岁及以下的人相比，60 岁以上（OR=0.05；CI，0.01-0.38）的年龄与较低的 burnout 有关。与低度 burnout 相比，存在高度 burnout 时的 CD-RISC 韧性平均得分较低（分别为 67.5±11.8 与 77.4±11.2，p<0.0001）。与 60 岁以上相比，与 40 岁及以下相比，年龄较大（60 岁以上与 40 岁以下相比，分别增加 7.77（95%CI，1.97-13.57）、5.54（CI，0.81-10.28）和 8.26（CI，1.96-14.57）），与主要专注于姑息治疗的实践和每周工作超过 60 小时相比，每周工作 40 小时以下，分别与更高的 CD-RISC 评分差异（更高的韧性）相关。
三分之一的加拿大姑息治疗医生表现出高度 burnout。预防 burnout 可能受益于提高个人的韧性技能，同时在组织层面实施系统的工作场所干预措施。
