Prevalence of burnout in healthcare professionals providing palliative care and the effect of interventions to reduce symptoms: A systematic literature review.

Background: In recent years there has been increasing attention for the prevalence and prevention of burnout among healthcare professionals. There is unclarity about prevalence of burnout in healthcare professionals providing palliative care and little is known about effective interventions in this area. Aim: To investigate the prevalence of (symptoms of) burnout in healthcare professionals providing palliative care and what interventions may reduce symptoms of burnout in this population. Design: A systematic literature review based on criteria of the PRISMA statement was performed on prevalence of burnout in healthcare professionals providing palliative care and interventions aimed at preventing burnout. Data sources: PubMed, PsycInfo and Cinahl were searched for studies published from 2008 to 2020. Quality of the studies was assessed using the method of Hawkers for systematically reviewing research. Results: In total 59 studies were included. Burnout among healthcare professionals providing palliative care ranged from 3% to 66%. No major differences in prevalence were found between nurses and physicians. Healthcare professionals providing palliative care in general settings experience more symptoms of burnout than those in specialised palliative care settings. Ten studies reported on the effects of interventions aimed at preventing burnout. Reduction of one or more symptoms of burnout after the intervention was reported in six studies which were aimed at learning meditation, improving communication skills, peer-coaching and art-therapy based supervision. Conclusion: The range of burnout among healthcare professionals providing palliative care varies widely. Interventions based on meditation, communication training, peer-coaching and art-therapy based supervision have positive effects but long-term outcomes are not known yet

Clinicians’ perceptions of the emotional impact of providing palliative care: A qualitative interview study.

Objectives. Many aspects of palliative care, such as managing (complicated) symptoms, conductinggoals-of-care conversations, and repeated exposure to loss, can be stressful to clinicians.Previous research on the emotional impact of providing palliative care was mainlydone in specialist settings. However, the majority of palliative care is provided by clinicianswho are not specialized in palliative care, and can be supported by palliative care specialistsonly when needed. Therefore, this study aimed to gain insight into the emotional impactof providing palliative care on clinicians, both palliative care generalists and specialists.Methods. A qualitative interview study among 21 clinicians (11 doctors and 10 nurses) workingin hospitals, home care, or nursing homes in the Netherlands was conducted. BetweenFebruary and June 2019, 13 palliative care generalists and 8 specialists were interviewed.Interviews were thematically analyzed by two researchers.Results. All clinicians considered the emotional impact of providing palliative care to be substantialand experienced both positive and negative aspects of providing palliative care. Severalaspects of providing palliative care can support or undermine emotional stability. These socalledfacilitators and barriers, such as practicing self-care and complexity of palliative care,were found at three different levels: individual, team, and organization.Significance of results. Although clinicians experience providing palliative care as meaningfuland valuable, the emotional impact is considerable. Negative and positive aspects often coexist.Further insight into the dynamics and magnitude of the emotional impact of providingpalliative care is needed in order to create a healthy working environment and develop adequateinterventions. Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Validation of the FACIT-Sp-12 in a Dutch cohort of patients with advanced cancer

Objective: Although the Dutch Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being 12 Item Scale (FACIT-Sp-12) has been used in several Dutch studies, no study has assessed the measurement properties of the translation. The aim of this study was to perform an item-reduction analysis, confirmatory factor analysis (CFA), test of reliability, and test of convergent validity. Methods: From the baseline data of a cohort study on experienced quality of care and quality of life (eQuiPe study), 400 advanced cancer patients without missing values on any of the variables were selected. In addition to demographic and religious/spiritual characteristics, study measures included the FACIT-Sp-12 and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC-QLQ-C30). Results: Item reduction analysis showed that Items 4 and 8 had low correlations to the total scale (0.75). CFA indicated a good fit for a three-factor structure with Meaning, Peace and Faith, and good Cronbach's α coefficients for the total as well as the subscales (0.71–0.86). The removal of Items 4, 8, and 12 further improved the goodness of fit and Cronbach's α coefficients. Convergent validity was adequate with the EORTC-QLQ-C30. Conclusion: Our analysis of the FACIT-Sp-12 revealed serious questions about three items and concerns about the Faith subscale. These problematic items deserve further attention so should be interpreted with care when using this scale. A future study could look into the items and test possible replacements

Spiritual well-being and associated factors in Dutch patients with advanced cancer

Context: Palliative care aims to support patients’ spiritual needs with the intention of promoting their spiritual well-being (SWB), an important dimension of quality of life. SWB is one of the less-studied dimensions of QoL, particularly in a secular country such as the Netherlands. Objectives: In this study we aimed to get a better understanding of SWB in Dutch patients with advanced cancer. We therefore examined its prominence and associated factors. Methods: We used the baseline data of a cohort study on experienced quality of care and quality of life (eQuiPe study), which included 1,103 patients with advanced cancer. In addition to sociodemographic and religious/spiritual characteristics, study measures comprised the SWB subscales Meaning, Peace, and Faith of the revised FACIT-Sp-12, spiritual problems and needs (PNPCsv), quality of life (EORTC-QLQ-C30) and satisfaction with healthcare professionals’ interpersonal skills (INPATSAT-32). Results: On average, patients experienced quite a bit of Meaning (8.9, SD 2.3), a little bit to somewhat Peace (6.8, SD 2.7), and very low levels of Faith (2.9, SD 3.7). Two-thirds (71%) of patients reported one or more spiritual problems, for which the majority (54%) wanted to receive attention. In the final multivariable models, only a few factors were associated with SWB, such as greater spiritual needs with lower levels of Meaning and Peace. Conclusion: Dutch patients with advanced cancer experience medium to low levels of Meaning, Peace, and Faith. More attention for their SWB is warranted