A Tale of Two Cities: Results of the ENABLE CHF-PC Early, Concurrent Palliative Care Heart Failure Feasibility Trial (SA538C)

Abstract

Objectives Discuss burnout, as identified and described by current hospice and palliative care clinicians, and its implications on the hospice and palliative care discipline. Identify potential ameliorating and protective factors against burnout applicable to the hospice and palliative care clinical workforce. Original Research Background. Clinical palliative care is stressful, with self-reported burnout rates as high as 62% among clinicians. To date, there has been scant qualitative investigation into the causes, ameliorators, and effects of this pervasive phenomenon. Alarming as such statistics may be, quantitative estimates in isolation cannot disentangle the predisposing, situational, and protective factors related to one’s experience of burnout; absent rigorous mixedmethods appraisal of the lived experience of burnout, feasible solutions to address burnout may be out of reach. Research Objectives. To explore sources, implications, and solutions vis-a-vis burnout among hospice and palliative care (HPC) clinicians. Methods. During the 2014 AAHPM/HPNA Annual Assembly, we conducted three semi-structured focus groups on the following topics: personal narratives of burnout, how burnout differs within HPC, and strategies to mitigate burnout. Two investigators independently analyzed data using template analysis, an inductive/deductive qualitative technique. Results. We interviewed 20 HPC clinicians (14 physicians, 4 advanced practitioners, 2 social workers). Participants were 65% female; overall, 55% had practiced for 0-5 years, 30% for 6-20 years, and 15% for 21+ years. We observed variability in sources of burnout between clinician types and by practice settings (i.e., hospice or palliative care). Common sources of burnout included: increasing workloads, tensions between non-specialists and HPC specialists, and regulatory issues. Interviewees proposed antiburnout solutions including: promoting the provision of generalist palliative care by colleagues, frequent rotations on-and-off service, and organizational support for self-care modalities. Participants expressed grave concerns about the stability of the HPC workforce and concerns of providing highquality palliative care in light of a distressed, overburdened discipline. Conclusion. Complementing recent survey data, our results illustrate the alarming prevalence, severity and potential ramifications of burnout on the HPC workforce. Additionally concerning is the paucity of protective structures and policies to attenuate burnout.