Top

Published in:

01-12-2020 | Care | Research article

Burnout and resilience among Canadian palliative care physicians

Authors: Cindy Wang, Pamela Grassau, Peter G. Lawlor, Colleen Webber, Shirley H. Bush, Bruno Gagnon, Monisha Kabir, Edward G. Spilg

Published in: BMC Palliative Care | Issue 1/2020

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Available only for authorised users

Maslach C, Jackson SE. The measurement of experienced burnout. J Organ Behav. 1981;2:99–113. https://doi.org/10.1002/job.4030020205.CrossRef

Maslach C, Jackson SE, Leiter MP. Maslach burnout inventory manual. 3rd ed. Palo Alto, CA: Consulting Psychologists Press; 1996.

Maslach C, Jackson SE, Leiter MP. Maslach burnout inventory manual. 4th ed. Menlo Park, CA: Mind Garden Inc; 2018.

Shirom A, Melamed S, Toker S, et al. Burnout, mental and physical health: a review of the evidence and a proposed explanatory model. Int Rev Ind Organ Psychol. 2005;20:269–309.

Melamed S, Shirom A, Toker S, et al. Burnout and risk of cardiovascular disease: evidence, possible causal paths, and promising research directions. Psychol Bull. 2006;132:327–53. https://doi.org/10.1037/0033-2909.132.3.327.CrossRefPubMed

Schaufeli W. Past performance and future perspectives of burnout research. South African J Indust Psychol. 2003;29. https://doi.org/10.4102/sajip.v29i4.127.

Pompili M, Innamorati M, Narciso V, et al. Burnout, hopelessness and suicide risk in medical doctors. Clin Ter. 2010;161:511–4 2010/12/25.PubMed

Argentero P, Dell'Olivo B, Ferretti MS. Staff burnout and patient satisfaction with the quality of dialysis care. Am J Kidney Dis. 2008;51:80–922007/12/25. https://doi.org/10.1053/j.ajkd.2007.09.011.CrossRefPubMed

Vogel L. CMA must address physician burnout, pharmacare, say doctors. CMAJ. 2017;189:E1171–e11722017/09/13. https://doi.org/10.1503/cmaj.1095493.CrossRefPubMedPubMedCentral

10.

Shanafelt TD, Bradley KA, Wipf JE, et al. Burnout and self-reported patient Care in an Internal Medicine Residency Program. Ann Intern Med. 2002;136:358–67. https://doi.org/10.7326/0003-4819-136-5-200203050-00008.CrossRefPubMed

11.

Prins JT, van der Heijden FM, Hoekstra-Weebers JE, et al. Burnout, engagement and resident physicians' self-reported errors. Psychol Health Med. 2009;14:654–662010/02/26. https://doi.org/10.1080/13548500903311554.CrossRefPubMed

12.

Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251:995–10002009/11/26. https://doi.org/10.1097/SLA.0b013e3181bfdab3.CrossRefPubMed

13.

West CP, Huschka MM, Novotny PJ, et al. Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA. 2006;296:1071–82006/09/07. https://doi.org/10.1001/jama.296.9.1071.CrossRefPubMed

14.

Williams ES, Manwell LB, Konrad TR, et al. The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: results from the MEMO study. Health Care Manage Rev. 2007;32:203–122007/08/02. https://doi.org/10.1097/01.Hmr.0000281626.28363.59.CrossRefPubMed

15.

Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008;336:488–912008/02/09. https://doi.org/10.1136/bmj.39469.763218.BE.CrossRefPubMedPubMedCentral

16.

Tei S, Becker C, Kawada R, et al. Can we predict burnout severity from empathy-related brain activity? Transl Psychiatry. 2014;4:e3932014/06/04. https://doi.org/10.1038/tp.2014.34.CrossRefPubMedPubMedCentral

17.

Wilkinson H, Whittington R, Perry L, et al. Examining the relationship between burnout and empathy in healthcare professionals: a systematic review. Burn Res. 2017;6:18–292017/09/05. https://doi.org/10.1016/j.burn.2017.06.003.CrossRefPubMedPubMedCentral

18.

Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract. 2002;52 Suppl:S9–12 2002/10/23.PubMed

19.

Soler JK, Yaman H, Esteva M, et al. Burnout in European family doctors: the EGPRN study. Fam Pract. 2008;25:245–652008/07/16. https://doi.org/10.1093/fampra/cmn038.CrossRefPubMed

20.

Siu C, Yuen SK, Cheung A. Burnout among public doctors in Hong Kong: cross-sectional survey. Hong Kong Med J. 2012;18:186–92 2012/06/06.PubMed

21.

Zhang Y, Feng X. The relationship between job satisfaction, burnout, and turnover intention among physicians from urban state-owned medical institutions in Hubei, China: a cross-sectional study. BMC Health Serv Res. 2011;11:2352011/09/29. https://doi.org/10.1186/1472-6963-11-235.CrossRefPubMedPubMedCentral

22.

Hoff T, Whitcomb WF, Nelson JR. Thriving and surviving in a new medical career: the case of hospitalist physicians. J Health Soc Behav. 2002;43:72–91 2002/04/16.PubMed

23.

Shanafelt TD, West CP, Sinsky C, et al. Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2017. Mayo Clin Proc. 2019;94:1681–94. https://doi.org/10.1016/j.mayocp.2018.10.023.CrossRefPubMed

24.

Yoon JD, Hunt NB, Ravella KC, et al. Physician burnout and the calling to Care for the Dying: a National Survey. Am J Hosp Palliat Med. 2017;34:931–7. https://doi.org/10.1177/1049909116661817.CrossRef

25.

Reddy SK, Yennu S, Tanco K, et al. Frequency of burnout among palliative care physicians participating in a continuing medical education course. J Pain Symptom Manage, DOI. 20202020/02/28. https://doi.org/10.1016/j.jpainsymman.2020.02.013.

26.

Kamal AH, Bull JH, Wolf SP, et al. RETRACTED: prevalence and predictors of burnout among hospice and palliative care clinicians in the U.S. J Pain Symptom Manage. 2016;51:690–6. https://doi.org/10.1016/j.jpainsymman.2015.10.020.CrossRefPubMed

27.

Kamal A, Bull JH, Wolf SP, et al. Letter to the editor regarding “prevalence and predictors of burnout among hospice and palliative care professionals”. J Pain Symptom Manage. 2020;59:e3–5. https://doi.org/10.1016/j.jpainsymman.2019.11.001.CrossRefPubMed

28.

Koh MY, Chong PH, Neo PS, et al. Burnout, psychological morbidity and use of coping mechanisms among palliative care practitioners: a multi-Centre cross-sectional study. Palliat Med. 2015;29:633–422015/04/02. https://doi.org/10.1177/0269216315575850.CrossRefPubMed

29.

Dunwoodie DA, Auret K. Psychological morbidity and burnout in palliative care doctors in Western Australia. Intern Med J. 2007;37:693–82007/05/23. https://doi.org/10.1111/j.1445-5994.2007.01384.x.CrossRefPubMed

30.

Dreano-Hartz S, Rhondali W, Ledoux M, et al. Burnout among physicians in palliative care: impact of clinical settings. Palliat Support Care. 2016;14:402–102015/10/16. https://doi.org/10.1017/s1478951515000991.CrossRefPubMed

31.

Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson resilience scale (CD-RISC). Depress Anxiety. 2003;18:76–822003/09/10. https://doi.org/10.1002/da.10113.CrossRefPubMed

32.

Dyrbye LN, Power DV, Massie FS, et al. Factors associated with resilience to and recovery from burnout: a prospective, multi-institutional study of US medical students. Med Educ. 2010;44:1016–262010/10/01. https://doi.org/10.1111/j.1365-2923.2010.03754.x.CrossRefPubMed

33.

Back AL, Steinhauser KE, Kamal AH, et al. Building resilience for palliative care clinicians: an approach to burnout prevention based on individual skills and workplace factors. J Pain Symptom Manage. 2016;52:284–912016/02/28. https://doi.org/10.1016/j.jpainsymman.2016.02.002.CrossRefPubMed

34.

Sood A, Prasad K, Schroeder D, et al. Stress management and resilience training among Department of Medicine faculty: a pilot randomized clinical trial. J Gen Intern Med. 2011;26:858–612011/02/01. https://doi.org/10.1007/s11606-011-1640-x.CrossRefPubMedPubMedCentral

35.

Perez GK, Haime V, Jackson V, et al. Promoting resiliency among palliative care clinicians: stressors, coping strategies, and training needs. J Palliat Med. 2015;18:332–72015/02/26. https://doi.org/10.1089/jpm.2014.0221.CrossRefPubMed

36.

Canadian Medical Association. CMA National Physician Health Survey. A National Snapshothttps://www.cma.ca/cma-national-physician-health-survey-national-snapshot; 2018.

37.

Kawamura Y, Takayashiki A, Ito M, et al. Stress factors associated with burnout among attending physicians: a cross-sectional study. J Clin Med Res. 2018;10:226–322018/02/09. https://doi.org/10.14740/jocmr3299w.CrossRefPubMedPubMedCentral

38.

Kamal AH, Bull JH, Wolf SP, et al. Prevalence and predictors of burnout among hospice and palliative care clinicians in the U.S. J Pain Symptom Manage. 2020;59:e6–e132015/12/02. https://doi.org/10.1016/j.jpainsymman.2015.10.020.CrossRefPubMed

39.

Morrison RS. A national palliative care strategy for Canada. J Palliat Med. 2018;21:S-63–75.CrossRef

40.

Eysenbach G. Improving the quality of web surveys: the checklist for reporting results of internet E-surveys (CHERRIES). J Med Internet Res. 2004;6:e342004/10/09. https://doi.org/10.2196/jmir.6.3.e34.CrossRefPubMedPubMedCentral

41.

Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90:1600–132015/12/15. https://doi.org/10.1016/j.mayocp.2015.08.023.CrossRefPubMed

42.

Windle G, Bennett KM, Noyes J. A methodological review of resilience measurement scales. Health Qual Life Outcomes. 2011;9:8. https://doi.org/10.1186/1477-7525-9-8.CrossRefPubMedPubMedCentral

43.

QSR International Pty Ltd. NVivo version 12 ed. Melbourne: QSR International; 2018.

44.

Boyatzis RE. Transforming qualitative information: thematic analysis and code development. Thousand Oaks: Sage; 1998.

45.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.

46.

Braun V, Clarke V. What can "thematic analysis" offer health and wellbeing researchers? Int J Qual Stud Health Well-being. 2014;9:26152. https://doi.org/10.3402/qhw.v9.26152.CrossRefPubMed

47.

Braun V, Clarke V. Thematic analysis. In: Cooper H, Camic PM, Long L, et al., editors. APA handbook of research methods in psychology. Washington, DC: American Psychological Association; 2012. p. 51–71.

48.

O'Dowd E, O'Connor P, Lydon S, et al. Stress, coping, and psychological resilience among physicians. BMC Health Serv Res. 2018;18:7302018/09/23. https://doi.org/10.1186/s12913-018-3541-8.CrossRefPubMedPubMedCentral

49.

Agarwal SD, Pabo E, Rozenblum R, et al. Professional dissonance and burnout in primary care: a qualitative study. JAMA Intern Med. 2020;180:395–401. https://doi.org/10.1001/jamainternmed.2019.6326.CrossRefPubMedPubMedCentral

50.

Kavalieratos D, Siconolfi DE, Steinhauser KE, et al. "it is like heart failure. It is chronic … and it will kill you": a qualitative analysis of burnout among hospice and palliative care clinicians. J Pain Symptom Manage. 2017;53:901–910.e9012017/01/04. https://doi.org/10.1016/j.jpainsymman.2016.12.337.CrossRefPubMedPubMedCentral

51.

Swetz KM, Harrington SE, Matsuyama RK, et al. Strategies for avoiding burnout in hospice and palliative medicine: peer advice for physicians on achieving longevity and fulfillment. J Palliat Med. 2009;12:773–72009/07/23. https://doi.org/10.1089/jpm.2009.0050.CrossRefPubMed

52.

Brady KJS, Trockel MT, Khan CT, et al. What do we mean by physician wellness? A systematic review of its definition and measurement. Acad Psychiatry. 2018;42:94–1082017/09/16. https://doi.org/10.1007/s40596-017-0781-6.CrossRefPubMed

53.

Davidson JR. Connor-Davidson Resilience Scale (CD-RISC) Manual, www.cd-risc.com. (2020, Accessed April 2020).

54.

Granek L, Buchman S. Improving physician well-being: lessons from palliative care. CMAJ. 2019;191:E380–e3812019/04/10. https://doi.org/10.1503/cmaj.190110.CrossRefPubMedPubMedCentral

55.

Arya A, Buchman S, Gagnon B, et al. Pandemic palliative care: beyond ventilators and saving lives. Can Med Assoc J. 2020;192:E400–4. https://doi.org/10.1503/cmaj.200465.CrossRef

56.

Lavin Venegas C, Nkangu MN, Duffy MC, et al. Interventions to improve resilience in physicians who have completed training: a systematic review. PLoS One. 2019;14:e0210512. https://doi.org/10.1371/journal.pone.0210512.

57.

West CP, Dyrbye LN, Sinsky C, et al. Resilience and burnout among physicians and the general US working population. JAMA Netw Open. 2020;3:e2093852020/07/03. https://doi.org/10.1001/jamanetworkopen.2020.9385.CrossRefPubMedPubMedCentral

58.

Toh YP, Lam B, Soo J, et al. Developing palliative care physicians through mentoring relationships. Palliat Med Care. 2017;4:1–61.

59.

Gazelle G, Liebschutz JM, Riess H. Physician burnout: coaching a way out. J Gen Intern Med. 2015;30:508–132014/12/20. https://doi.org/10.1007/s11606-014-3144-y.CrossRefPubMed

60.

Leiter MP, Maslach C. Six areas of worklife: a model of the organizational context of burnout. J Health Hum Serv Adm. 1999;21:472–89 2000/01/06.PubMed

61.

West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med. 2018;283:516–292018/03/06. https://doi.org/10.1111/joim.12752.CrossRefPubMed

62.

LaDonna KA, Taylor T, Lingard L. Why open-ended survey questions are unlikely to support rigorous qualitative insights. Acad Med. 2018;93:347–92017/12/08. https://doi.org/10.1097/acm.0000000000002088.CrossRefPubMed

63.

O'Cathain A, Thomas KJ. "any other comments?" open questions on questionnaires – a bane or a bonus to research? BMC Med Res Methodol. 2004;4:25. https://doi.org/10.1186/1471-2288-4-25.CrossRefPubMedPubMedCentral

64.

Mills J, Wand T, Fraser JA. Exploring the meaning and practice of self-care among palliative care nurses and doctors: a qualitative study. BMC Palliat Care. 2018;17:632018/04/20. https://doi.org/10.1186/s12904-018-0318-0.CrossRefPubMedPubMedCentral

65.

Koh MYH, Hum AYM, Khoo HS, et al. Burnout and resilience after a decade in palliative care: what survivors have to teach us. A qualitative study of palliative care clinicians with more than 10 years of experience. J Pain Symptom Manage. 2020;59:105–15. https://doi.org/10.1016/j.jpainsymman.2019.08.008.CrossRefPubMed

66.

West CP, Dyrbye LN, Erwin PJ, et al. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet. 2016;388:2272–812016/10/04. https://doi.org/10.1016/s0140-6736(16)31279-x.CrossRefPubMed

67.

Rotenstein LS, Torre M, Ramos MA, et al. Prevalence of burnout among physicians: a systematic review. Jama. 2018;320:1131–502018/10/17. https://doi.org/10.1001/jama.2018.12777.CrossRefPubMedPubMedCentral

Title: Burnout and resilience among Canadian palliative care physicians
Authors: Cindy Wang
Pamela Grassau
Peter G. Lawlor
Colleen Webber
Shirley H. Bush
Bruno Gagnon
Monisha Kabir
Edward G. Spilg
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Care
Burnout Syndrome
Published in: BMC Palliative Care / Issue 1/2020
Electronic ISSN: 1472-684X
DOI: https://doi.org/10.1186/s12904-020-00677-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Burnout and resilience among Canadian palliative care physicians

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2020

Using the technology acceptance model to explore health provider and administrator perceptions of the usefulness and ease of using technology in palliative care

Perceptions of patients with end-stage kidney disease (ESKD) and their informal caregivers on palliative care as a treatment option: a qualitative study

Should analyses of large, national palliative care data sets with patient reported outcomes (PROs) be restricted to services with high patient participation? A register-based study

Complementary music therapy for cancer patients in at-home palliative care and their caregivers: protocol for a multicentre randomised controlled trial

Negotiating the turning point in the transition from curative to palliative treatment: a linguistic analysis of medical records of dying patients

A mixed methods investigation of end-of-life surrogate decisions among older adults