Ethical Decisions in Palliative Care: Interprofessional Relations as a Burnout Protective Factor? Results From a Mixed-Methods Multicenter Study in Portugal.
BACKGROUND
Ethical decisions are part of contemporary practices in palliative care. The need of making such decisions is associated to higher burnout levels and other work related problems among healthcare professionals.


OBJECTIVE
As part of the project entitled "Decisions in End-of-Life Care in Spain and Portugal" (DELiCaSP), this study aims to (i) identify the most common ethical decisions made by Portuguese palliative care teams and (ii) understand how the making of such decisions relates to burnout.


METHODS
A mixed methods study was conducted with 9 palliative care teams, using (i) questionnaires of socio-demographic and professional variables, work-related experiences, (ii) the Maslach Burnout Inventory, (iii) interviews and (iv) observations. These teams were geographically dispersed across the country, covering the North, Centrum and South regions, and heterogeneous: Five palliative care units for inpatients; three home care teams; and one hospital support team. A total of 20 interviews and 240 hours of observations were completed until reaching saturation.


RESULTS
The most common ethical decisions were related to communication issues (information disclosure of the diagnosis and prognosis), forgoing treatment and sedation. Although perceived as stressful, emotionally demanding and challenging, ethical decisions were not significantly associated with burnout.


CONCLUSIONS
Making ethical decisions is not associated with higher burnout levels among professionals working in Portuguese palliative care teams. This can be explained by the interprofessional decision-making process followed by these teams, which promotes a sense of shared-decision and team-based empowerment; and by the advanced level of interdisciplinary education in palliative care that these professionals have.
Universidad de Las Palmas de Gran Canaria, Facultad de Ciencias de la Salud, Departamento de Enfermería, Las Palmas, Spain Universidade Católica Portuguesa, Instituto de Bioética, Gabinete de Investigação em Bioética, Porto, Portugal.
Pablo
P
Hernández-Marrero
Universidade Católica Portuguesa, Instituto de Bioética, Gabinete de Investigação em Bioética, Porto, Portugal martinspereira.sandra@gmail.com.
Sandra Martins
SM
Pereira
Ana Sofia
AS
Carvalho
D000328:Adult; D002055:Burnout, Professional / Q000523:psychology*; D003142:Communication; D003657:Decision Making; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D010166:Palliative Care / Q000941:ethics* / Q000523:psychology*; D011174:Portugal; D065840:Protective Factors; D012959:Socioeconomic Factors
burnout; end-of-life care; ethical decisions; ethical issues; interprofessional relations; mixed-methods; palliative care; shared decision making