title: Prevalence and Predictors of Burnout Among Hospice and Palliative Care Clinicians in the U.S.
abstract: BACKGROUND
  Many clinical disciplines report high rates of burnout, which lead to low quality of care. Palliative care clinicians routinely manage patients with significant suffering, aiming to improve quality of life. As a major role of palliative care clinicians involves educating patients and caregivers regarding identifying priorities and balancing stress, we wondered how clinician self-management of burnout matches against the emotionally exhaustive nature of the work.
  
  
  OBJECTIVE
  We sought to understand the prevalence and predictors of burnout using a discipline-wide survey.
  
  
  METHODS
  We asked American Academy of Hospice and Palliative Medicine clinician members to complete an electronic survey querying demographic factors, job responsibilities, and the Maslach Burnout Inventory. We performed univariate and multivariate regression analyses to identify predictors of high rates of burnout.
  
  
  RESULTS
  We received 1357 responses (response rate 30%). Overall, we observed a burnout rate of 62%, with higher rates reported by nonphysician clinicians. Most burnout stemmed from emotional exhaustion, with depersonalization comprising a minor portion. Factors associated with higher rates of burnout include working in smaller organizations, working longer hours, being younger than 50 years, and working weekends. We did not observe different rates between palliative care clinicians and hospice clinicians. Higher rated self-management activities to mitigate burnout include participating in interpersonal relationships and taking vacations.
  
  
  CONCLUSIONS
  Burnout is a major issue facing the palliative care clinician workforce. Strategies at the discipline-wide and individual levels are needed to sustain the delivery of responsive, available, high-quality palliative care for all patients with serious illness.
authors.affiliation: Duke Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA; Duke Cancer Institute, Durham, North Carolina, USA. Electronic address: arif.kamal@duke.edu.
authors.forename: Arif H
authors.initials: AH
authors.lastname: Kamal
authors.affiliation: Four Seasons Compassion for Life, Flat Rock, North Carolina, USA.
authors.forename: Janet H
authors.initials: JH
authors.lastname: Bull
authors.affiliation: Duke Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Wolf
authors.affiliation: University of Alabama-Birmingham, Birmingham, Alabama, USA.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Swetz
authors.affiliation: Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Tait D
authors.initials: TD
authors.lastname: Shanafelt
authors.affiliation: American Academy of Hospice and Palliative Medicine, Rosemont, Illinois, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Ast
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Dio
authors.initials: D
authors.lastname: Kavalieratos
authors.affiliation: University of Kansas, Kansas City, Kansas, USA.
authors.forename: Christian T
authors.initials: CT
authors.lastname: Sinclair
authors.affiliation: Duke Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA.
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002055:Burnout, Professional / Q000453:epidemiology*; D005260:Female; D017051:Hospice Care / Q000523:psychology / Q000706:statistics & numerical data*; D006738:Hospices / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology / Q000706:statistics & numerical data*; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D012955:Societies, Medical; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Burnout; palliative care; workforce