title: "It Is Like Heart Failure. It Is Chronic … and It Will Kill You": A Qualitative Analysis of Burnout Among Hospice and Palliative Care Clinicians.
abstract: Although prior surveys have identified rates of self-reported burnout among palliative care clinicians as high as 62%, limited data exist to elucidate the causes, ameliorators, and effects of this phenomenon.
  
  
  
  We explored burnout among palliative care clinicians, specifically their experiences with burnout, their perceived sources of burnout, and potential individual, interpersonal, organizational, and policy-level solutions to address burnout.
  
  
  
  During the 2014 American Academy of Hospice and Palliative Medicine/Hospice and Palliative Nurses Association Annual Assembly, we conducted three focus groups to examine personal narratives of burnout, how burnout differs within hospice and palliative care, and strategies to mitigate burnout. Two investigators independently analyzed data using template analysis, an inductive/deductive qualitative analytic technique.
  
  
  
  We interviewed 20 palliative care clinicians (14 physicians, four advanced practice providers, and two social workers). Common sources of burnout included increasing workload, tensions between nonspecialists and palliative care specialists, and regulatory issues. We heard grave concerns about the stability of the palliative care workforce and concerns about providing high-quality palliative care in light of a distressed and overburdened discipline. Participants proposed antiburnout solutions, including promoting the provision of generalist palliative care, frequent rotations on-and-off service, and organizational support for self-care. We observed variability in sources of burnout between clinician type and by practice setting, such as role monotony among full-time clinicians.
  
  
  
  Our results reinforce and expand on the severity and potential ramifications of burnout on the palliative care workforce. Future research is needed to confirm our findings and investigate interventions to address or prevent burnout.
authors.affiliation: Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Electronic address: diok@pitt.edu.
authors.forename: Dio
authors.initials: D
authors.lastname: Kavalieratos
authors.affiliation: Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Siconolfi
authors.affiliation: Durham Veterans Administration and Division of General Internal Medicine, Duke School of Medicine, Durham, North Carolina, USA.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Steinhauser
authors.affiliation: Four Seasons, Hendersonville, North Carolina, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Bull
authors.affiliation: Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
authors.affiliation: Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Swetz
authors.affiliation: Duke Cancer Institute and Division of Medical Oncology, Duke School of Medicine, Durham, North Carolina, USA.
authors.forename: Arif H
authors.initials: AH
authors.lastname: Kamal
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D002055:Burnout, Professional / Q000453:epidemiology* / Q000523:psychology*; D002908:Chronic Disease / Q000453:epidemiology / Q000523:psychology; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data*; D012307:Risk Factors; D000068217:Social Workers / Q000523:psychology / Q000706:statistics & numerical data*
keywords: Burnout; focus groups; health workforce; palliative care; qualitative research; resilience