Impact of confrontation to patient suffering and death on wellbeing and burnout in professionals: a cross-sectional study

Abstract

Background: Palliative care and oncology generate a risk of burnout and psychological distress in professionals. This study aims to identify both psychopathological and positive factors related to work mental health. The aims of the study were (i) to explore the extent to which these professionals are confronted with suffering, illness, and death; and the prevalence of psychological distress and/or burnout, (ii) to identify potential determinants of burnout and psychological wellbeing at work, (iii) to develop an integrative model of mental health and to identify frequency and impact of confrontations with death, and (iv) to identify profiles of professionals are at risk of developing a mental health disorder or, conversely, characterized by wellbeing. Methods: A cross-sectional study was conducted in palliative care and oncology with questionnaires evaluating confrontations with death, coping, burnout, psychological distress, personality, self-esteem, well-being and meaning at work. Regressions, clustering, and structural equation modelling analyses were performed. Results: 109 professionals participated (58% from oncology and 42% from palliative care, 79% were female, 65% were between 30 and 49 years old). Aim i: 30% witnessed an intolerable suffering at least 9 times a month, 45% reported moderate to high level of burnout, 39% anxiety and 11% depression. Aim ii: the determinants of burnout are conscientiousness (b=0.18, p=.040), neuroticism (b=0.23, p=.002), work meaning (b=-0.25, p=.020) and wellbeing (b=-0.25, p=.020) (R2=0.44). The determinants of wellbeing are work meaning (b= 0.46, p<.001), depersonalization (b= 0.18, p=.006), self-esteem (b=0.14, p=.010), fulfilment (b=0.15, p=.020) emotional exhaustion (b=- 0.23, p<.001) (R2=0.71). Aim iii: the integrative model includes both well-being (self-esteem, conscientiousness) and psychopathology (neuroticism, anxiety) parameters, and strongly satisfied the standard SEM goodness of fit indices (e.g., CFI, IFI, and TLI ≥ 0.95). Aim iv: three profiles were identified: (a) a “distressed profile” with a majority of professionals at the patient's bedside, (b) a “disengaged profile” with professionals working as second-line consultants, (c) a “wellbeing profile” with the administrative and research teams. Conclusions: An integrative approach is essential to understand the full range of mental health issues for professionals. Meaning at work is a key factor in an interventional perspective that should primarily affect front-line professionals with limited experience.