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Effects of end-of-life care on medical health professionals: A dialectical approach

Published online by Cambridge University Press:  30 March 2021

Yaffa Naomi Stokar Open the ORCID record for Yaffa Naomi Stokar [Opens in a new window]  and
Ruth Pat-Horenczyk
Yaffa Naomi Stokar*
Affiliation:
The Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel
Ruth Pat-Horenczyk
Affiliation:
The Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel
*
Author for correspondence: Yaffa Naomi Stokar, The Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel. E-mail: [email protected]
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Abstract

Objective

The provision of end-of-life (EOL) care has complex effects on both the professional and personal well-being of medical health personnel (MHP). Previous studies have mostly focused on negative or positive influences as mutually exclusive effects. This study offers a new conceptualization by applying a dialectical lens, looking at secondary traumatic stress (STS) and post-traumatic growth (PTG) as dual possible coexisting phenomena. The creation of four theoretically possible profiles, based on the combinations of high or low levels in each dimension, offers a practical translation of this idea toward intervention development.

Method

Data were collected at a large tertiary pediatric medical center (n = 1,123) aiming at assessing all personnel. Research methods included collecting demographic data and using validated scales to assess STS, PTG, burnout, compassion satisfaction, and both personal and professional social support.

Results

We classified four response profiles according to the STS and PTG levels: (1) Dialectical-impact, high STS/high PTG, (2) Growth-dominant, high PTG/low STS, (3) Stress-dominant, high STS/low PTG, and (4) Limited-impact, low STS/low PTG. The four profiles differed based on profession, but not other demographics. Physicians were represented significantly higher in the Stress-dominant profile; nurses were highly represented in the Dialectical-impact profile. A significant difference was found when adding reported EOL care as a distinct factor with a higher relative proportion of the “dialectical” response among those reporting providing EOL care.

Significance of results

Findings from this study point toward the recognition and understanding of the complexity resulting from the provision of EOL care. A more complex profile classification, including the dialectical profile, may reflect a broader tendency to ways that MHP are affected by their work. Introducing “dialectical thinking” can lead to more personalized and precise intervention planning for MHP. Tailored interventions promoting personal and professional well-being, based on individual profiles, can contribute to more effective interventions and better resource utilization.

Keywords

BurnoutEnd-of-life careSecondary traumatic stressMedical health professionals' well-beingPost-traumatic growth
Type
Original Article
Information
Palliative & Supportive Care , Volume 20 , Issue 1 , February 2022 , pp. 76 - 83
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

REFERENCES

Agrawal, V, Plantinga, L, Abdel-Kader, K, et al. (2020) Burnout and emotional well-being among nephrology fellows: A national online survey. Journal of the American Society of Nephrology 31(4), 675–685.CrossRefGoogle ScholarPubMed
Beasley, TM and Schumacker, RE (1995) Multiple regression approach to analyzing contingency tables: Post hoc and planned comparison procedures. The Journal of Experimental Education 64(1), 79–93.CrossRefGoogle Scholar
Ben-Porat, A and Itzhaky, H (2009) Implications of treating family violence for the therapist: Secondary traumatization, vicarious traumatization, and growth. Journal of Family Violence 24(7), 507–515.CrossRefGoogle Scholar
Boston, PH and Mount, BM (2006) The caregiver's perspective on existential and spiritual distress in palliative care. Journal of Pain and Symptom Management 32(1), 13–26.CrossRefGoogle ScholarPubMed
Bride, BE (2007) Prevalence of secondary traumatic stress among social workers. Social Work 52(1), 63–70.CrossRefGoogle ScholarPubMed
Bride, BE, Robinson, MM, Yegidis, B, et al. (2004) Development and validation of the secondary traumatic stress scale. Research on Social Work Practice 14(1), 27–35.CrossRefGoogle Scholar
Broad, JB, Gott, M, Kim, H, et al. (2013) Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics. International Journal of Public Health 58(2), 257–267.CrossRefGoogle Scholar
Brown, M, Tucker, P, Rapport, F, et al. (2010) The impact of shift patterns on junior doctors’ perceptions of fatigue, training, work/life balance and the role of social support. Quality and Safety in Health Care 19(6), e36.Google ScholarPubMed
Cobb, S (1976) Social support as a moderator of life stress. Psychosomatic Medicine 38(5), 300–314.CrossRefGoogle ScholarPubMed
Coetzee, SK and Klopper, HC (2010) Compassion fatigue within nursing practice: A concept analysis. Nursing & Health Sciences 12(2), 235–243.CrossRefGoogle ScholarPubMed
Cohen, S, Underwood, LG and Gottlieb, BH (2000) Social Support Measurement and Intervention: A Guide for Health and Social Scientists. New York: Oxford University Press.CrossRefGoogle Scholar
Dyrbye, LN, West, CP, Satele, D, et al. (2011) Work/home conflict and burnout among academic internal medicine physicians. Archives of Internal Medicine 171(13), 1207–1209.CrossRefGoogle ScholarPubMed
Etzion, D (1984) Moderating effect of social support on the stress–burnout relationship. Journal of Applied Psychology 69(4), 615.CrossRefGoogle ScholarPubMed
Gellie, A, Mills, A, Levinson, M, et al. (2014) Death: A foe to be conquered? Questioning the paradigm. Age and Ageing 44(1), 7–10.CrossRefGoogle ScholarPubMed
Granek, L, Tozer, R, Mazzotta, P, et al. (2012) Nature and impact of grief over patient loss on oncologists’ personal and professional lives. Archives of Internal Medicine 172(12), 964–966.CrossRefGoogle ScholarPubMed
Granek, L, Bartels, U, Scheinemann, K, et al. (2015) Grief reactions and impact of patient death on pediatric oncologists. Pediatric Blood & Cancer 62(1), 134–142.CrossRefGoogle ScholarPubMed
Hall, LH, Johnson, J, Watt, I, et al. (2016) Healthcare staff wellbeing, burnout, and patient safety: A systematic review. PLoS ONE 11, 7.CrossRefGoogle ScholarPubMed
Hamama, L, Hamama-Raz, Y, Stokar, YN, et al. (2019) Burnout and perceived social support: The mediating role of secondary traumatization in nurses vs. Physicians. Journal of Advanced Nursing 75(11), 2742–2752.CrossRefGoogle ScholarPubMed
Henderson, V (1964) The nature of nursing. The American Journal of Nursing 64(8), 62–68.Google ScholarPubMed
House, JS (1981) Work Stress and Social Support. Reading, MA: Addison-Wesley.Google Scholar
IBM, Corp. (2017) IBM SPSS Statistics for Windows (Version 25). Armonk, NY: IBM Corp.Google Scholar
Jackson, VA, Mack, J, Matsuyama, R, et al. (2008) A qualitative study of oncologists’ approaches to end-of-life care. Journal of Palliative Medicine 11(6), 893–906.CrossRefGoogle ScholarPubMed
Jansen, L, Hoffmeister, M, Chang-Claude, J, et al. (2011) Benefit finding and post-traumatic growth in long-term colorectal cancer survivors: Prevalence, determinants, and associations with quality of life. British Journal of Cancer 105(8), 1158–1165.CrossRefGoogle ScholarPubMed
Jenkins, R and Elliott, P (2004) Stressors, burnout and social support: Nurses in acute mental health settings. Journal of Advanced Nursing 48(6), 622–631.CrossRefGoogle ScholarPubMed
Kearney, MK, Weininger, RB, Vachon, ML, et al. (2009) Self-care of physicians caring for patients at the end of life: “being connected… a key to my survival”. JAMA 301(11), 1155–1164.CrossRefGoogle Scholar
Khamisa, N, Peltzer, K and Oldenburg, B (2013) Burnout in relation to specific contributing factors and health outcomes among nurses: A systematic review. International Journal of Environmental Research and Public Health 10(6), 2214–2240.CrossRefGoogle ScholarPubMed
Kutner, JS and Kilbourn, KM (2009) Bereavement: Addressing challenges faced by advanced cancer patients, their caregivers, and their physicians. Primary Care: Clinics in Office Practice 36(4), 825–844.CrossRefGoogle ScholarPubMed
Lee, H-F, Kuo, C-C, Chien, T-W, et al. (2016) A meta-analysis of the effects of coping strategies on reducing nurse burnout. Applied Nursing Research 31, 100–110.CrossRefGoogle ScholarPubMed
Manning-Jones, S, de Terte, I and Stephens, C (2017) The relationship between vicarious posttraumatic growth and secondary traumatic stress among health professionals. Journal of Loss and Trauma 22(3), 256–270.CrossRefGoogle Scholar
Maslach, C and Jackson, SE (1981) The measurement of experienced burnout. Journal of Organizational Behavior 2(2), 99–113.CrossRefGoogle Scholar
Maslach, C, Schaufeli, WB and Leiter, MP (2001) Job burnout. Annual Review of Psychology 52(1), 397–422.CrossRefGoogle ScholarPubMed
Narayanan, SS, Onn, W and Cheang, A (2016) The influence of perceived social support and self-efficacy on resilience among first year Malaysian students. Kajian Malaysia: Journal of Malaysian Studies 34(2), 1–23.CrossRefGoogle Scholar
Neville, TH, Agarwal, N, Swinton, M, et al. (2019) Improving end-of-life care in the intensive care unit: Clinicians’ experiences with the 3 wishes project. Journal of Palliative Medicine 22(12), 1561–1567.CrossRefGoogle ScholarPubMed
Nie, Z, Jin, Y, He, L, et al. (2015) Correlation of burnout with social support in hospital nurses. International Journal of Clinical and Experimental Medicine 8(10), 19144.Google ScholarPubMed
Ommen, O, Thuem, S, Pfaff, H, et al. (2011) The relationship between social support, shared decision-making and patient's trust in doctors: A cross-sectional survey of 2,197 inpatients using the Cologne Patient Questionnaire. International Journal of Public Health 56(3), 319–327.CrossRefGoogle ScholarPubMed
Oreskovich, MR, Shanafelt, T, Dyrbye, LN, et al. (2015) The prevalence of substance use disorders in American physicians. The American Journal on Addictions 24(1), 30–38.CrossRefGoogle ScholarPubMed
Pascual, MF (2011) Anxiety of nursing staff in the face of death in critical care units and its relationship with the patients’ age. Enfermeria Intensiva 22(3), 96–103.Google Scholar
Pat-Horenczyk, R, Perry, S, Hamama-Raz, Y, et al. (2015) Posttraumatic growth in breast cancer survivors: Constructive and illusory aspects. Journal of Traumatic Stress 28(3), 214–222.CrossRefGoogle ScholarPubMed
Peters, L, Cant, R, Payne, S, et al. (2013) How death anxiety impacts nurses’ caring for patients at the end of life: A review of literature. The Open Nursing Journal 7, 14.CrossRefGoogle ScholarPubMed
Rauvola, RS, Vega, DM and Lavigne, KN (2019) Compassion fatigue, secondary traumatic stress, and vicarious traumatization: A qualitative review and research agenda. Occupational Health Science 3(3), 297–336.CrossRefGoogle Scholar
Ruotsalainen, JH, Verbeek, JH, Mariné, A, et al. (2014) Preventing occupational stress in healthcare workers. Cochrane Database of Systematic Reviews 2014(11), CD002892.Google Scholar
Sanchez-Reilly, S, Morrison, LJ, Carey, E, et al. (2013) Caring for oneself to care for others: Physicians and their self-care. The Journal of Supportive Oncology 11(2), 75.CrossRefGoogle ScholarPubMed
Sansó, N, Galiana, L, Oliver, A, et al. (2015) Palliative care professionals’ inner life: Exploring the relationships among awareness, self-care, and compassion satisfaction and fatigue, burnout, and coping with death. Journal of Pain and Symptom Management 50(2), 200–207.CrossRefGoogle ScholarPubMed
Shanafelt, TD, Balch, CM, Dyrbye, L, et al. (2011) Special report: Suicidal ideation among American surgeons. Archives of surgery 146(1), 54–62.CrossRefGoogle ScholarPubMed
Shanafelt, TD, Boone, S, Tan, L, et al. (2012) Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Archives of Internal Medicine 172(18), 1377–1385.CrossRefGoogle Scholar
Shanafelt, TD, Gradishar, WJ, Kosty, M, et al. (2014) Burnout and career satisfaction among US oncologists. Journal of Clinical Oncology 32(7), 678.CrossRefGoogle ScholarPubMed
Shanafelt, TD, Hasan, O, Dyrbye, LN, et al. (2015) Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Paper presented at the Mayo Clinic Proceedings.CrossRefGoogle Scholar
Shanafelt, TD, West, CP, Sinsky, C, et al. (2019) Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2017. Paper presented at the Mayo Clinic Proceedings.CrossRefGoogle Scholar
Shavitt, S, Cho, YI, Johnson, TP, et al. (2016) Culture moderates the relation between perceived stress, social support, and mental and physical health. Journal of Cross-Cultural Psychology 47(7), 956–980.CrossRefGoogle Scholar
Shiri, S, Wexler, ID, Alkalay, Y, et al. (2008) Positive psychological impact of treating victims of politically motivated violence among hospital-based health care providers. Psychotherapy and Psychosomatics 77(5), 315–318.CrossRefGoogle ScholarPubMed
Sinclair, S, Raffin-Bouchal, S, Venturato, L, et al. (2017) Compassion fatigue: A meta-narrative review of the healthcare literature. International Journal of Nursing Studies 69, 9–24.CrossRefGoogle ScholarPubMed
Slocum-Gori, S, Hemsworth, D, Chan, WW, et al. (2013) Understanding compassion satisfaction, compassion fatigue and burnout: A survey of the hospice palliative care workforce. Palliative Medicine 27(2), 172–178.CrossRefGoogle ScholarPubMed
Sochos, A, Bowers, A and Kinman, G (2012) Work stressors, social support, and burnout in junior doctors: Exploring direct and indirect pathways. Journal of Employment Counseling 49(2), 62–73.CrossRefGoogle Scholar
Sorenson, C, Bolick, B, Wright, K, et al. (2016) Understanding compassion fatigue in healthcare providers: A review of current literature. Journal of Nursing Scholarship 48(5), 456–465.CrossRefGoogle ScholarPubMed
Stamm, BH (2002) Measuring compassion satisfaction as well as fatigue: Developmental history of the compassion satisfaction and fatigue test. In C. R. Figley (Ed.), Psychosocial stress series, no. 24. Treating Compassion Fatigue. Brunner-Routledge, pp. 107–119.Google Scholar
Stamm, BH (2006) Professional Quality of Life: Compassion Fatigue and Satisfaction Subscales, R-IV (Pro-QOL). Retrieved from: http://www.isu.edu/~bhstamm.Google Scholar
Stamm, BH (2010) The Concise ProQOL Manual, 2nd ed. Pocatello, ID: proqol.org.Google Scholar
Taubman-Ben-Ari, O and Weintroub, A (2008) Meaning in life and personal growth among pediatric physicians and nurses. Death Studies 32(7), 621–645.CrossRefGoogle ScholarPubMed
Tedeschi, RG and Calhoun, LG (1995) Trauma and Transformation. Thousand Oaks: Sage.Google Scholar
Tedeschi, RG and Calhoun, LG (1996) The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress 9(3), 455–471.CrossRefGoogle ScholarPubMed
Tedeschi, RG, Park, CL and Calhoun, LG (Eds.) (1998) Posttraumatic growth: Conceptual issues. In Posttraumatic growth: Positive changes in the aftermath of crisis. Routledge, pp. 9–30.CrossRefGoogle Scholar
Teno, JM, Gozalo, P, Trivedi, AN, et al. (2018) Site of death, place of care, and health care transitions among US medicare beneficiaries, 2000–2015. JAMA 320(3), 264–271.CrossRefGoogle ScholarPubMed
The Israeli Ministry of Health (2018) The large burnout survey among health care workers, 2018. Retrieved from: https://www.health.gov.il/NewsAndEvents/SpokemanMesseges/Documents/18102018A.pdf.Google Scholar
Thoits, PA (2010) Stress and health: Major findings and policy implications. Journal of Health and Social Behavior 51(1_suppl), S41–S53.CrossRefGoogle ScholarPubMed
Veselska, Z, Madarasova Geckova, A, Gajdosova, B, et al. (2010) Socio-economic differences in self-esteem of adolescents influenced by personality, mental health and social support. European Journal of Public Health 20(6), 647–652.CrossRefGoogle ScholarPubMed
Waddill-Goad, S (2016) Nurse Burnout: Overcoming Stress in Nursing. Indianapolis: Sigma Theta Tau.Google Scholar
Woodhead, EL, Northrop, L and Edelstein, B (2016) Stress, social support, and burnout among long-term care nursing staff. Journal of Applied Gerontology 35(1), 84–105.CrossRefGoogle ScholarPubMed
Wurm, W, Vogel, K, Holl, A, et al. (2016) Depression-burnout overlap in physicians. PLoS ONE 11(3), e0149913.CrossRefGoogle ScholarPubMed
Zimet, GD, Dahlem, NW, Zimet, SG, et al. (1988) The multidimensional scale of perceived social support. Journal of Personality Assessment 52(1), 30–41.CrossRefGoogle Scholar
Zoellner, T and Maercker, A (2006) Posttraumatic growth in clinical psychology — A critical review and introduction of a two component model. Clinical Psychology Review 26(5), 626–653.CrossRefGoogle ScholarPubMed