Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-05-01T01:58:05.041Z Has data issue: false hasContentIssue false
  • English
  • Français

Distress, demoralization, and fulfillment among palliative care providers during the COVID-19 pandemic

Published online by Cambridge University Press:  01 December 2023

Michael Tang Open the ORCID record for Michael Tang [Opens in a new window] ,
Sujin Ann-Yi ,
Donna S. Zhukovsky ,
Bryan Fellman  and
Eduardo Bruera
Michael Tang*
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Sujin Ann-Yi
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Donna S. Zhukovsky
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Bryan Fellman
Affiliation:
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Eduardo Bruera
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
*
Corresponding author: Michael Tang; Email: MJTang@mdanderson.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

Prolonged distress is a risk factor for burnout among health-care providers (HCP) and may contribute to demoralization. We examined sources of distress during the COVID-19 pandemic and associations with demoralization.

Methods

This prospective cross-sectional survey of HCP was conducted among palliative care providers of an academic medical center. Participants completed a survey evaluating sources of distress and the Demoralization Scale-II (DS-II) to measure the intensity of demoralization.

Results

Of 106 eligible participants, 74 (70%) completed the survey. DS-II median (range) score was 2 (0–19). There were no statistically significant associations with demographic characteristics. Participants reported high rates of distress for multiple reasons and high rates of sense of fulfillment (90%) and satisfaction (89%) with their profession.

Significance of results

Our study identified high levels of distress but low demoralization rates. Further study to evaluate fulfillment and satisfaction as protective factors against demoralization and burnout is indicated.

Keywords

DemoralizationburnoutCOVID-19fulfillmentpalliative care
Type
Original Article
Information
Palliative & Supportive Care , First View , pp. 1 - 5
Check for updates
Copyright
© The Author(s), 2023. Published by Cambridge University Press.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agarwal, SD, Pabo, E, Rozenblum, R, et al. (2020) Professional dissonance and burnout in primary care: A qualitative study. JAMA Internal Medicine 180(3), 395–401. doi:10.1001/jamainternmed.2019.6326CrossRefGoogle ScholarPubMed
Ameli, R, Sinaii, N, West, CP, et al. (2020) Effect of a brief mindfulness-based program on stress in health care professionals at a US biomedical research hospital: A randomized clinical trial. JAMA Network Open 3(8), . doi:10.1001/jamanetworkopen.2020.13424CrossRefGoogle Scholar
Bozdağ, F and Ergün, N (2021) Psychological resilience of healthcare professionals during COVID-19 pandemic. Psychological Reports 124(6), 2567–2586. doi:10.1177/0033294120965477CrossRefGoogle ScholarPubMed
Bramati, PS, Swan, A, Urbauer, DL, et al. (2023) Evaluation of a daily nine-item “Handbook for Self-Care at Work” for palliative care clinicians. Journal of Palliative Medicine 26(5), 622–626. doi:10.1089/jpm.2022.0347CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention (2021) COVID data tracker. vol. 2021.Google Scholar
Chan, AOM (2004) Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore. Occupational Medicine 54(3), 190–196. doi:10.1093/occmed/kqh027CrossRefGoogle Scholar
Clarke, DM and Kissane, DW (2002) Demoralization: Its phenomenology and importance. Australian & New Zealand Journal of Psychiatry 36(6), 733–742. doi:10.1046/j.1440-1614.2002.01086.xCrossRefGoogle ScholarPubMed
Dahlin, ME and Runeson, B (2007) Burnout and psychiatric morbidity among medical students entering clinical training: A three year prospective questionnaire and interview-based study. BMC Medical Education 7, . doi:10.1186/1472-6920-7-6CrossRefGoogle ScholarPubMed
Gabel, S (2013) Demoralization in health professional practice: Development, amelioration, and implications for continuing education. Journal of Continuing Education in the Health Professions 33(2), 118–126. doi:10.1002/chp.21175CrossRefGoogle ScholarPubMed
Ishak, WW, Lederer, S, Mandili, C, et al. (2009) Burnout during residency training: A literature review. Journal of Graduate Medical Education 1(2), 236–242. doi:10.4300/JGME-D-09-00054.1CrossRefGoogle ScholarPubMed
Jacobsen, JC, Maytal, G and Stern, TA (2007) Demoralization in medical practice. The Primary Care Companion to the Journal of Clinical Psychiatry 9(2), 139–143. doi:10.4088/PCC.v09n0208CrossRefGoogle ScholarPubMed
Kissane, DW, Wein, S, Love, A, et al. (2004) The Demoralization Scale: A report of its development and preliminary validation. Journal of Palliative Care 20(4), 269–276. doi:10.1177/082585970402000402CrossRefGoogle Scholar
Koh, D, Lim, MK, Chia, SE, et al. (2005) Risk perception and impact of Severe Acute Respiratory Syndrome (SARS) on work and personal lives of healthcare workers in Singapore: What can we learn? Medical Care 43(7), 676–682. doi:10.1097/01.mlr.0000167181.36730.ccCrossRefGoogle ScholarPubMed
Lancee, WJ, Maunder, RG and Goldbloom, DS (2008) Prevalence of psychiatric disorders among Toronto hospital workers one to two years after the SARS outbreak. Psychiatric Services 59(1), 91–95. doi:10.1176/ps.2008.59.1.91CrossRefGoogle ScholarPubMed
Lee, SM, Kang, WS, Cho, A-R, et al. (2018) Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Comprehensive Psychiatry 87, 123–127. doi:10.1016/j.comppsych.2018.10.003CrossRefGoogle ScholarPubMed
Maguen, S and Price, MA (2020) Moral injury in the wake of coronavirus: Attending to the psychological impact of the pandemic. Psychological Trauma: Theory, Research, Practice, and Policy 12(S1), S131–s132. doi:10.1037/tra0000780CrossRefGoogle Scholar
Maslach, C, Schaufeli, WB and Leiter, MP (2001) Job burnout. Annual Review of Psychology 52, 397–422. doi:10.1146/annurev.psych.52.1.397CrossRefGoogle ScholarPubMed
Maunder, RG, Lancee, WJ, Rourke, S, et al. (2004) Factors associated with the psychological impact of severe acute respiratory syndrome on nurses and other hospital workers in Toronto. Psychosomatic Medicine 66(6), 938–942. doi:10.1097/01.psy.0000145673.84698.18CrossRefGoogle ScholarPubMed
Nickell, LA (2004) Psychosocial effects of SARS on hospital staff: Survey of a large tertiary care institution. Canadian Medical Association Journal 170(5), 793–798. doi:10.1503/cmaj.1031077CrossRefGoogle ScholarPubMed
Pappa, S, Ntella, V, Giannakas, T, et al. (2020) Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain, Behavior, and Immunity 88, 901–907. doi:10.1016/j.bbi.2020.05.026CrossRefGoogle ScholarPubMed
Petzold, MB, Bendau, A, Plag, J, et al. (2020) Risk, resilience, psychological distress, and anxiety at the beginning of the COVID-19 pandemic in Germany. Brain and Behavior 10(9), . doi:10.1002/brb3.1745CrossRefGoogle ScholarPubMed
Phua, DH, Tang, HK and Tham, KY (2005) Coping responses of emergency physicians and nurses to the 2003 severe acute respiratory syndrome outbreak. Academic Emergency Medicine 12(4), 322–328. doi:10.1197/j.aem.2004.11.015CrossRefGoogle Scholar
Robinson, S, Kissane, DW, Brooker, J, et al. (2015) A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: A decade of research. Journal of Pain Symptom Management 49(3), 595–610. doi:10.1016/j.jpainsymman.2014.07.008CrossRefGoogle Scholar
Robinson, S, Kissane, DW, Brooker, J, et al. (2016) Refinement and revalidation of the demoralization scale: The DS-II-external validity. Cancer 122(14), 2260–2267. doi:10.1002/cncr.30012CrossRefGoogle ScholarPubMed
Rosen, IM, Gimotty, PA, Shea, JA, et al. (2006) Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Academic Medicine 81(1), 82–85. doi:10.1097/00001888-200601000-00020CrossRefGoogle ScholarPubMed
Sharifi, M, Asadi-Pooya, AA and Mousavi-Roknabadi, RS (2021) Burnout among healthcare providers of COVID-19; a systematic review of epidemiology and recommendations. Archives of Academic Emergency Medicine 9(1), .doi:10.22037/aaem.v9i1.1004Google ScholarPubMed
Tam, CWC, Pang, EPF, Lam, LCW, et al. (2004) Severe acute respiratory syndrome (SARS) in Hong Kong in 2003: Stress and psychological impact among frontline healthcare workers. Psychological Medicine 34(7), 1197–1204. doi:10.1017/S0033291704002247CrossRefGoogle Scholar
Varani, S, Ostan, R, Franchini, L, et al. (2021) Caring advanced cancer patients at home during COVID-19 outbreak: Burnout and psychological morbidity among palliative care professionals in Italy. Journal of Pain and Symptom Management 61(2), e4–e12. doi:10.1016/j.jpainsymman.2020.11.026CrossRefGoogle ScholarPubMed