Healthcare professionals working in palliative and oncological care are confronted daily with serious illnesses, or the suffering and death of their patients, which can leave marking impressions. Indeed, dealing with the loss of patients has been recognized as one of the most challenging demands of clinical practice careers to date (1, 2). Other important sources of stress in the profession are just as relevant to note, such as the stress involved in delivering bad news (3), relieving difficult patient symptoms (4), or arbitrating complicated family relations (5, 6). These challenges provide some central examples for which the increased risk of burnout that has been identified in healthcare careers could be explained.
In healthcare professions, the problem of burnout spurs numerous repercussions in the field as it has been associated with poorer physical and mental health (7, 8), lower quality of patient care (9, 10), more medical errors (11, 12), lower empathy (13), employee absenteeism, and turnover (14). Prevalence rates of burnout and its precursors in the sector can be considered worrisome. A recent meta-analysis in oncological care reported rates of 30% for emotional exhaustion in nurses (15) and 32% in physicians (16). A systematic review in palliative care revealed prevalence rates of 17% for burnout, in which nurses scored higher in emotional exhaustion (19%) and depersonalization (8%), and physicians scored lower in their sense of personal accomplishment (41%) (17). Despite these career challenges and pathological rates, it is remarkable to note that in various studies as many as 70% professionals have reported limited degrees of emotional exhaustion. This begs the question, why and what can be learned to better protect the remaining third of professionals who are vulnerable to such pathologies?
Previous research has identified the risk of burnout as not only linked to work context and degree of workload (18), but also individual factors such as personality traits (19), self-esteem (20), and mental or affective disorders like depression (21). In fact, the relationship between burnout and depression among nurses, for example, has been well documented (22). Furthermore, several studies evaluating professionals in oncological and palliative care have demonstrated that certain personality traits, such as higher openness, conscientiousness, and extraversion traits, are linked to a higher sense of professional accomplishment and lower levels of burnout (23, 24). Moreover, higher levels of global self-esteem (25) and work meaning (5) have been identified as protective factors against burnout in nurses; the latter factor has been defined as the ability to derive existential meaning from one’s work execution, experiences, and purpose (26). These psychological and individual factors may explain in part, why a large proportion of caregivers are not, or are only minimally impacted psychologically, by regular exposure to patient suffering and death.
Research interests in addressing pathologies like burn out and depression have seen significant diversification over the last twenty years, especially with regard to emergent frameworks such as salutogenesis (27–29) and positive psychology (30). These frameworks place additional emphasis on considering positive health factors, which for example, could be crucially protective. Indeed, they advocate that research on the conditions and processes contributing to the optimal functioning of individuals, groups, and institutions (31) is just as important as researching illness and pathology, and these positive health understandings could play an essential, complimentary role in addressing said pathologies, especially through prevention.
Psychological wellbeing at work can be defined as a positive work experience that engenders life satisfaction, confidence, and contentment, which is developed by the individual and their social relations at work (32). Addressing the professional wellbeing of healthcare providers is not only important on the individual level, but also on various organizational and societal levels, as professional wellbeing has been found to influence work engagement, performance (33), and employee retention. Considering current society’s excessively large ageing population, improved work wellbeing for better employee retention could crucially respond to the worrisome lack of professionals in palliative career to treat them. Research on work wellbeing has so far demonstrated that self-esteem (34), as well as the personality traits of conscientiousness, extraversion, and agreeableness (35), predict improved subjective wellbeing, while the neuroticism trait predicts worse subjective wellbeing (35). In addition, one’s sense of work meaning, notably as an intrinsic motivator (36), has been found to positively influence an employee’s affective commitment to an organization, as well as their psychological wellbeing at work (26). In this respect, being able to derive work meaning might constitute a cornerstone strategy for oncological and palliative care professionals in their ability to appropriately adapt to regular exposure to patient suffering and death. Also, recent research may suggest several important elements that may be complimentary to this protective angle, such as human relationships, death acceptance, and one’s sense of dignity (2).
Regarding healthcare provider careers, no previous study can be identified to our knowledge that simultaneously assessed the protective factors against mental disorders and those for wellbeing at work. In this respect, the present study aimed to draw upon an integrative approach through a multifactorial analysis of, for example, work context variables, personality traits, self-esteem, work meaning, and confrontation dynamics, that combine to determine wellbeing outcomes in healthcare providers repeatedly facing patient suffering and death. Such integrative approaches have been notably encouraged within the framework of second wave positive psychology: PP 2.0 (37–40). This nuanced approach assesses complex interactions not only by the consideration of positive factors and individual resources, but also of those that may be considered part of the dark, yet inseparable, side of human experience, such as loss and suffering. Indeed, the human experience of regular confrontation to patient suffering and death in oncological and palliative care presents a unique opportunity to study such experiences in a more holistic manner. Furthermore, the potential to gain a better understanding of the interplay between positive and negative factors in the work context can contribute to improved employee-wellbeing programs establishing appropriate work-life balance. So far and only recently, this notion has been investigated formally in respect to burnout (41).
The principal aims of the present study were to (i) explore the extent to which healthcare providers who are regularly confronted with suffering, illness, and death are stricken with psychological distress and/or burnout; (ii) identify potential determinants of burnout and psychological wellbeing at work in healthcare professionals; (iii) develop a comprehensive and integrative model of wellbeing for healthcare professionals confronted with death and suffering, as a preliminary model that can be refined in further researches; and finally (iv) identify profiles of healthcare professionals who are particularly at risk of developing a mental health disorder or, conversely, possess a robust wellbeing, which could be used in future preventative or targeted employee wellbeing programs. We hypothesized that a strong sense of work meaning, high self-esteem, select personality factors, low predisposition to anxiety and depression, and the ability to interpret the end of life positively, would be the most protective factors against burnout and coincide as determinants of wellbeing at work.