Murielle Ruer

Burnout syndrome is a work-related professional distress. Palliative care physicians often have to deal with complex end-of-life situations and are at risk of presenting with burnout syndrome, which has been little studied in this population. Our study aims to identify the impact of clinical settings (in a palliative care unit (PCU) or on a palliative care mobile team (PCMT)) on palliative care physicians. We undertook a cross-sectional study using a questionnaire that included the Maslach Burnout Inventory (MBI), and we gathered sociodemographic and professional data. The questionnaire was sent to all 590 physicians working in palliative care in France between July of 2012 and February of 2013. The response rate was 61, 8% after three reminders. Some 27 (9%) participants showed high emotional exhaustion, 12 (4%) suffered from a high degree of depersonalization, and 71 (18%) had feelings of low personal accomplishment. Physicians working on a PCMT tended (p = 0.051) to be more likely to suffer from emotional exhaustion than their colleagues. Physicians working on a PCMT worked on smaller teams (fewer physicians, p < 0.001; fewer nonphysicians, p < 0.001). They spent less time doing research (p = 0.019), had fewer resources (p = 0.004), and their expertise seemed to be underrecognized by their colleagues (p = 0.023). The prevalence of burnout in palliative care physicians was low and in fact lower than that reported in other populations (e.g., oncologists). Working on a palliative care mobile team can be a more risky situation, associated with a lack of medical and paramedical staff.

ABSTRACT Palliative care is given in a context of serious, evolving or terminal, illness. In this setting, mobile palliative care teams (MPCT) are called in to prevent the development of particularly complex situations. We have noted however that after two years of implementation in our teaching hospital (which has both a MPCT and a palliative care unit), 60% of the first MPCT consultations concerned a patient who had already reached the terminal phase. It was thus hypothesized that the clinical missions of the MPCT were not well-understood by the hospital physicians. In order to check this hypothesis, we sent an anonymous questionnaire to all of the hospital physicians who collaborate with the MPCT in order to ascertain their knowledge and representations of palliative care. The response rate was 36%. Results showed that the definition of palliative care is not well-understood, as are the different phases of palliation (initial, terminal) and the differences between a mobile team and a palliative care unit. In addition, although 84% of the physicians were aware that palliative care is not limited to the terminally ill, the majority felt that the palliative care unit was of limited use before the terminal phase. Why? There probably is still a negative connotation connected with the MPCT. However, beyond this question of image, there is also the aspect of certain team practices which may generate a certain degree of resistance to collaboration. Future perspectives thus must include reflection on physician representations of palliative care in order to maintain useful collaboration for meaningful companionship so important for palliative care.