Effects of end-of-life care on medical health professionals: A dialectical approach
- 30 March 2021
- journal article
- research article
- Published by Cambridge University Press (CUP) in Palliative & Supportive Care
- Vol. 20 (1), 76-83
- https://doi.org/10.1017/s1478951521000365
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
This publication has 60 references indexed in Scilit:
- Burnout in Relation to Specific Contributing Factors and Health Outcomes among Nurses: A Systematic ReviewInternational Journal of Environmental Research and Public Health, 2013
- How Death Anxiety Impacts Nurses’ Caring for Patients at the End of Life: A Review of LiteratureThe Open Nursing Journal, 2013
- Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US PopulationJAMA Internal Medicine, 2012
- 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 statisticsInternational Journal of Public Health, 2012
- Understanding Compassion Satisfaction, Compassion Fatigue and Burnout: A survey of the hospice palliative care workforcePalliative Medicine, 2011
- Benefit finding and post-traumatic growth in long-term colorectal cancer survivors: prevalence, determinants, and associations with quality of lifeBritish Journal of Cancer, 2011
- The impact of shift patterns on junior doctors' perceptions of fatigue, training, work/life balance and the role of social supportBMJ Quality & Safety, 2010
- Stress and Health: Major Findings and Policy ImplicationsJournal of Health and Social Behavior, 2010
- A Qualitative Study of Oncologists' Approaches to End-of-Life CareJournal of Palliative Medicine, 2008
- The Caregiver's Perspective on Existential and Spiritual Distress in Palliative CareJournal of Pain and Symptom Management, 2006