Prevalence of burnout in health professionals working in palliative care: a systematic review
Authors: Parola Vitor , Coelho Adriana , Cardoso Daniela , Sandgren Anna , Apóstolo João 
Published: July 2017

EXECUTIVE SUMMARY

Background
More than ever, the current increasing need for palliative care leads to health professionals providing this type of care which further leads to multiple challenges, and stressful and demanding situations. The multiple challenges of working in palliative care put health professionals working in this context at the risk of burnout.

Objectives
To examine the evidence on the prevalence of burnout among health professionals working in palliative care.

Inclusion criteria Types of participants
The current review included studies that encompass qualified health professionals working in palliative care, caring for patients 18 years of age or older.

Condition
The current review considered studies reporting on the point prevalence of burnout, measured by a burnout scale, such as, but not limited to, the Maslach Burnout Inventory, Burnout Measure and Copenhagen Burnout Inventory.

Context
The current review considered studies conducted in the context of specialist palliative care, more specifically, palliative care units, specialized palliative home care or hospices.

Types of studies
The current review considered observational study designs, including prospective and retrospective cohort, case-control and cross-sectional studies.

Search strategy
An initial search of MEDLINE (via PubMed) and CINAHL was undertaken, followed by a second search for published and unpublished studies since 1975 in major healthcare-related electronic databases. Studies written in English, Spanish and Portuguese were included.

Methodological quality
Two independent reviewers assessed the methodological quality of studies using the standardized critical appraisal instrument from the Joanna Briggs Institute. No studies were excluded from the review based on the methodological appraisal.

Data extraction
Data were extracted using a data extraction table, taking into account the review questions.

Data synthesis
Significant differences were found between condition measures, thus we were unable to perform a meta-analysis.

Results
Eight cross-sectional studies met the inclusion criteria, with a total of 1406 health professionals. The sample was limited to nurses, physicians and social workers. None of the included articles presented data about other health professionals. Seven of the included studies assessed the prevalence of burnout using the same instrument – the Maslach Burnout Inventory. Data revealed a prevalence of burnout of 17.3% among health professionals. Personal Accomplishment was the sub-scale from the Maslach Burnout Inventory that had the highest prevalence (19.5%). Nurses had higher levels of Emotional Exhaustion (19.5%) and Depersonalization (8.2%), and physicians had lower levels of Personal Accomplishment (41.2%). The prevalence of burnout was, however, higher in social workers (27%). The palliative care context with the highest prevalence of burnout was home care (19.6%).

Conclusion
The current systematic review contributes to a body of empirical knowledge that can facilitate the professional development of palliative care teams by highlighting the prevalence of burnout in health professionals, which staff category is the most affected (social workers), and which palliative care context has the highest prevalence (home care).