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Am J Hosp Palliat Care. 2018 Aug 5:1049909118792517. doi: 10.1177/1049909118792517. [Epub ahead of print]

Association of Perceived Futile or Potentially Inappropriate Care With Burnout and Thoughts of Quitting Among Health-Care Providers.

Author information

1
1 Center for Research on End-Of-Life Care, Weill Cornell Medicine, NY, USA.
2
2 Department of Medicine, Weill Cornell Medicine, NY, USA.
3
3 Division of Geriatrics and Palliative Care Medicine, NewYork-Presbyterian /Queens, NY, USA.

Abstract

BACKGROUND:

Futile or potentially inappropriate care (futile/PIC) has been suggested as a factor contributing to clinician well-being; however, little is known about this association.

OBJECTIVE:

To determine whether futile/PIC provision is associated with measures of clinician well-being.

DESIGN:

Cross-sectional, self-administered, online questionnaire.

SETTING:

Two New York City Hospitals.

PARTICIPANTS:

Attending physicians, residents, nurses, and physician assistants in the fields of internal medicine, surgery, neurology, or intensive care. Exposure(s): Provision of perceived futile/PIC.

MEASUREMENTS:

Main outcomes included (1) clinician burnout, measured using the Physician Worklife Study screen; (2) clinician depression, measured using the Patient Health Questionnaire; and (3) intention to quit, measured using questions assessing thoughts of quitting and how seriously it is being considered.

RESULTS:

Of 1784 clinicians who received surveys, 349 participated. Across all clinicians, 91% reported that they either had or had possibly provided futile/PIC to a patient. Overall, 43.4% of clinicians screened positive for burnout syndrome, 7.8% screened positive for depression, and 35.5% reported thoughts of leaving their job as a result of futile/PIC. The amount of perceived futile/PIC provided was associated with burnout (odds ratio [OR] 3.8 [16-30 patients vs 1-2 patients]; 95% confidence interval [CI]: 1.1-12.8) and having thoughts of quitting (OR, 7.4 [16-30 patients vs 1-2 patients]; 95% CI: 2.0-27), independent of depression, position, department, and the number of dying patients cared for.

CONCLUSIONS:

A large majority of clinicians report providing futile/PIC, and such care is associated with measures of clinician well-being, including burnout and intention to quit.

KEYWORDS:

burnout; clinician well-being; end-of-life care; medical futility

PMID:
30079753
DOI:
10.1177/1049909118792517

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