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J Pain Symptom Manage. 2019 Nov 25. pii: S0885-3924(19)30672-4. doi: 10.1016/j.jpainsymman.2019.11.017. [Epub ahead of print]

Prevalence and Predictors of Burnout among Hospice and Palliative Care Clinicians in the US.

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Duke Center for Learning Health Care, Duke Clinical Research Institute, Durham, NC; Duke Cancer Institute, Durham, NC. Electronic address:
Four Seasons Compassion for Life, Flat Rock, NC.
Duke Center for Learning Health Care, Duke Clinical Research Institute, Durham, NC.
University of Alabama - Birmingham, Birmingham, AL.
Mayo Clinic, Rochester, MN.
American Academy of Hospice and Palliative Medicine, Rosemont, IL.
University of Pittsburgh, Pittsburgh, PA.
University of Kansas, Kansas City, KS.



Many clinical disciplines report high rates of burnout, which leads to low quality of care. Palliative care clinicians routinely manage patients with significant suffering, aiming to improve quality of life. As a major role of palliative care clinicians involves educating patients and caregivers regarding identifying priorities and balancing stress, we wondered how clinician self-management of burnout matches against the emotionally exhaustive nature of the work.


We sought to understand the prevalence and predictors of burnout using a discipline-wide survey.


We asked American Academy of Hospice and Palliative Medicine clinician members to complete an electronic survey querying demographic factors, job responsibilities, and the Maslach Burnout Inventory. We performed univariate and multivariable regression analyses to identify predictors of high rates of burnout.


We received 1357 responses (response rate 30%). Overall, we observed a burnout rate of 38.7%, with higher rates reported by non-physician clinicians. Most burnout stemmed from emotional exhaustion, with depersonalization comprising a minor portion. Factors associated with higher odds of burnout include non-physician clinical roles, working in smaller organizations, working longer hours, being younger than 50 years of age, and working weekends. We did not observe different rates between palliative care clinicians and hospice clinicians. Higher rated self-management activities to mitigate burnout include participating in interpersonal relationships and taking vacations.


Burnout is a major issue facing the palliative care clinician workforce. Strategies at the discipline-wide and individual levels are needed to sustain the delivery of responsive, available, high quality palliative care for all patients with serious illness.

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