Original Article| Volume 62, ISSUE 3, e38-e45, September 2021

Healthcare Professionals’ Work-Related Stress in Palliative Care: A Cross-Sectional Survey



      Providing palliative care can lead to work-related stress and ultimately to burnout. The need for palliative care will further increase due to population aging and people living longer with life-threatening diseases. Therefore, a healthy palliative care workforce is vital.


      This study aims to get insight into the experienced work-related stress among healthcare professionals providing palliative care in the Netherlands and their strategies and needs in relation to maintaining a healthy work-life balance.


      A cross-sectional online survey among members of the Dutch Association for Palliative Care Professionals was conducted between February and March 2020. Burnout was assessed by the validated Burnout Assessment Tool. Self-constructed questions assessed strategies and needs of healthcare professionals providing palliative care regarding work-related stress.


      In total 179 eligible respondents responded (response rate 54%). Respondents were mostly female (79%) and older than 50 years (66%). Most respondents were nurses (47%) and physicians (39%). Two-thirds of respondents (69%) experienced a median level of burnout and 2% a (very) high level. Furthermore, 7% had been on sick leave due to burnout. Although healthcare professionals engage on average in 3.7 coping activities, a quarter (23%) felt that these activities were not sufficient to maintain balanced. Respondents feel a need for activities aimed at the team and organisation level such as feeling emotionally safe within their team.


      Symptoms of burnout are quite prevalent among healthcare professionals providing palliative care in the Netherlands. Healthcare professionals have a need for team and organisation approaches to maintain a healthy work-life balance.

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        • Tunnah K JA
        • Johnstone R
        Stress in hospice at home nurses: a qualitative study of their experiences of their work and wellbeing.
        Int J Palliat Nurs. 2012; 18: 283-289
        • Gama G BF
        • Vieira M
        Personal determinants of nurses’ burnout in end of life care.
        Eur J Oncol Nurs. 2014; 18: 527-533
        • Sinclair S.
        Impact of death and dying on the personal lives and practices of palliative and hospice care professionals.
        CMAJ. 2011; 2: 183
        • Koh MYH
        • Hum AYM
        • Khoo HS
        • et al.
        Burnout and resilience after a decade in palliative care: what survivors have to teach us. A qualitative study of palliative care clinicians with more than 10 years of experience.
        J Pain Symptom Manage. 2020; 59: 105-115
        • Ingebretsen LP
        • Sagbakken M
        Hospice nurses’ emotional challenges in their encounters with the dying.
        Int J Qual Stud Health Well-being. 2016; 11: 31170
        • Bakker AB
        • Demerouti E
        • Verbeke W.
        Using the job demands-resources model to predict burnout and performance.
        Hum Resour Manage. 2004; 43: 83-104
      1. <Job burnout_2001_Maslach, Schaufeli, Leiter.pdf>.

      2. <Maslach, Leiter and Schaufeli_2008_measuring burnout.pdf>.

        • Schaufeli WB
        • Desart S
        • De Witte H.
        Burnout Assessment Tool (BAT)-Development, validity, and reliability.
        Int J Environ Res Public Health. 2020; 17: 9495
        • Schaufeli WB DWHDS
        User Manual – Burnout Assessment Tool (BAT) – Version 2.0.
        • Parola V
        • Coelho A
        • Cardoso D
        • et al.
        Prevalence of burnout in health professionals working in palliative care: a systematic review.
        JBI Database System Rev Implement Rep. 2017; 15: 1905-1933
      3. Demographic trends of workforce. Available at: Accessed October 29, 2020.

        • Etkind SN
        • Bone AE
        • Gomes B
        • et al.
        How many people will need palliative care in 2040? Past trends, future projections and implications for services.
        BMC Med. 2017; 15: 102
        • United Nations DoEaSA
        Population division.
        World Population Ageing, 2015 (Report no. (ST/ESA/SER.A/390))
        • Dijxhoorn AFQ
        • Brom L
        • van der Linden YM
        • et al.
        Prevalence of burnout in healthcare professionals providing palliative care and the effect of interventions to reduce symptoms: a systematic literature review.
        Palliat Med. 2021; 35: 6-26
        • Hill RC
        • Dempster M
        • Donnelly M
        • et al.
        Improving the wellbeing of staff who work in palliative care settings: a systematic review of psychosocial interventions.
        Palliat Med. 2016; 30: 825-833
        • von Elm E AD
        • Egger M
        • Pocock SJ
        • Gøtzsche PC
        • Vandenbroucke JP
        Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        BMJ. 2007; 305: 806-808
      4. Uw onderzoek: WMO-plichtig of niet? Available at: Accessed October 29, 2020.

        • Houkes I
        • Winants Y
        • Twellaar M
        • et al.
        Development of burnout over time and the causal order of the three dimensions of burnout among male and female GPs. A three-wave panel study.
        BMC Public Health. 2011; 11: 240
        • van der Wal RA
        • Bucx MJ
        • Hendriks JC
        • et al.
        Psychological distress, burnout and personality traits in Dutch anaesthesiologists: a survey.
        Eur J Anaesthesiol. 2016; 33: 179-186
        • Hernandez-Marrero P PS
        • Carvalho AS
        Ethical decisions in palliative care: interprofessional relations as a burnout protective factor? Results from a Mixed-Methods Multicenter Study in Portugal.
        Am J Hosp Palliat Care. 2016; 33: 723-732
        • O'Mahony S ZM
        • Hoerger M
        • Levine S
        • Baron A
        • Gerhart J
        Compassion fatigue among palliative care clinicians: findings on personality factors and years of service.
        Am J Hosp Palliat Care. 2018; 35: 343-347
        • Parola V
        • Coelho A
        • Romero AA
        • et al.
        The construction of the health professional in palliative care contexts: a scoping review on caring for the person at the end of life.
        Porto Biomed J. 2018; 3: e10
        • Samson T
        • Shvartzman P
        Association between level of exposure to death and dying and professional quality of life among palliative care workers.
        Palliat Support Care. 2018; 16: 442-451
        • Müller M PD
        • Markett S
        • Jaspers B
        How many patient deaths can a team cope with?: a nationwide survey of palliative care units in Germany.
        Schmerz. 2009; 23: 600-608
        • Koh MY
        • Chong PH
        • Neo PS
        • et al.
        Burnout, psychological morbidity and use of coping mechanisms among palliative care practitioners: A multi-centre cross-sectional study.
        Palliat Med. 2015; 29: 633-642
        • Swetz KM HS
        • Matsuyama RK
        • Shanafelt TD
        • Lyckholm LJ
        Strategies for avoiding burnout in hospice and palliative medicine: peer advice for physicians on achieving longevity and fulfillment.
        J Palliat Med. 2009; 12: 773-777
        • Harrison KL
        • Dzeng E
        • Ritchie CS
        • et al.
        Addressing palliative care clinician burnout in organizations: a workforce necessity, an ethical imperative.
        J Pain Symptom Manage. 2017; 53: 1091-1096
        • Back AL
        • Steinhauser KE
        • Kamal AH
        • et al.
        Building resilience for palliative care clinicians: an approach to burnout prevention based on individual skills and workplace factors.
        J Pain Symptom Manage. 2016; 52: 284-291
        • Gillman L
        • Adams J
        • Kovac R
        • et al.
        Strategies to promote coping and resilience in oncology and palliative care nurses caring for adult patients with malignancy: a comprehensive systematic review.
        JBI Database System Rev Implement Rep. 2015; 13: 131-204
        • Simonetti JA
        • Clinton WL
        • Taylor L
        • et al.
        The impact of survey nonresponse on estimates of healthcare employee burnout.
        Healthc (Amst). 2020; 8100451
        • Bradley M
        • Chahar P.
        Burnout of healthcare providers during COVID-19.
        Cleve Clin J Med. 2020;
        • Berg Jvd.
        Telephone line and buddies against stress.
        De Volkskrant. 2020;
      5. Special team keeps healthcare professional going: 'Dokter is ook maar een mens'. Available at: Accessed March 15, 2021.