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Burnout in Palliative Care - Difficult Cases: Qualitative Study
  1. Mervyn Yong Hwang Koh1,
  2. Marysol Dalisay Gallardo1,
  3. Hwee Sing Khoo2 and
  4. Allyn Hum1
  1. 1 Palliative Medicine, Tan Tock Seng Hospital, Singapore
  2. 2 Health Outcomes and Medical Education Research (HOMER), National Healthcare Group, Singapore
  1. Correspondence to Dr Mervyn Yong Hwang Koh, Palliative Medicine, Tan Tock Seng Hospital 11, Jalan Tan Tock, Seng, 308433, Singapore; mervyn_koh{at}


Objectives Burnout is common among palliative care clinicians, occurring as a result of emotions experienced in caring for challenging patients or families. Awareness of these scenarios helps clinicians and teams appropriately manage their own emotions and prevent burnout. We studied challenging clinical situations and the emotions encountered by experienced palliative care clinicians which could potentially contribute to burnout.

Methods A qualitative study was conducted using semistructured interviews with purposive sampling of 18 palliative care clinicians—5 doctors, 10 nurses and 3 social workers who worked in various palliative care settings (hospital palliative care team, home hospice and inpatient hospice). The interviews were recorded verbatim, transcribed and analysed using a thematic analysis approach.

Results The mean age of the interviewees was 52 years old and the mean number of years practising palliative care was 15.7 years (ranging from 10 to 25 years). The following clinical situations were reported by our respondents as particularly challenging, potentially leading to burnout: (1) abusive patients and families, (2) ‘bad deaths’, (3) death of young patients, (4) complex cases, and (5) having multiple deaths or difficult cases at any one time. Emotions encountered in the course of care of these cases included: (1) feeling overwhelmed, (2) having a sense of helplessness and failure, as well as (3) a sense of injustice.

Conclusion The challenging cases we described evoke strong emotional reactions from palliative care clinicians that need to be adequately addressed to prevent burnout.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. Not applicable.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. Not applicable.

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  • Correction notice This article has been corrected since it was first published. The title has been corrected.

  • Contributors MYHK, AH and HSK conceptualised the study together and were all involved in the design of the study, the interview questionnaire, ensuring the integrity of the interview process and manuscript transcription, cleaned and analysed the data, conducted the thematic analysis according to Braun and Clarke’s methodology and drafted and revised the manuscript. MYHK is the guarantor of the study. MDG was involved in analysing the data, drafting and revising the manuscript.

  • Funding This study was funded by a grant from Health Outcomes and Medical Education Research, National Healthcare Group (grant no. FY18/A03).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.