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Psychological well-being of hospice staff: systematic review
  1. Andrew Papworth1,
  2. Lucy Ziegler2,
  3. Bryony Beresford3,
  4. Suzanne Mukherjee3,
  5. Lorna Fraser1,
  6. Victoria Fisher1,
  7. Mark O'Neill1,
  8. Su Golder1,
  9. Andre Bedendo1 and
  10. Johanna Taylor1
  1. 1Department of Health Sciences, University of York, York, UK
  2. 2School of Medicine, University of Leeds, Leeds, UK
  3. 3Social Policy Research Unit, School for Business and Society, University of York, York, UK
  1. Correspondence to Prof Lucy Ziegler, School of Health Sciences, University of Leeds, LS2 9JT Leeds, UK; l.e.ziegler{at}


Background Poor psychological well-being among healthcare staff has implications for staff sickness and absence rates, and impacts on the quality, cost and safety of patient care. Although numerous studies have explored the well-being of hospice staff, study findings vary and the evidence has not yet been reviewed and synthesised. Using job demands-resources (JD-R) theory, this review aimed to investigate what factors are associated with the well-being of hospice staff.

Methods We searched MEDLINE, CINAHL and PsycINFO for peer-reviewed quantitative, qualitative or mixed-methods studies focused on understanding what contributes to the well-being of hospice staff who provide care to patients (adults and children). The date of the last search was 11 March 2022. Studies were published from 2000 onwards in the English language and conducted in Organisation for Economic Co-operation and Development countries. Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was conducted using a result-based convergent design, which involved an iterative, thematic approach of collating data into distinct factors and mapping these to the JD-R theory.

Results A total of 4016 unique records were screened by title and abstract, 115 full-text articles were retrieved and reviewed and 27 articles describing 23 studies were included in the review. The majority of the evidence came from studies of staff working with adult patients. Twenty-seven individual factors were identified in the included studies. There is a strong and moderate evidence that 21 of the 27 identified factors can influence hospice staff well-being. These 21 factors can be grouped into three categories: (1) those that are specific to the hospice environment and role, such as the complexity and diversity of the hospice role; (2) those that have been found to be associated with well-being in other similar settings, such as relationships with patients and their families; and (3) those that affect workers regardless of their role and work environment, that is, that are not unique to working in a healthcare role, such as workload and working relationships. There was strong evidence that neither staff demographic characteristics nor education level can influence well-being.

Discussion The factors identified in this review highlight the importance of assessing both positive and negative domains of experience to determine coping interventions. Hospice organisations should aim to offer a wide range of interventions to ensure their staff have access to something that works for them. These should involve continuing or commencing initiatives to protect the factors that make hospices good environments in which to work, as well as recognising that hospice staff are also subject to many of the same factors that affect psychological well-being in all work environments. Only two studies included in the review were set in children’s hospices, suggesting that more research is needed in these settings.

PROSPERO registration number CRD42019136721 (Deviations from the protocol are noted in Table 8, Supplementary material).

  • Psychological care
  • Hospice care
  • Education and training
  • Supportive care

Data availability statement

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  • Contributors Conception and design of study: JT, AP, BB, LF, SM. Acquisition and assessment of studies: AP, JT, SG, BB, LF, SM, LZ, MO'N, VF, AB. Analysis and/or interpretation of data: AP, JT, VF, LZ, BB, LF, SM. Drafting the manuscript: AP, JT, LZ. Approval of the version of the manuscript to be published: all authors. LZ is responsible for the overall content as the guarantor.

  • Funding This study was funded by the Martin House Research Centre: a partnership between the University of York and Martin House Hospice Care for Children and Young People.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.