Ethical decisions in palliative care: a burnout risk factor?: results from a mixed-methods multicentre study in Portugal

Background: Ethical decision-making in end-of-life care is perceived asstressful. Making ethical decisionsisrelated to higher levels of burnout among health professionals. Aims: To identify the most common ethical decisions made by Portuguese palliative care teams and understand how the making ofsuch decisionsrelatesto burnout. Methods: Mixed methodsstudy in 9 palliative care teams. Data was collected through: questionnaires ofsocio-demographic and profession-related variables, and work-related experiences; Maslach Burnout Inventory; interviews; observations. Quantitative data analysesincluded descriptive, uni and multivariate logistic regressions; qualitative data was analysed inductively with themes/categories emerging from data. Triangulation ensured reliability. A total of 88 professionals(66% response rate) were included, 11 nurses and 9 physicians were interviewed and 240 hours of observations were fulfilled. Results: The most common ethical decisions were caused by communication issues, forgoing treatment and terminalsedation. Although perceived as a burnout risk factor in the speech of the participants, quantitative data showed that making ethical decisions was notsignificantly associated with burnout. These findings were explained through the analysis of the transcripts of interviews and field-notes: The decision-making process using an interdisciplinary team approach and consulting ethical committees were identified as protective factors against burnout. Conclusions: Making ethical decisionsis not associated with burnout among professionals working in Portuguese palliative care teams. Thisis explained by the ethical deliberation and decision-making processfollowed by these teams. Promoting palliative care skills among professionals providing end-of-life care in othersettings might be useful to diminish burnout related to making ethical end-of-life decisions.