Ethical decisions in Portuguese palliative care units: a burnout risk factor?: a mixed methods multicentre study in PT

Background: Ethical decision-making in end-of-life care is often perceived as stressful. Aims: To identify the most common ethical decisions made by Portuguese palliative care teams and how the making of such decisions relates to burnout among these professionals. Methods: A mixed methods study was performed in 9 palliative care teams. Data was collected through questionnaires, Maslach Burnout Inventory, interviews and observations. Quantitative data analysis included both descriptive, univariate and multivariate logistic regression analyses; qualitative data was analysed inductively with categories and themes being embedded in the data. Results were triangulated to ensure reliability of the findings. Results: Communication issues caused the most common ethical decisions, followed by forgoing treatment and terminal sedation. Although perceived as a risk factor for burnout in the discourse of the participants, quantitative data showed that the need to make ethical decisions was not significantly associated with higher burnout levels. A possible explanation for these findings could be found through the analysis of the transcripts of interviews and field notes: the decision-making process, in which an interdisciplinary approach took place and ethical resources were used, was identified as a protective factor against burnout. Conclusions: Making ethical decisions is not associated with burnout among professionals working in Portuguese specialised palliative care units. This might be explained by the ethical deliberation and decision-making process followed by these teams. Promoting palliative care skills among other professionals providing end-of-life care might be useful to diminish burnout and other work-related problems related to making ethical end-of-life decisions.