Wellness and distress in healthcare professionals dealing with end-of-life and bioethical issues (WeDistress HELL): An observational, multicentre, cross-sectional research project with a multimethod design

Introduction: Medical practice implies an increasing amount of bioethical issues that may negatively impact on health care professionals wellbeing. However, to date, little is known about the experience of burnout and (moral) distress related with end of life and bioethical issues in everyday working life. Objectives: to study variables (meaning in life, stress, moral distress, ethical climate, resilience, positive and negative affects) that may impact on health care professionals dealing with end-of-life and bioethics issues. Materials and methods: The study will be conducted using a multi-method design, using both quantitative and qualitative approaches. The anonymous questionnaire administered one time only to each participant was composed by socio-demographic questions, Maslach Burnout Inventory – General Survey, Schedule for Meaning in Life Evaluation, Maugeri Stress Index, Moral Distress Scale-Revised, Hospital Ethical Climate Survey, Connor-Davidson Resilience Scale, Positive Affect and Negative Affect Scale. Semi-structured interviews have been conducted, too. Main results: Managerial support and ethical vision of patient care were negatively related to emotional exhaustion, directly and through moral distress. Professionals high in resilience and positive affectivity benefited more from the protective effect of managerial support on emotional exhaustion through moral distress. Moreover, resilience improves healthcare professionals’ wellbeing and professional self-efficacy, directly and indirectly, as mediated by the ethical vision of patient care. Highly resilient professionals benefit more from the positive effect of ethical vision of patient care on wellbeing in presence of high managerial support. The qualitative part shed light on both stressors (e.g. emotion management regarding death, communication of poor diagnosis/prognosis) and protective factors (e.g. social support, positive approach and value of past experience) experienced by palliative care professionals and medical student. Moreover, palliative care professionals considered the Italian law on Advance Directives as a useful instrument for self-determination and protection despite the presence of some critical aspects. Discussion: This study may help to focus on risk and protective factors to be monitored during the health care provider’s career. It may also provide information useful for preventing and supportive interventions in medical practice with end-of-life and life-threatening patients.