Burnout And Resilience after a Decade in Palliative Care (BARD): What 'Survivors' have to teach us. A Qualitative Study of Palliative Care Clinicians with more than 10 years of experience.

Burnout is common amongst palliative care clinicians. Resilience helps to reduce burnout, compassion fatigue and is associated with longevity in palliative care.We aimed to study palliative care clinicians who have remained in the field for longer than 10 years to deepen our understanding on their views on burnout and resilience.We conducted a qualitative study using semi-structured interviews and purposive sampling on 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 mean age of the interviewees was 52 years old and the mean number of years practicing palliative care was 15.7 years (ranging from 10 -25 years). The interviews were recorded verbatim, transcribed and analysed using a grounded theory approach.4 major themes emerged from our analysis - Struggling, Changing Mindset, Adapting and Resilience (SCAR). Intervening conditions such as self-awareness, reflection, and evolution were also important factors. The core phenomenon of our study was that of 'Transformational Growth' - a process which palliative care clinicians have to go through before they achieve resilience. We also further classified resilience into both personal and collective resilience.Our findings highlight the evolving process of transformational growth which palliative care clinicians must repeatedly undergo as they strive towards sustained resilience and longevity. It also stresses the importance of taking individual and collective responsibility towards building a culture of personal and team resilience.