Hostname: page-component-7d684dbfc8-jr2wd Total loading time: 0 Render date: 2023-09-23T16:36:26.229Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "coreDisableSocialShare": false, "coreDisableEcommerceForArticlePurchase": false, "coreDisableEcommerceForBookPurchase": false, "coreDisableEcommerceForElementPurchase": false, "coreUseNewShare": true, "useRatesEcommerce": true } hasContentIssue false

The burden in palliative care assistance: A comparison of psychosocial risks and burnout between inpatient hospice and home care services workers

Published online by Cambridge University Press:  26 January 2022

Alice Fattori*
Occupational Health Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Matilde Pedruzzi
Department of Clinical Science and Community Health, University of Milan, Italy
Carlo Cantarella
Department of Clinical Science and Community Health, University of Milan, Italy
Matteo Bonzini
Occupational Health Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy Department of Clinical Science and Community Health, University of Milan, Italy
Author for correspondence: Alice Fattori, Occupational Health Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via San Barnaba 8, 20122 Milan, Italy. E-mail:



Literature suggests that home care professionals could be at higher risk of burnout than their colleagues in hospital settings, but research on home-based palliative care is still limited. Our study investigates psychosocial risk factors and burnout among workers involved in palliative care, comparing inpatient hospice, and home care settings.


A cross-sectional study was carried out in a single palliative care organization providing inpatient hospice-based and home care-based assistance in a large urban area of Northern Italy. Participants completed a self-administered questionnaire collecting socio-demographic and occupational data, psychosocial risk factors, and burnout scales (Psychosocial Safety Climate 4; Conflict and Offensive Behavior — COPSOQ II; Work Life Boundaries; Work-home Interaction; Peer Support — HSE; Copenhagen Burnout Inventory).


The study sample included 106 subjects (95% of the overall eligible working population) who were predominantly female (68%) and nurses (57%), with a mean age of 41 years. Compared to inpatient hospice staff, home care workers reported more frequent communications with colleagues (p = 0.03) and patients/caregivers (p = 0.01), while there were no differences in the perception of work intrusiveness. Inpatient hospice workers showed lower peer support (p = 0.08) and lower psychosocial safety climate (p = 0.001) than home care colleagues. The experience of aggressive behaviors was rare, and it was relatively more frequent among inpatient hospice workers, female workers, and health assistants. Average scores of burnout scales were similar for both groups except for caregiver-related burnout, which was higher among inpatient hospice workers compared to home care colleagues (p = 0.008). The number of subjects at risk for work-related burnout was similar for both groups.

Significance of results

Our study confirms the presence of psychological and physical fatigue in both home-based and inpatient hospice palliative care. Results suggest that home care assistance may not be characterized by higher psychological burden compared to inpatient hospice setting. Given the general tendency to increase home-based care in our aging population, it is essential to broaden the knowledge of psychosocial risks in this specific context to properly protect workers’ health.

Original Article
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Abernethy, A, Ast, K, Bull, J, et al. (2016) Prevalence and predictors of burnout among hospice and palliative care clinicians in the U.S. Journal of Pain and Symptom Management 51(4), 87.Google Scholar
Ashforth, BE, Kreiner, GE and Fugate, M (2000) All in a day's work: Boundries and micro role transition. Academy of Management Review 25(3), 472491. doi:10.5465/AMR.2000.3363315CrossRefGoogle Scholar
Borritz, M and Kristensen, TS (2004). Normative data from a representative Danish population on personal burnout and results from the PUMA study on personal burnout, work burnout, and client burnout. Retrieved January 15, 2007.Google Scholar
Camerino, D, Sandri, M, Sartori, S, et al. (2010) Shiftwork, work-family conflict among Italian nurses, and prevention efficacy. Chronobiology International 27(5), 11051123.CrossRefGoogle ScholarPubMed
Clark, SC (2000) Work/family border theory: A new theory of work/family balance. Human Relations 53(6), 747770. doi:10.1177/0018726700536001CrossRefGoogle Scholar
Danielsen, B (2018) Experiences and challenges of homecare nurses and general practitioners in homebased palliative care: A qualitative study. BMC Palliative Care 17(1), 95.CrossRefGoogle Scholar
Denton, MA, Zeytinoğlu, IU and Davies, S (2002) Working in clients’ homes: The impact on the mental health and well-being of visiting homecare workers. Home Health Care Services Quarterly 21(1), 1.CrossRefGoogle Scholar
Derks, D, van Duin, D and Tims, M, et al. (2015) Smartphone use and work–home interference: The moderating role of social norms and employee work engagement. Journal of Occupational and Organizational Psychology 88(1), 155177.CrossRefGoogle Scholar
Dollard, MF (2019) The PSC-4: A short PSC tool. In Dollard, MF, Dormann, C & Idris, MA (eds.), Psychosocial Safety Climate. Springer Nature, pp. 385410.CrossRefGoogle Scholar
Dollard, MF and Bakker, AB (2010) Psychosocial safety climate as a precursor to conducive work environments, psychological health problems, and employee engagement. Journal of Occupational and Organizational Psychology 83, 579599.CrossRefGoogle Scholar
Ellenbecker, CH, Samia, L, Cushman, MJ, et al. ( (ed.), 2008) Patient safety and quality in home health care. In Hughes, R (ed.), Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Agency for Healthcare Research and Quality (US), pp. 301340.Google Scholar
Feldman, P, Bridges, J and Peng, TR (2005). Working Conditions and Adverse Events in Home Health Care. Rockville, MD: Agency for Healthcare Research and Quality; 2001–2005. RO1 HS11962.Google Scholar
Fillion, L, Saint-Laurent, L and Rousseau, N (2003) Les stresseurs liés a` la pratique infirmie`re en soins palliatifs: Les points de vue des infirmie`res [stressors related to the nursing practice in palliative care: The nurses’ point of view]. Les Cahiers de Soins Palliatifs 4, 540.Google Scholar
Fiorilli, C, De Stasio, S, Benevene, P, et al. (2015) Copenhagen burnout inventory (CBI): A validation study in an Italian teacher group. Testing, Psychometrics, Methodology in Applied Psychology 22(4), 537551.Google Scholar
Ganann, R, Weeres, A, Lam, A, et al. (2019) Optimization of homecare nurses in Canada: A scoping review. Health & Social Care in the Community 27(5), e604e621.CrossRefGoogle Scholar
Geurts, SAE, Taris, TW, Kompier, MAJ, et al. (2005) Work-home interaction from a work psychological perspective: Development and validation of a new questionnaire, the SWING. Work & Stress 19(4), 319339.CrossRefGoogle Scholar
Graham, J, Ramirez, AJ, Cull, A, et al. (1996) Job stress and satisfaction among palliative physicians. Palliative Medicine 10, 185194.CrossRefGoogle ScholarPubMed
Health and Safety Executive (2004). Psychosocial working conditions in Great Britain in 2004. Retrieved April 7, 2008, from Scholar
Hoare, S, Morris, ZS, Kelly, MP, et al. (2015) Do patients want to die at home? A systematic review of the UK literature, focused on missing preferences for place of death. PLoS ONE 10(11), e0142723.CrossRefGoogle Scholar
Idris, MA, Dollard, MF, Coward, J, et al. (2012) Psychosocial safety climate: Conceptual distinctiveness and effect on job demands and worker psychological health. Safety Science 50(1), 1928.CrossRefGoogle Scholar
Kamau, C, Medisauskaite, A and Lopes, B (2014) Orientations can avert psychosocial risks to palliative staff. Psycho-Oncology 23, 716718.CrossRefGoogle ScholarPubMed
Kearney, MK, Weininger, RB, Vachon, ML, et al. (2009) Self-care of physicians caring for patients at the end of life:“Being connected... a key to my survival”. Jama 301(11), 11551164.CrossRefGoogle Scholar
Koh, MYH, Chong, PH, Neo, PSH, et al. (2015) Burnout, psychological morbidity and use of coping mechanisms among palliative care practitioners: A multi-centre cross-sectional study. Palliative Medicine 29(7), 633642.CrossRefGoogle ScholarPubMed
Kristensen, TS, Borritz, M, Villadsen, E, et al. (2005) The Copenhagen Burnout Inventory: A new tool for the assessment of burnout. Work & Stress 19(3), 192207.CrossRefGoogle Scholar
Kroposki, M and Alexander, JW (2006) Correlation among client satisfaction, nursing perception of outcomes, and organizational variables. Home Healthc Nurse 24(2), 8794.CrossRefGoogle ScholarPubMed
Law, R, Dollard, MF, Tuckey, MR, et al. (2011) Psychosocial safety climate as alead indicator of workplace bullying and harassment, job resources, psychological health and employee engagement. Accident Analysis and Prevention 43, 17821793.CrossRefGoogle Scholar
Martins Pereira, S, Fonseca, AM, Sofia Carvalho, A, et al. (2011) Burnout in palliative care: A systematic review. Nursing ethics 18(3), 317326.CrossRefGoogle Scholar
Maslach, C and Leiter, MP (2016) Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry 15(2), 103111.CrossRefGoogle ScholarPubMed
Maslach, C and Schaufeli, WB (1993) Historical and conceptual development of burnout. In Schaufeli, WB, Maslch, C and Marek, T (eds.), Professional Burnout. Recent Development in Theory and Research. New York: Taylor and Francis, pp. 116.Google Scholar
Maslach, C, Leiter, MP and Fink, BG (ed) (2000) Encyclopedia of Stress. New York: Academic Press.Google Scholar
NIOSH (2010) NIOSH Hazard Review: Occupational Hazards in Home Healthcare. DHHS (NIOSH) Publication Number 2010-125. January 2010.Google Scholar
O'Connor, K, Neff, DM and Pitman, S (2018) Burnout in mental health professionals: A systematic review and meta-analysis of prevalence and determinants. European Psychiatry 53, 7499.CrossRefGoogle ScholarPubMed
Owen, MS, Bailey, TS and Dollard, MF (2016) Psychosocial safety climate as a multilevel extension of ERI theory: Evidence from Australia. Work stress and health in a globalized economy. Cham: Springer, pp. 189217.CrossRefGoogle Scholar
Parola, V, Coelho, A, Cardoso, D, et al. (2017) Prevalence of burnout in health professionals working in palliative care: A systematic review. JBI Database of Systematic Reviews and Implementation Reports 15(7), 19051933.CrossRefGoogle ScholarPubMed
Peeters, MC, Montgomery, AJ, Bakker, AB, et al. (2005) Balancing work and home: How job and home demands are related to burnout. International Journal of Stress Management 12(1), 43.CrossRefGoogle Scholar
Pejtersen, JH, Kristensen, TS, Borg, V, et al. (2010) The second version of the Copenhagen psychosocial questionnaire. Scandinavian Journal of Public Health 38(3), 824.CrossRefGoogle ScholarPubMed
Rabbetts, L, Harrington, A and Breaden, K (2020) Nurses’ experience of providing home-based palliative care in the country setting: An integrated literature review. International Journal of Nursing Practice 26(1), e12773.CrossRefGoogle ScholarPubMed
Rizo-Baeza, M, Mendiola-Infante, SV, Sepehri, A, et al. (2018) Burnout syndrome in nurses working in palliative care units: An analysis of associated factors. Journal of Nursing Management 26(1), 1925.CrossRefGoogle ScholarPubMed
Rokach, A (2005) Caring for those who care for the dying: Coping with the demands on palliative care workers. Palliative & Supportive Care 3, 325332.CrossRefGoogle ScholarPubMed
Rokach, A (2017) Palliative care workers: Demands and stresses. JOJ Nursing & Health Care 1(1), 12.CrossRefGoogle Scholar
Rotenstein, LS, Torre, M, Ramos, MA, et al. (2018) Prevalence of burnout among physicians: A systematic review. JAMA 320(11), 11311150.CrossRefGoogle ScholarPubMed
Salvagioni, DAJ, Melanda, FN, Mesas, AE, et al. (2017) Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PLoS ONE 12(10), e0185781.CrossRefGoogle ScholarPubMed
Sestili, C, Scalingi, S, Cianfanelli, S, et al. (2018) Reliability and use of Copenhagen burnout inventory in Italian sample of university professors. International journal of environmental research and public health 15(8), 1708.CrossRefGoogle ScholarPubMed
Spector, PE, Zhou, ZE and Che, XX (2014) Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review. International Journal of Nursing Studies 51(1), 7284.CrossRefGoogle ScholarPubMed
Spetz, J, Stone, RI, Chapman, SA, et al. (2019) Home and community-based workforce for patients with serious illness requires support to meet growing needs. Health Affairs 38(6), 902909.CrossRefGoogle ScholarPubMed
Teruya, N, Sunagawa, Y, Sunagawa, H, et al. (2019) Visiting nurses’ perspectives on practices to achieve end-of-life cancer patients’ wishes for death at home: A qualitative study. Asia-Pacific Journal of Oncology Nursing 6(4), 389.CrossRefGoogle ScholarPubMed
Uren, S and Graham, T (2013) Subjective experiences of coping among caregivers in palliative care. The Online Journal of Issues in Nursing 18(2).Google ScholarPubMed
Vachon, MLS (2008) Stress and burnout in palliative medicine. In Walsh, D, Caraceni, AE and Fainsinger, R (eds.), Palliative Medicine, Philadelphia, PA: Elsevier, pp. 7583.Google Scholar
Wepfer, AG, Allen, TD, Brauchli, R, et al. (2018) Work-life boundaries and well-being: Does work-to-life integration impair well-being through lack of recovery? Journal of Business and Psychology 33(6), 727740.CrossRefGoogle Scholar
White, K, Wilkes, L, Cooper, K, et al. (2004) The impact of unrelieved patient suffering on palliative care nurses. International Journal of Palliative Nursing 10, 438444.CrossRefGoogle ScholarPubMed
World Health Organization (2019) International Statistical Classification of Diseases and Related Health Problems, 11th ed. Geneva.Google Scholar
Zadow, AJ, Dollard, MF, Mclinton, SS, et al. (2017) Psychosocial safety climate, emotional exhaustion, and work injuries in healthcare workplaces. Stress and Health 33(5), 558569.CrossRefGoogle ScholarPubMed