Behind the care: emotional struggles, burnout, and denial in Kazakhstan's professional palliative care workforce

Background
This exploratory study investigates the emotional impact of palliative care provision among healthcare professionals in resource-limited settings, specifically in Kazakhstan. As a middle-income country with a growing burden of chronic diseases, the palliative care sector in Kazakhstan faces increasing challenges to address burnout.

Methods
Due to limited existing knowledge, an exploratory design was adopted, employing grounded theory approach to discover professionals’ understanding of their experiences, emotional stressors, and burnout development. In-depth qualitative interviews were conducted with 60 palliative care professionals (41 nurses, 19 physicians) from 4 hospices, 2 PCUs of cancer centers, and 1 nursing department from diverse geographical locations within Kazakhstan. The data collection phase was carried out between May 2021 and July 2022. Analysis focused on identifying stressors leading to burnout and coping mechanisms used by palliative care professionals.

Results
The study identifies key stressors, including emotional involvement with patients, communication challenges with relatives, witnessing patient frailty and death, lack of personal accomplishment, and emotional labor. A unique finding is the widespread denial of emotional impact among participants, expressed through normalization of work-related stress and suppression of emotions. Through analysis, four key themes were identified as central to the findings: (1) stressors contributing to burnout, (2) denial of emotional impact, (3) coping mechanisms, and (4) attitudes towards seeking psychological help.

Conclusions
The present study has revealed that the denial of emotional impact, along with the downplaying or dismissal of the impact of stress, is a recurring pattern among healthcare workers providing palliative care to terminally ill patients in Kazakhstan. The findings of this study underscore the need for tailored training to address the specific emotional needs of palliative care workers, focusing on effective communication, techniques for emotional regulation, stress management, and self-care practices to help professionals cope with the emotional demands of their work.