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- Burnout e Vinculação em Oncologia e Fim de VidaPublication . Gonçalves, Florbela dos Santos; Viana, Joaquim Manuel da Silva; Sousa, Miguel Castelo Branco Craveiro deIntroduction The current shortage of human resources in the healthcare sector is increasingly recognized as a critical public health issue, with projections indicating that this challenge will escalate in the coming years. While poor working conditions have traditionally been regarded as the primary cause of burnout, emerging evidence underscores the pivotal role of personality traits, including attachment styles, in the development of this syndrome. The concept of burnout was first introduced by Herbert Freudenberger in the 1970s, defining it as a state characterized by despersonalization, emotional exhaustion and demotivation linked to work. Over time, tools to assess and measure burnout have been developed and refined. One of the most widely used instruments is the Maslach Burnout Inventory (MBI), created by Christina Maslach. According to this framework, burnout syndrome is defined by three core dimensions: emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. Despite its widespread application across various professional domains, some critics have questioned the validity of the MBI, particularly the interpretation of depersonalization, which may function as an adaptive coping mechanism rather than an unequivocal symptom of burnout. Burnout typically arises from prolonged exposure to stress, especially when an individual’s expectations are incongruent with their work environment. Although unfavorable working conditions are strongly associated with the syndrome, not all individuals respond to such conditions in the same way. This has led to increasing interest in the role of individual personality traits and their contribution to the susceptibility to burnout. The Copenhagen Burnout Inventory (CBI), developed by Kristensen et al, offers an alternative, open-access instrument designed to evaluate burnout. It assesses three distinct dimensions: personal burnout, work-related burnout, and client/patient-related burnout. The presence of burnout significantly jeopardizes healthcare professionals' performance and well-being, as it has been associated with adverse outcomes such as addictive behaviors, sleep disorders, and depression. Burnout is a prevalent issue among healthcare professionals, particularly those caring for patients experiencing profound suffering, such as individuals with cancer or other advanced chronic diseases. Recognizing that not all individuals exposed to similar work environments develop burnout, increasing attention has been directed toward understanding the role of individual characteristics in the syndrome's onset. Among these factors, the study of attachment traits revealed useful as a promising root to understand variability in burnout production and development of preventive strategies. Attachment theory asserts that early childhood experiences critically shape emotional bonds and interpersonal relationships, which, in turn, influence workplace behavior. John Bowlby’s pioneering research on emotional attachment demonstrated its relevance to various organizational and professional contexts. Individuals with a secure attachment style, often linked to a positive outlook, are more resilient to workplace stressors. Conversely, an insecure attachment style is generally associated with greater susceptibility to burnout and diminished professional performance. This insight may help explain why some healthcare professionals develop burnout under similarly stressful conditions, while others remain unaffected. Objectives The primary objective of this study was to determine whether there is an association between attachment style and the risk of burnout in a population of healthcare professionals working in an Oncology Hospital. The secondary objectives of this study are as follows: - To assess the risk of burnout in individuals working with oncology and palliative care patients; - To identify the various attachment styles exhibited by healthcare professionals in oncology and palliative care; - To determine potential predictors of burnout in the population of healthcare professionals working in oncology and palliative care; - To assess the professional quality of life in the population of professionals working at the Oncology hospital; - To explore the potential association between burnout and the quality of professional life in individuals working with cancer patients and in palliative care. Materials and Methods This was a cross-sectional, descriptive, and correlational study conducted between January and December 2018. The study was carried out at the Portuguese Institute of Oncology of Coimbra Francisco Gentil, EPE, involving 1003 healthcare professionals from the institution who were invited to participate The inclusion criteria encompassed healthcare professionals aged ≥18 years, currently employed at the institution, willing to participate, and able to provide written informed consent, with an adequate understanding of the study objectives. Healthcare professionals who declined participation and those with diagnosed psychopathologies were excluded. Of the 1003 professionals invited, 337 participated, 626 declined to participate, and 40 were excluded due to psychiatric conditions. Thus, a convenience sample of 337 healthcare professionals was obtained, yielding a response rate of 36%. The assessment protocol included a sociodemographic questionnaire, burnout assessments via the Maslach Burnout Inventory (MBI) and the Copenhagen Burnout Inventory (CBI), the Adult Attachment Scale, the Professional Quality of Life-5 Scale (ProQOL-5), and a single question: "Is it common to work with patients in palliative care?" This question allowed for the categorization of the sample into two groups: professionals who had exclusively worked with non-palliative oncology patients and those who had worked with palliative oncology patients. Statistical analyses were performed using IBM SPSS Statistics V.25 software, with significance tests conducted at the 5% level. Results It was observed that 76.8% of the healthcare professionals in the sample were involved in the care of non-palliative oncology patients. Upon comparing the two groups of professionals using CBI, it was found that more than 50% of the participants reported high levels of personal burnout, with no statistically significant differences between the groups (53.5% in one group and 56.8% in the other, p=0.619). Similar findings were noted for the work-related (p=0.626) and patient-related (p=0.672) dimensions of burnout. The analysis of the correlation between burnout dimensions and attachment style demonstrated that higher scores in emotional exhaustion, depersonalization, work-related burnout, and patient-related burnout were significantly associated with increased levels of anxiety (p<0.001). These findings were consistent across both groups, including professionals working with patients in the advanced stages of oncological diseases. The exploration of the correlation between burnout dimensions and the dimensions of the Adult Attachment Scale revealed that elevated scores in emotional exhaustion, depersonalization, work-related burnout, and patient-related burnout were significantly associated with higher levels of anxiety (p<0.001). These findings were consistent in the sample of professionals working with patients in the advanced stages of oncological diseases. Further exploration of the correlation between burnout dimensions and the dimensions of Professional Quality of Life (ProQOL-5) did not reveal any statistically significant differences between the two groups within the sample. Discussion and Conclusions Working in oncology and palliative care requires effective communication and a resilient personality from healthcare professionals. Without these two key factors, the likelihood of burnout increases. The etiology of burnout is multifactorial, involving both occupational factors and the personality traits of healthcare professionals, with attachment style being particularly significant. In the studied sample, no statistically significant differences were found between the two groups of healthcare professionals. Higher levels of anxiety were correlated with increased levels of both patient-related and work-related burnout, suggesting that an insecure attachment pattern may predispose individuals to burnout. Both groups experienced a similar quality of working life. The most significant contributor to burnout in this sample was the number of hours worked per week, leading to prolonged exposure to human suffering. Preventive measures, including the pursuit of personal well-being, regular physical activity, mindfulness practices, and the maintenance of proper sleep hygiene, can help reduce the risk of burnout. This study was enhanced by the use of two established burnout scales, including the Copenhagen Burnout Inventory (CBI), and by examining the correlation between burnout levels, attachment style, and the professional quality of life among healthcare professionals caring for cancer patients, some of whom were in end-of-life stages.