Bearing the Weight of End-of-Life Work: A Qualitative Study of Emotional Experience and Coping Among Palliative Care Professionals in Northern Italy

Abstract

Background: Palliative care is a clinically, relationally and emotionally demanding field. Continuous exposure to suffering and death exposes professionals to compassion fatigue, vicarious trauma and grief, and burnout, while also offering opportunities for compassion satisfaction and meaning-making. How professionals cope is central to sustaining the supporting role in diseases with a poor prognosis. Objectives: To explore the emotional and experiential dimensions of palliative care work and the coping strategies, individual and team-based, that professionals deploy when accompanying patients and families at the end of life. Methods: Reflexive thematic analysis of 16 semi-structured interviews with palliative care professionals (5 physicians, 7 nurses, 3 psychologists, and 1 social-health worker; 14 women and 2 men) recruited from hospices, hospital wards and home-based services in Northern Italy. Sample size was guided by an information power model. Reporting follows the COREQ checklist. Results: Four themes were constructed: (1) the unsustainability of the workload; (2) the pleasure of care between empathic relationship, listening and welcoming; (3) the holistic role of the professional; and (4) the awareness of death. Across themes, participants mobilised a layered repertoire of problem-, emotion- and meaning-focused coping. Narratives fitting a structured moral-distress pattern were comparatively limited in participants’ accounts. Conclusions: Sustaining supporting roles in poor-prognosis care may require more than individual resilience; it depends on organisational support—structured supervision, reflective spaces, and communication and emotional training—that makes professionals’ largely informal coping work a shared and sustainable resource.