Likelihood of Death Within One Year Among a National Cohort of Hospital Inpatients in Scotland.

To the Editor: We thank Beas and Dı́az-Pardav e for their continued interest in our article demonstrating high burnout among palliative care clinicians. Burnout is ultimately a complex, multifaceted syndrome characterized by varying degrees of emotional exhaustion, depersonalization, and low sense of personal accomplishment. As the authors highlight, a variety of approaches have been used to assess and report on burnout in the literature. Burnout is best considered a continuous variable and the experience of burnout a continuum. A dichotomous categorization (burned out vs. not burned out) is, however, a commonly accepted and practical approach to describe the prevalence of burnout. We applied the most widely used convention to categorize burnout, which considers those with high scores on either the emotional exhaustion and/or depersonalization domain to be experiencing at least one symptom of burnout. Evidence indicates that high scores on either the depersonalization or emotional exhaustion subscales have high discriminatory ability and that a high score in either of these two domains identifies individuals whose degree of burnout results in adverse personal and professional consequences. Evidences also suggest that this approach better identifies those individuals experiencing the adverse consequences of burnout than more restrictive approaches to categorization. Accordingly, there is strong evidence for the way burnout was categorized in our study and the high prevalence of this syndrome among palliative care professionals is cause for concern. Additional studies are now needed to identify practical approaches for health care organizations to reduce burnout and promote engagement in the palliative care workforce.