Paediatric Healthcare Worker Burnout and Empathic Distress Fatigue
Healthcare workers (HCWs) caring for seriously ill children (SIC) face a uniquely intense emotional burden, including repeated child deaths, end-of-life decision-making, and prolonged relationships with distressed families. Burnout and workforce attrition in this group carry direct implications for care quality and Singapore's healthcare workforce sustainability.
Objective: This three-phase programme aims to 1. characterise the burden of Empathic Distress Fatigue (EDF) and burnout among paediatric SIC HCWs in Singapore, 2. understand the mechanisms driving the EDF→burnout pathway, and 3. co-design and pilot a targeted evidence-based intervention. EDF, the self-oriented emotional depletion arising from empathic over-identification with patient suffering, is neurobiologically distinct from burnout and is its proximal upstream driver.
Design: Three-component mixed-methods programme. (1) A cross-sectional survey (~N=220) across KKH and HCA StarPALS measuring EDF (EFS-HP), burnout (OLBI), psychological distress (PHQ-4), resilience (BRCS-4), and turnover intention (TIS-6). (2) A qualitative study using Reflexive Thematic Analysis exploring the lived experience of EDF and its contextual determinants. (3) A proposed two-aim intervention study: Aim 1 co-designs an Acceptance and Commitment Therapy (ACT)-based programme guided by Intervention Mapping (IM); Aim 2 tests its feasibility in a single-arm pilot (n=30).
Key findings to date: 74.3% of HCWs caring for SIC met criteria for full burnout (95% CI: 68.3–80.2%); 48.5% reported high turnover intention; and 22.9% screened positive for anxiety. EDF was the dominant modifiable predictor of burnout (multivariable OR=3.80, 95% CI: 1.64–8.79, p=0.002). Adding EDF, resilience, and distress to a demographic and work-factor model increased explained variance in exhaustion from 14.6% to 60.5% (ΔR²=0.46, p<0.001), confirming the primacy of emotional over structural mechanisms. Allied health professionals had the highest burnout prevalence (77.8%) and turnover intention. Discriminant validity analyses confirmed EDF and burnout are empirically distinct constructs (r=0.59), supporting EDF as an independent and actionable intervention target.
Principal Investigator
Dr. Felicia Ang Jia Ler, Research Fellow, Lien Centre for Palliative Care (LCPC), Health Services Research & Population Health (HSRPH), Duke-NUS Medical School
Any Other Information
Phase 1 and 2: Funded by LCPC.
Phase 3 funding: NMRC Population Health Research Grant – New Investigator Grant (PHRGNIG), resubmission pending (target July 2026).
Ethics approval: NUS-IRB-2026-26 (phase 1); NUS-IRB-2026-394 (phase 2).