Truth on ProQOL and Burnout Assessment-Development and Intercultural Validation of the Brief ProQOL-12 from the Professional Quality of Life, Version 5.

OBJECTIVE: The prevalence of burnout is becoming a public health issue across the world. This study developed and validated Brief ProQOL-12, formed from the existing, but yet unvalidated 30-item ProQOL-5. METHODS: Study 1-Eight intercultural samples of helping professionals from four continents (n = 4,129). Validation included step-wise appraisal and multi-group invariance testing. Study 2-Ethnically and occupationally-balanced sample (n = 453). Rasch modeling, factor analysis, analysis of measure correlates, and scale refinements. RESULTS: ProQOL-5 (30-item) did not fit among any continential or national samples, including North America. Study 1-Provisional ProQOL-12 showed good internal structure and measurement invariance. Study 2-Brief ProQOL-12 had an excellent fit in the ethnically and occupationally diverse sample. Included ProQOL 5 items were: 9, 10, 12-14, 18, 19, 21, 24-26, and 30. The reliability and validity of the Brief ProQOL-12 were significantly improved over the 30-item measure. Rasch modeling and factor analysis indicated that the measure was reliable, valid interculturally and occupationally. CONCLUSIONS: The ProQOL-5 (30-item) reliability and validity concerns were resolved in this 12-item measure which was refined to include a more realistic time context of seven days and time definite Likert ranges. These enhancements increased validity, as evidenced by the improvement in all model fit indicators in the excellent range in Study 2. Transcending culture and ethnicity with proven psychometric robustness, the Brief ProQOL-12 serves as a valuable resource for evaluating burnout risk and well-being across heterogeneous ethnic, cultural, and occupational landscapes.

How do enrollees feel about support in Big Hospices? - The caregiver experience of emotional, spiritual, and bereavement support by profit status among large US providers.

OBJECTIVES: Recent findings narrate profiteering detrimentally impacting hospice care quality. However, no study has examined the caregiver experience of emotional and spiritual support expressed online. The purpose was to evaluate the hospice caregiver's experience of emotional, spiritual, and bereavement support and whether the care was respectful and compassionate to the care unit. METHODS: Retrospective mixed methods of sentiment and quantitative analysis. Sources were online caregiver reviews (n = 4,279), Consumer Assessment of Healthcare Providers and Systems (CAHPS) data on the 50 largest US hospices. RESULTS: Caring and compassionate professionals were lauded in nonprofit (+.57) and for-profit settings (+.46). The nonprofit experience was in the excellent range (+42) for emotional, spiritual, and bereavement support but fell to dissatisfying (-.15) among for-profits. A respectful experience (16%) was much less commonly expressed than a compassionate one (38%). Distribution of CAHPS "Treating patient with respect" (M = 89.62, SD = 2.63) and "Emotional and spiritual support" (M = 89.80, SD = 2.04) limited inter-hospice comparisons. SIGNIFICANCE OF RESULTS: Compassionate professionals were thanked and praised regardless of profit status. Sadly, anger was expressed toward large, for-profits more fixated on census than emotional, spiritual, and bereavement support; thankfully nonprofits were more supportive. CAHPS items for "Treating patient with respect" and "Emotional, spiritual support" offer limited discriminating value since low CAHPS performers always had relatively high scores on these 2, yet otherwise low scores on the remaining 6. Online reviews on the same topics provide a more substantive and realistic appraisal - distinguishing high from low performers. A higher bar than mere respect is needed for the tender experience of death, dying, and grieving. Compassion is an especially relevant addition to CAHPS since caregivers named compassionate staff as a distinguishing factor. Parity for mental health at end of life is a vital research topic. Future research should also explore the caregiver expectations set on admission.

Development of a model and method for hospice quality assessment from natural language processing (NLP) analysis of online caregiver reviews.

OBJECTIVES: With a fraction of hospices having their Consumer Assessment of Healthcare Providers and Systems (CAHPS®) scores on Hospice Compare, a significant reservoir of hospice quality data remains in online caregiver reviews. The purpose of this study was to develop a method and model of hospice quality assessment from caregiver reviews using Watson's carative model. METHODS: Retrospective mixed methods of pilot qualitative thematic analysis and sentiment analysis using NLP of Google and Yelp caregiver reviews between 2013 and 2023. We employed stratified sampling, weighted according to hospice size, to emulate the daily census of enrollees across the United States. Sentiment analysis was performed (n = 3393) using Google NLP. RESULTS: Two themes with the highest prevalence had moderately positive sentiments (S): Caring staff (+.47) and Care quality, comfort and cleanliness (+.41). Other positive sentiment scores with high prevalence were Gratitude and thanks (+.81), "Treating the patient with respect" (+.54), and "Emotional, spiritual, bereavement support" (+.60). Lowest sentiment scores were "Insurance, administrative or billing" (-.37), "Lack of staffing" (-.32), and "Communication with the family" (-.01). SIGNIFICANCE OF RESULTS: In the developed quality model, caregivers recommended hospices with caring staff, providing quality care, responsive to requests, and offering family support, including bereavement care. All ten Watson's carative factors and all eight CAHPS measures were presented in the discovered review themes of the quality model. Close-ended CAHPS scores and open-ended online reviews have substantial conceptual overlap and complementary insights. Future hospice quality research should explore caregiver expectations and compare review themes by profit status.

Overall US Hospice Quality According to Decedent Caregivers-Natural Language Processing and Sentiment Analysis of 3389 Online Caregiver Reviews.

Objectives: With an untapped quality resource in online hospice reviews, study aims were exploring hospice caregiver experiences and assessing their expectations of the hospice Medicare benefit. Methods: Topical and sentiment analysis was conducted using natural language processing (NLP) of Google and Yelp caregiver reviews (n = 3393) between 2013-2023 using Google NLP. Stratified sampling weighted by hospice size to approximate the daily census of US hospice enrollees. Results: Overall caregiver sentiment of hospice care was neutral (S = .14). Therapeutic, achievable expectations and misperceptions, unachievable expectations were, respectively, the most and least prevalent domains. Four topics with the highest prevalence, all had moderately positive sentiments: caring staff, staff professionalism and knowledge; emotional, spiritual, bereavement support; and responsive, timely or helpful. Lowest sentiments scores were lack of staffing; promises made, but not kept, pain, symptoms and medications; sped-up death, hasted, or sedated; and money, staff motivations. Significance of Results: Caregivers overall rating of hospice was neutral, largely due to moderate sentiment on achievable expectations in two-thirds of reviews mixed with unachievable expectations in one-sixth of reviews. Hospice caregivers were most likely to recommend hospices with caring staff, providing quality care, responsive to requests, and offering family support. Lack of staff, inadequate pain-symptom management were the two biggest barriers to hospice quality. All eight CAHPS measures were found in the discovered review topics. Close-ended CAHPS scores and open-ended online reviews have complementary insights. Future research should explore associations between CAHPS and review insights.

Caregiver and Employee Experience Among Big Hospices-Ranking of the Largest US Hospices by Three Quality Indicators.

BACKGROUND: Several studies chronicle profit-making negatively impacting US hospice care quality. However, no study has reported on caregiver satisfaction expressed online by hospice. OBJECTIVES: Assess the relationship between online caregiver sentiment, market share, profit status, and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) scores among the 50 largest US hospices. METHODS: Retrospective mixed methods of sentiment and multivariate regression analysis. Data sources were online caregiver reviews, provider CAHPS hospice survey data. RESULTS: Being a larger, for-profit predicted diminished caregiver and employee satisfaction. Caregiver Sentiment and CAHPS Composite were so highly associated (r = .862, P < .001), that they are converging on overall caregiver satisfaction. With large effect, CAHPS Star Rating was significantly higher than Review Star Rating. For-profits had significantly higher overall Emotional Intensity than non-profit hospices, again with large effect. Caregiver Sentiment, Review Star Rating, and Glassdoor Composite each predicted CAHPS Composite. Lack of staffing was more frequent among for-profits (13%) than non-profits (6%). Out-of-scope expectations prevalence was 9%. CONCLUSION: Caregiver and employees had better experiences with non-profits than for-profits. Anger and frustration was expressed toward large, for-profit providers more focused on admissions, profiteering, and paying dividends than actual care. The CAHPS appears to draw more satisfied caregivers. Whereas, online reviewing provides open-ended, real-time voicing of care quality concerns. Even with distinct methods, CAHPS survey and review sentiment analysis converge on caregiver satisfaction, yet CAHPS paints a much rosier picture of hospice quality than online reviews. Future research should explore sentiments by topic and hospice to increase customer advocacy.

The Mindful Helping and Self-Care Model: Mindful Self-Care and Quality of Life Among a Racially Balanced Sample of Helping Professionals.

This study explored the Mindful Helping and Self-Care model and validated the Mindful Self-Care Scale (MSCS) among three racially balanced samples of helping professionals (n = 1,534). The study employed a cross-sectional, self-report design. The racial representation of participants was American Indian (n = 68), Asian (n = 351), African American (n = 384), Latino (n = 325), White (n = 301), and other (n = 114). The MSCS (33 items) showed good internal structure and measurement invariance to support generalizability across the three groups studied. With parsimony for application development, the Brief-MSCS (24 items) had a stronger internal structure across the three groups. Mindful self-care and secondary traumatic stress mediated the relationship between burnout and compassion satisfaction, as the total effects were greater than the direct effects. Mindful self-care practices were associated with reduced burnout risk. Mediation analysis results supported the Mindful Helping and Self-Care model. The empirical foundation for the 33-item MSCS and 24-item Brief-MSCS is further supported in this study. Both are excellent instruments for measuring mindful self-care factors in helping professionals using a behavioral frequency approach in a weekly time context. The Brief-MSCS is a more concise measure, making it particularly useful for application development. The reliability, construct, and concurrent validity of the MSCS and Brief-MSCS were confirmed. Mind-body practice is self-care; expressions vary by racial group and are associated with overall wellness. Future research should focus on professionals and cultures outside North America.

Hospice Glassdoor and CAHPS® Scores-Glassdoor Scores and Hospice Financial Characteristics Predict Hospice Consumer Assessment of Healthcare Providers and Systems Scores.

BACKGROUND: Recent public data transparency on both decedent caregiver satisfaction and employee satisfaction is impacting the three most essential needs of any hospice, admitting hospice enrollees, attracting hospice professionals and delivering on quality. AIM: Explore the relationship between Glassdoor hospice employee recommendation data, hospice financial characteristics, and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) scores among the 50 largest US hospices. DESIGN: Retrospective data with multivariate regression analysis. DATA SOURCES: Provider CAHPS hospice survey data from 2019-2020 and Glassdoor employee recommendation data. RESULTS: Glassdoor Composite and CAHPS Composite were positively correlated (r = .469, p < .01). Glassdoor scores, profit status, and acquisition status predicted Hospice CAHPS scores and explained 44% of the variation in CAHPS Composite. Being a large, for-profit hospice in acquisition status each predicted lower CAHPS scores. Non-profit hospices had significantly higher Glassdoor and CAHPS scores than for-profit hospices. CAHPS Composite and CAHPS Star Rating have potential as global indicators to inform customers of a given hospice's overall quality on the Hospice Compare website of CMS. CONCLUSIONS: Hospice leaders seeking improvements in CAHPS scores are encouraged to seek feedback on whether their own employees would recommend their hospice to a friend. Communication and responsiveness were the strongest indicators of overall hospice quality. Skelton hospice staffing models must give way to realistic models that value company culture and employee satisfaction. Hospice quality and hospice profits are not necessarily mutually exclusive. Future research should explore the difference in themes emerging from positive and negative online caregiver reviews.

The Relationship Between Sexual Compulsivity, Emotional and Spiritual Distress of Religious and Non-religious Internet Pornography Users.

This study sought to examine the relationship between the sexual compulsivity, emotional and spiritual distress of religious and non-religious adults who sought assessment for pornography addiction on the Internet. Religious (n = 350) and non-religious (n = 114) data were analyzed separately with a one-way between-subjects multivariate analysis of variance. The Kalichman Sexual Compulsivity Scale was used to divide the religious and non-religious into three groups: non-sexually compulsive (NCs); moderately sexually compulsive and sexually compulsive (SCs). All of the dependent variables, except age, were significantly higher for SCs than NCs for the religious. For the non-religious, all of the dependent variables, except age and time spent viewing Internet pornography (IP), were significantly higher for SCs than NCs. The non-religious spent significantly more time viewing IP than the religious. Yet, the religious were significantly more sexually compulsive. Emotional distress and spiritual distress were found to be significantly higher for SCs than the NCs regardless of religiosity. The non-religious were significantly more anxious and stressed than the religious. Specific religious affiliations did not have any significant bearing on the degree of sexual compulsivity. Religious practice, being associated with less viewing of IP, suggests the likelihood that moral reasons may provide some rationale for not viewing IP. At the same time, religious practice might reinforce shame in the addiction cycle thus religious individuals may be more at-risk to developing a compulsive pattern of viewing IP. The implications of the findings and suggestions for future research are presented.

Validation of the Mindful Self-Care Scale (MSCS) and development of the Brief-MSCS among hospice and healthcare professionals: a confirmatory factor analysis approach to validation.

OBJECTIVE: In the emotionally intense field of healthcare, the ability to peacefully inhabit one's body, maintain good boundaries, and be fully present during care is essential. This study aimed to validate the recently developed Mindful Self-Care Scale (MSCS) among hospice and healthcare professionals and develop a brief version of the 33-item MSCS. METHOD: A sample of hospice and healthcare professionals from all 50 states (n = 858) was used. A confirmatory factor analysis was run using a rigorous methodology for validation and item reduction to develop a brief version of the 33-item MSCS. The brief MSCS (B-MSCS) was developed by identifying items for exclusion through examination of conceptual overlap, descriptive statistics by detecting sources of improvement model fit using confirmatory factor analysis. Model modifications were done sequentially and with regard to theoretical considerations. RESULT: The existing model, 33-item MSCS with six subscales, had good fit to the data with all indicators in acceptable ranges (chi-square/df = 3.08, df (480), p < 0.01, root mean square error of approximation = 0.059, comparative fit index = 0.915, Tucker and Lewis's index of fit = 0.907). Nine items were excluded on the basis of very low loadings and conceptual and empirical overlap with other items. SIGNIFICANCE OF RESULTS: The final 24-item, B-MSCS model was consistent with the original conceptual model and had a closer fit to the data (chi-square/df = 1.85, df (215), p < 0.01, root mean square error of approximation = 0.041, comparative fit index = 0.961, Tucker and Lewis's index of fit = 0.955). In addition, the reliability, construct, and concurrent validity of the MSCS and B-MSCS were in the acceptable and good ranges, respectively. Mean and standard deviation of the MSCS and B-MSCS scores were similar; B-MSCS mean scores well approximated the MSCS scores. Informal mindful self-care, in the process of everyday life, was practiced more regularly and associated with increased wellness and reduced burnout risk than formal mind-body practices.

Factors Predicting Burnout Among Chaplains: Compassion Satisfaction, Organizational Factors, and the Mediators of Mindful Self-Care and Secondary Traumatic Stress.

This study predicted Burnout from the self-care practices, compassion satisfaction, secondary traumatic stress, and organizational factors among chaplains who participated from all 50 states (N = 534). A hierarchical regression model indicated that the combined effect of compassion satisfaction, secondary traumatic stress, mindful self-care, demographic, and organizational factors explained 83.2% of the variance in Burnout. Chaplains serving in a hospital were slightly more at risk for Burnout than those in hospice or other settings. Organizational factors that most predicted Burnout were feeling bogged down by the "system" (25.7%) and an overwhelming caseload (19.9%). Each self-care category was a statistically significant protective factor against Burnout risk. The strongest protective factors against Burnout in order of strength were self-compassion and purpose, supportive structure, mindful self-awareness, mindful relaxation, supportive relationships, and physical care. For secondary traumatic stress, supportive structure, mindful self-awareness, and self-compassion and purpose were the strongest protective factors. Chaplains who engaged in multiple and frequent self-care strategies experienced higher professional quality of life and low Burnout risk. In the chaplain's journey toward wellness, a reflective practice of feeling good about doing good and mindful self-care are vital. The significance, implications, and limitations of the study were discussed.

Mindful Self-Care and Secondary Traumatic Stress Mediate a Relationship Between Compassion Satisfaction and Burnout Risk Among Hospice Care Professionals.

BACKGROUND: Effective self-care in hospice is anecdotally proclaimed to reduce burnout risk. Yet, the topic has received little empirical attention. PURPOSE: This study developed a model for predicting burnout risk from compassion satisfaction (CS), secondary traumatic stress (STS), and mindful self-care. PARTICIPANTS: Hospice care professionals (n = 324). DESIGN: Cross-sectional self-report survey. RESULTS: Mindful self-care was correlated with CS ( r = 0.497, p < .01), Burnout ( r = -0.726, p < .01), and STS ( r = -0.276, p < .01). A multiple regression model indicated that the combined effect of CS, STS, and mindful self-care explained 73.7% of the variance in Burnout. Mindful self-care and STS mediated a relationship between CS and Burnout. Each self-care category was statistically significant protective factors against burnout risk ( p < .01). Associations with Burnout in order of strength were self-compassion and purpose (SC; r = -0.673), supportive structure (SS; r = -0.650), mindful self-awareness (MS; r = -0.642), mindful relaxation (MR; r = -0.531), supportive relationships (SR; r = -0.503), and physical care (PC; r = -0.435). However, for STS, only SS ( r = -0.407, p < .01) and MR ( r = -0.285, p < .05) were statistically significant protective factors. CONCLUSION: Hospice care professional had higher self-care, CS, lower STS, and Burnout compared to published norms. Those who engaged in multiple and frequent self-care strategies experienced higher professional quality of life. Implications for hospice providers and suggestions for future research are discussed.