{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T07:15:28Z","timestamp":1791875728443,"version":"4.3.4"},"reference-count":67,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"crossref","award":["T32RN009356"],"award-info":[{"award-number":["T32RN009356"]}],"id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"abstract":"<jats:sec>\n                    <jats:title>\n                      <jats:italic toggle=\"yes\">Purpose:<\/jats:italic>\n                    <\/jats:title>\n                    <jats:p>Inpatient clinicians may experience distress when providing complex care for the millions of Americans with serious illness hospitalized yearly. Understanding the types and clinical impact of clinician distress when caring for seriously ill inpatients can inform supportive interventions to minimize burnout symptoms. This study aims to identify distinct distress trajectories among clinicians caring for seriously ill inpatients over time using mobile ecological momentary assessments (mEMAs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>\n                      <jats:italic toggle=\"yes\">Methods:<\/jats:italic>\n                    <\/jats:title>\n                    <jats:p>We performed latent class cluster analysis of clinicians\u2019 prospective serial mEMAs to identify unique distress trajectories and estimated univariate ordinal logistic regression models using generated estimating equations methods to explore the relationship between distress type and patient and clinician characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>\n                      <jats:italic toggle=\"yes\">Results:<\/jats:italic>\n                    <\/jats:title>\n                    <jats:p>\n                      We identified four distinct clinician distress trajectories from clinician responses (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 142): low distress (23.2%), moderate distress (33.1%), high distress (23.9%), and variable distress (19.7%). The majority of patients had a primary malignancy (77.9%). Clinicians self-reported multiple symptoms: fatigue (59.3%), stress (57.4%), worry (47.2%), insomnia (33.3%), anger (13.9%), sadness (9.3%), and pain (4.6%). Clinicians\u2019 discipline (advanced practice provider [APP] vs. physician;\n                      <jats:italic toggle=\"yes\">\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 9.11,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.0025) and emotions (\n                      <jats:italic toggle=\"yes\">\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 11.29,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.0008) were significantly associated with the distress trajectory. Clinicians who had an increase in reported emotions were likely to be in a higher distress trajectory (odds ratio [OR] 1.90,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.001), as were APPs compared with physicians (OR 6.16,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.003).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>\n                      <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic>\n                    <\/jats:title>\n                    <jats:p>Clinicians experience distinct trajectories of distress while caring for seriously ill inpatients. While all groups experienced degrees of distress, identifying clinicians with high distress may enable health systems to target supportive interventions and resources in a timely manner to mitigate potential burnout and other emotional states.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10966218261430591","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T16:45:17Z","timestamp":1773852317000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["A Cluster Analysis of Clinician Distress Trajectories when Caring for Seriously Ill Hospitalized Patients"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4665-0108","authenticated-orcid":false,"given":"Anessa M.","family":"Foxwell","sequence":"first","affiliation":[{"name":"Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA."},{"name":"NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA."},{"name":"Clinical Practices of the University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania, USA."},{"name":"Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salimah H.","family":"Meghani","sequence":"additional","affiliation":[{"name":"NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA."},{"name":"Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine R.","family":"Courtright","sequence":"additional","affiliation":[{"name":"Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA."},{"name":"Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liming","family":"Huang","sequence":"additional","affiliation":[{"name":"University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Rhodes","sequence":"additional","affiliation":[{"name":"University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet A.","family":"Deatrick","sequence":"additional","affiliation":[{"name":"University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen B.","family":"Hirschman","sequence":"additional","affiliation":[{"name":"NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA."},{"name":"Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connie M.","family":"Ulrich","sequence":"additional","affiliation":[{"name":"NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA."},{"name":"Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"e_1_3_3_2_1","unstructured":"1.American Hospital Association (AHA). 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