From applause to disappointment - appreciation among healthcare providers that provided end-of-life care during the COVID-19 pandemic and its impact on well-being - a longitudinal mixed methods study (the CO-LIVE study)

BACKGROUND: The healthcare sector is facing increasing work pressure, making a healthy workforce essential. Appreciation is a factor influencing well-being, and the COVID-19 pandemic offers valuable insights into this. This study aims to: 1) describe to what extent end-of-life care providers felt appreciated and understood during the first 18 months of the pandemic, 2) examine the impact of appreciation on their well-being, and 3) explore their perceptions of what appreciation should look like.

METHODS: A longitudinal mixed methods study among healthcare providers in the Netherlands delivering end-of-life care during the COVID-19 pandemic. Surveys were conducted at four timepoints (n = 302), and interviews were conducted at three timepoints (n = 17) during the first 18 months of the pandemic. Generalized Estimating Equations analysis was performed on the quantitative data and thematic analysis was conducted on the interview data.

RESULTS: This study shows that feeling of appreciation among healthcare providers peaked in the first wave of the pandemic, but significantly dropped in the second wave, with only about half of the healthcare providers feeling appreciated. This slightly improved afterwards. Furthermore, nearly half of healthcare providers felt misunderstood during the first 18 months of the pandemic. Additionally, this study shows that between September 2020 and September 2021 about 1 in 3 healthcare providers had a score on the Well-Being Index indicating higher risk for burnout. Feeling appreciated and not feeling understood were both significantly associated with worse well-being. Interviews revealed that nurses did not always feel understood and appreciated by society, employers, patients and their families, as well as their own friends and family, leading to feelings of sadness, anger, and frustration. Three major themes emerged: 'recognizing real needs, 'we are not in this together' and 'short-lived appreciation that failed to lead to structural changes'.

CONCLUSIONS: This study shows that during the COVID-19 pandemic, healthcare providers often felt neither appreciated nor understood, which is associated with lower scores of well-being. The expressed appreciation often did meet their needs or expectations, from both employers and society. With healthcare provider well-being still under strain, sustained attention to appreciation and understanding is important for retaining the workforce.