Impact of a decision-making support framework on nurse burnout and quality of end-of-life care: A before-and-after study in intensive care units

Yoshihiko Takahashi; Shu Utsumi; Kenji Fujizuka; Hiroyuki Suzuki; Yumiko Takadera; Mitsunobu Nakamura

doi:10.1016/j.ijnsa.2025.100438

Impact of a decision-making support framework on nurse burnout and quality of end-of-life care: A before-and-after study in intensive care units

Int J Nurs Stud Adv. 2025 Oct 22:9:100438. doi: 10.1016/j.ijnsa.2025.100438. eCollection 2025 Dec.

Authors

Yoshihiko Takahashi^{1

2}, Shu Utsumi³, Kenji Fujizuka¹, Hiroyuki Suzuki¹, Yumiko Takadera⁴, Mitsunobu Nakamura¹

Affiliations

¹ Advanced Medical Emergency Department and Critical Care Center, Maebashi Red Cross Hospital, Gunma, Japan.
² Emergency and Critical Care Medicine Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
³ Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
⁴ Department of Nursing, Intensive Care Unit, Advanced Medical Emergency Department and Critical Care Center, Maebashi Red Cross Hospital, Gunma, Japan.

Abstract

Background: The high incidence of burnout syndrome among intensive care unit nurses highlights the need for effective prevention strategies. Poor decision-making in end-of-life care contributes to nurse burnout syndrome through a decline in the quality of end-of-life care; however, the effects of enhancing decision-making support remain unclear.

Objectives: To examine the relationship between enhanced decision-making support in end-of-life care, nurse burnout syndrome, and the quality of end-of-life care.

Methods: A before-and-after intervention study was conducted in a 24-bed mixed intensive care unit at a tertiary emergency medical center in Japan. In September 2022, a decision-making support framework, developed through an international Delphi meeting in 2020, was introduced. Pre- and post-intervention questionnaires (August 2022, 2023) assessed nurse burnout syndrome using the Maslach Burnout Inventory and nurses' evaluation of end-of-life care using the Quality of Dying and Death scale. Univariate analysis used t-tests or Mann-Whitney U tests for continuous variables and chi-squared or Fisher's exact tests for categorical variables. Multivariate analysis used multiple regression, adjusting for nurses' age, sex, and intensive care unit experience.

Results: Among the 70 nurses, 51 (73%) completed pre- and post-intervention surveys. While the Maslach Burnout Inventory showed no statistically significant change (15 vs. 11, p = 0.177), the subscales of emotional exhaustion (15 vs. 14, p = 0.089) and depersonalization (12 vs. 10, p = 0.087) showed trends toward improvement. No significant subgroup differences were observed based on sex, age, or intensive care unit experience. However, the Quality of Dying and Death scale showed a significant improvement (33 vs. 27, p = 0.002), which remained significant in the multivariate analysis (β = 5.015, p = 0.02). Subgroup analysis revealed more pronounced improvements in the Quality of Dying and Death scale among female nurses, those under 30, and nurses with less than five years of intensive care unit experience.

Conclusions: The decision-making support framework was associated with a non-significant reduction in burnout syndrome but a significant improvement in nurses' evaluation of end-of-life care. This suggests that factors contributing to burnout syndrome in end-of-life care may have improved. Further large-scale, multicenter studies are required to determine whether this intervention ultimately contributes to mitigating burnout syndrome.

Keywords: Burnout; Decision-making; End-of-life; Intensive care unit; Nurse; Palliative care.