(Mis)alignment of employer support and needs of healthcare providers in end-of-life care during a healthcare crisis: a longitudinal mixed-method study during the COVID-19 pandemic (the CO-LIVE study).

BACKGROUND: The COVID-19 pandemic highlighted various issues regarding healthcare providers' well-being and their need for employer support. OBJECTIVES: This study aims to show the extent and manner in which end-of-life care providers were supported by their employers during the COVID-19 pandemic, and whether their needs and the support they received matched. DESIGN: A longitudinal mixed-methods study among healthcare providers delivering end-of-life care during the COVID-19 pandemic. METHODS: 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. Descriptive analysis was performed on the quantitative data, and thematic analysis was conducted on the interview data. RESULTS: The survey indicated that healthcare providers' need for support decreased over the pandemic, yet 18 months after its onset, nearly one in five still needed more support than usual. About one in three healthcare providers felt inadequately supported emotionally across the four periods. Disparities in employer support were found, with fewer healthcare providers receiving support than those who desired it. Interviews revealed that healthcare providers needed their employers to show interest and appreciation and involve them in decision-making. There was also a need for accessible professional support, efforts to reduce the stigma around seeking it, and the facilitation of peer support. In addition, healthcare providers desired practical support during the crisis, such as COVID-19 protection, scheduling, and good information provision. CONCLUSION: The COVID-19 pandemic has revealed issues concerning the well-being of healthcare providers. This study gives insight into the amount and type of employer support needed. However, the support provided has often been misaligned with the needs of healthcare providers. As we face another potential healthcare crisis with shortages and high workloads, it is important to maintain focus on the well-being of healthcare providers. Employers must invest in appropriate and effective support measures. Plain language summary: (Mis)alignment of employer support and needs of healthcare providers in end-of-life care during a healthcare crisis The COVID-19 pandemic acted as a pressure cooker, exposing various issues regarding healthcare providers' wellbeing and their need for employer support. This study aimed to understand how these healthcare providers were supported by their employers and if the support matched their needs. We conducted surveys with 302 healthcare providers at four different times during the pandemic and interviewed 17 providers at three different times. Our findings showed that the need for support decreased over time, but even 18 months into the pandemic, nearly 20% of providers still needed more support than usual. About one-third of providers felt they were not adequately supported emotionally. Furthermore, not all healthcare providers received the support they wanted from their employer, with fewer providers getting support than those who wanted it. Our interviews revealed that healthcare providers needed their employers to show interest in them, appreciate their work, and involve them in decision-making. They also wanted easy access to professional support, less stigma around seeking help, and more opportunities for peer support. Practical needs included adequate COVID-19 protection, better scheduling, and clear information. In conclusion, while the pandemic has emphasized the importance of supporting healthcare providers, the support provided by employers often did not meet their needs. As we face ongoing healthcare challenges, it is important for employers to invest in effective and appropriate support measures to ensure the well-being of healthcare providers.