Jeffrey Silver Humanism in Healthcare Research Roundup – January 2019

The Jeffrey Silver Humanism in Healthcare Research Roundup features summaries of recently published studies on humanism in healthcare. To receive email notification of new studies once per month, enter your information here and select “Jeffrey Silver Research Roundup” from the checkboxes at the bottom. See previous posts in this series.

Publications from Gold Foundation-Affiliated Authors

Association of clinical specialty with symptoms of burnout and career choice regret among us resident physicians  Dyrbye LN, Burke SE, Hardeman RR, Herrin J, Wittlin NM, Yeazel M, Dovidio JF, Cunningham B, White RO, Phelan SM, Satele DV, Shanafelt TD, van Ryn M. JAMA. 2018 Sep 18;320(11):1114-1130.
Drs. Lotte Dyrbye and Tait Shanafelt are Mapping the Landscape grantees.
What factors are associated with burnout and career choice regret for resident physicians? Do rates vary by clinical specialty? A prospective cohort study of 4,732 resident physicians was invited to respond to questionnaires in the first and fourth years of medical school and the second year of residency. 45.2% of resident physicians reported symptoms of burnout and 14.1% reported career choice regret. The specialty areas of urology, neurology, emergency medicine, and surgery were associated with higher relative risks of reported symptoms of burnout compared to internal medicine. Females had higher rates of burnout and levels of anxiety, and Hispanic and Latino residents had a higher relative risk of specialty choice regret. Students with higher empathy during medical school had a lower risk of burnout during residency. Burnout and specialty area were significantly associated with career choice regret.

Educating patient-centered, systems-aware physicians: a qualitative analysis of medical student perceptions of value-added clinical systems learning roles Free full text     Gonzalo JD, Wolpaw D, Graaf D, Thompson BM. BMC Med Educ. 2018 Nov 1;18(1):248.
Dr. Daniel Wolpaw is a Mapping the Landscape grantees.
How does one shift from physician-centered care to patient-centered care? “Value-added” roles for medical students may provide one path, according to this study. Such experiential roles aim to teach knowledge, attitudes, and skills to medical schools while also positively impacting health outcomes. This study aims to understand how students perceived the educational value of such roles in a newly established program. 792 student logs from 363 patients and six student interviews were analyzed. Six educational benefits emerged, including increased understanding of the patient’s perspective on his/her health and care, barriers and social determinants of health, delivery of care, interprofessional collaboration, clinical medicine, and communication.

Humanistic communication in the evaluation of shared decision making: A systematic review     Kunneman M, Gionfriddo MR, Toloza FJK, Gärtner FR, Spencer-Bonilla G, Hargraves IG, Erwin PJ, Montori VM. Patient Educ Couns. 2018 Nov 12. pii: S0738-3991(18)30971-6.
Drs. Marleen Kunneman, Ian Hargraves, and Victor Montori and Mrs. Erwin are Mapping the Landscape grantees.
Shared decision making (SDM) is often viewed as patient-centered care, but much of the training and research has focused on technique, such as the proper order of steps. Do studies that evaluate SDM take into account humanistic communication (respect, compassion, empathy)? This systematic review identified 154 studies; 9% included statements related to humanistic communication in the background of the study, impact of the study, patients or providers account, results, or discussion of implication. Researchers used 11 instruments to assess SDM quality, for a total of 192 items across the studies; only 7 of those items (3.6%) related to humanistic communication. This raises concern that SDM could assessed and taught in such a way to be technically correct yet lack a humanistic connection or empathy, and thus be ineffective. The authors suggest that the current best practices in SDM may need to be revisited to incorporate humanistic aspects.

Residency program factors associated with depressive symptoms in internal medicine interns: a prospective cohort study     Pereira-Lima K, Gupta RR, Guille C, Sen S. Acad Med. 2018 Dec 18.
Dr. Srijan Sen and Mrs. Karina Pereira-Lima are Mapping the Landscape grantees.
During training, many medical residents develop depressive symptoms. This large, prospective longitudinal study examined the potential influence of organizational, workload and academic variables on the development of depressive symptoms. 1,276 first-year residents at 54 internal medicine programs were given an online survey and the Patient Health Questionnaire (PHQ-9) before their internship and then quarterly during their internship. The survey asked about duty hours, workload satisfaction, and the learning environment. Also, data from the American Medical Association Fellowship and Residency Electronic Interactive Database (FREIDA online) and program research rankings from Doximity were used. PHQ-9 scores increased during internship. Levels of depressive symptoms varied widely across internal medicine residency programs. Lack of timely and appropriate faculty feedback, a negative learning experience, increase in work hours, and higher research ranking position were linked to increased depressive symptoms. Improved conditions and targeted interventions among these variables may improve wellness and mental health of interns.

Other Publications

Everyday and unavoidable coproduction: Exploring patient participation in the delivery of healthcare services Free full text      Baim-Lance A, Tietz D, Lever H, Swart M, Agins B. Sociol Health Illn. 2019 Jan;41(1):128-142.
Coproduction, a concept that in healthcare illuminates the omnipresent and essential influence of patients, has drawn increasing attention. The authors note that a narrowed definition of coproduction often focuses on engaging patients in planning and evaluation – missing the point that coproduction is always present in care itself. To understand coproduction more fully, researchers recruited 45 patients from HIV clinics to participate in a 15-month ethnography through repeated semi-structured interviews. Patients shared their experiences and insights into their own care. Thematic analysis identified three categories (to build, to accept, and to object). The authors found that coproduction is relational in many ways and relies upon the blurring of boundaries, such as when patients act as proto-professionals, sharing tips or assuaging concerns of fellow patients. They recommend acknowledging the ongoing acts of coproduction by patients that are already in place and looking for further ways to improve everyday coproduction.

Mindful self-compassion training reduces stress and burnout symptoms among practicing psychologists: a randomized controlled trial of a brief web-based intervention Free full text      Eriksson T, Germundsjö L, Åström E, Rönnlund M. Front Psychol. 2018 Nov 27;9:2340.
As stress and burnout have increased in healthcare professionals, mindfulness training has drawn attention as potential way to help lower stress and burnout and increase empathy and self-compassion. This study aimed to examine the relationships between stress, burnout, self-compassion and self-coldness and test whether a web-based format, which could be more convenient and cost effective than in-person mindfulness trainings, could be effective. In a randomized controlled trial of 101 psychologists, about half participated in a 6-week web-based mindful self-compassion program while the other half were put on a wait list. The training included 15-minute exercises 6 days a week. Instruments included the Self-Compassion Scale (SCS), the Five Facets of Mindfulness Questionnaire (FFMQ), the Perceived Stress Scale (PSS), and the Shirom Melamed Burnout Questionnaire (SMBQ) in a pre/post test design. Results included higher reported self-compassion and mindfulness and lower self-coldness scores in the intervention group. Changes in burnout were more strongly linked to changes in self-coldness than self-compassion. More study is needed, but this research supports the effectiveness of web-based mindfulness/self-compassion training interventions.

Cohorting trauma patients in a medical/surgical unit at a level 1 pediatric trauma center to enhance interdisciplinary collaboration and documentation     Meyer LK, Nanassy AD, Lavella H, Arthur LG, Grewal H. J Trauma Nurs. 2019 Jan/Feb;26(1):17-25.
Can cohorting trauma patients to a single unit improve communication and compliance with standards of care? This study examined interdisciplinary communication and documentation after cohorting trauma patients to one medical/surgical unit and starting daily interdisciplinary rounds. In pre- and postcohorting surveys, 41 nurses responded to items related to safety, comfort with trauma patients, and efficacy of cohorting. Perceptions of teamwork, safety, and staff support increased significantly. Additionally, cohorting resulted in improved compliance with documentation following trauma standards of care, as compared with records from two years previous.

Stress, coping, and psychological resilience among physicians Free full text      O’Dowd E, O’Connor P, Lydon S, Mongan O, Connolly F, Diskin C, McLoughlin A, Rabbitt L, McVicker L, Reid-McDermott B, Byrne D. BMC Health Serv Res. 2018 Sep 21;18(1):730.
How can interventions help physicians increase resilience, an important way to protect against burnout? As a starting point, this study aimed to learn how physicians define resilience, identify challenges in the workplace, and examine strategies for coping. Data from 68 semi-structured interviews were examined using deductive content-analysis. Five themes were identified. First, “Nature of Resilience” illuminated that physicians viewed resilience as “coping” with adversity, rather than “thriving.” Second, “Challenges of the Profession” included long hours, lack of resources, and strenuous workloads. Third, “Job-related Gratification” highlighted supportive aspects of the profession, such as gratification from healing patients and financial factors. Fourth, “Resilience Strategies (Protective)” included engagement in leisure activities, support from colleagues, family and friends, asking for help, maintaining boundaries with patients, and professionalism. Fifth, “Resilience Strategies (Attitudes)” highlighted perspective, acceptance, self-awareness, appreciation, and self-efficacy. Future interventions could benefit from these findings by taking into account how physicians view resilience and noting both the benefits of individual-level strategies and the critical need for systems-level approaches.

Assessing compassion fatigue risk among nurses in a large urban trauma center     Wijdenes KL, Badger TA, Sheppard KG. J Nurs Adm. 2019 Jan;49(1):19-23.
Compassion fatigue is defined as stress that can lead to poor physical and emotional outcomes among nurses. The authors explain that “compassion fatigue is composed of secondary traumatic stress (STS), burnout (BO), and compassion satisfaction (CS).” They further note that compassion fatigue is the result of a greater experience of stress and burnout in proportion to compassion satisfaction. The study examined the prevalence and severity of compassion fatigue across length of employment and unit of practice among nurses who were working within a large urban hospital system.  315 nurses completed the survey; 46% of nurses reported moderate to high compassion fatigue. The risk of compassion fatigue was significantly associated with years of employment, unit worked, job changes, and use of sick days. These were among the findings that may be used to identify critical time periods and/or opportunities for targeted interventions to address compassion fatigue and burnout.

Tresa Kaur

Research Roundup Editor

Disseminates current issues, trends, and research on humanism and healthcare.