Jeffrey Silver Humanism in Healthcare Research Roundup – January 2022

Black woman with stethoscope reading

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.

Digitally Disconnected: Qualitative Study of Patient Perspectives on the Digital Divide and Potential Solutions Alkureishi MA, Choo ZY, Rahman A, Ho K, Benning-Shorb J, Lenti G, Velázquez Sánchez I, Zhu M, Shah SD, Lee WW. JMIR Hum Factors. 2021 Dec 15;8(4):e33364. doi: 10.2196/33364. PMID: 34705664; PMCID: PMC8675564.  Dr. Maria Alcocer Alkureishi and Dr. Wei Wei Lee have been Gold Foundation grantees.
With the ongoing COVID-19 pandemic, utilization of video and phone telehealth visits has increased tremendously. Yet the adoption of telemedicine has also raised concerns about the “digital divide,” that is, a “societal division between those who have the technological means to make full use of technology and those who face barriers preventing proper use and benefit.” To understand patient perspectives regarding this digital divide, Dr. Maria Alcocer Alkureishi and colleagues conducted 54 semi-structured phone interviews with adult patients and parents of pediatric patients who obtained care from the University of Chicago Medical Center. They then used a grounded theory approach to examine the transcripts, with specific emphasis on the causes, impacts, responsible actors, and potential solutions. They recognized four causes driving the digital divide: (1) limited technology literacy, (2) limited technology access, (3) unawareness of technology resources, and (4) negative personal attitudes toward technology. Participants also voiced that the digital divide affects not only healthcare, but also impacts economic stability and perpetuates greater disparities in education, employment, societal division, and individual isolation. With this understanding, the authors then identified how responsible actors (the government, communities and individuals, healthcare organizations, and private companies) can bridge this divide: understanding technology needs, ensuring access to technology, providing technology training, and supporting low-tech healthcare modalities. These insights help set an advocacy agenda to support “both high- and low-tech forms of health care delivery for those unable to cross the divide.”

Medical Students’ Creation of Original Poetry, Comics, and Masks to Explore Professional Identity Formation Shapiro J, McMullin J, Miotto G, Nguyen T, Hurria A, Nguyen MA. J Med Humanit. 2021 Dec;42(4):603-625. doi: 10.1007/s10912-021-09713-2. Epub 2021 Nov 15. PMID: 34779996; PMCID: PMC8664798. Free full text Dr. Johanna Shapiro has been a Gold Foundation grantee
Medical school is an important time for students to begin to develop their professional identities. But professional identity formation is often difficult to directly assess. Artmaking may help to uncover the challenges and opportunities associated with professional identity formation. To explore this, Dr. Johanna Shapiro and colleagues conducted a mixed-methods study among 94 third-year medical students at the University of California, Irvine. Students could create comics, masks, or poetry during a one-week intersession between clinical work. The researchers found that making poetry and comics stimulated self-reflection while making masks was more enjoyable and stress-reducing. They also developed a conceptual model to help understand the tension between professional and personal identities. Four subthemes were articulated: imposter syndrome, isolation, a longing for well-being and connection, and emotional expression. Altogether, the authors conclude that while artmaking can have an important role in professional identity formation, the modality of artmaking can affect students differently. This study helps to build a foundation to better understand and evaluate these differences.

Symbolic Solidarity or Virtue Signaling? A Critical Discourse Analysis of the Public Statements Released by Academic Medical Organizations in the Wake of the Killing of George Floyd Brown A, Auguste E, Omobhude F, Bakana N, Sukhera J. Acad Med. 2022 Jan 18. doi: 10.1097/ACM.0000000000004597. Epub ahead of print. PMID: 35044980. Free full text Dr. Javeed Sukhera has been a Gold Foundation grantee and a Gold Humanism Scholar at the Harvard Macy Institute.
The killing of George Floyd, an unarmed 46-year-old Black man, by a white police officer sparked public outcries demanding collective action to combat racism and reignited support for the Black Lives Matter (BLM) movement, including at medical schools and academic medical organizations. Many medical schools released public statements condemning racism and expressing solidarity with Black communities. Dr. Allison Brown and colleagues examined 45 such statements using Fairclough’s 3-dimensional framework for critical discourse analysis (descriptive, interpretive, explanatory). They found that many statements often reflected hierarchical thinking and power differentials through formal, analytical, guarded, and distanced language. They also found several tensions in statements between explicit messaging and implied ideologies, which seemed to absolve organizations of structural culpability in maintaining or reinforcing racism. Moreover, statements often minimized anti-Black racism through a variety of means: the absence of Black voices and perspectives in statements, lack of self-reflection on historical and ongoing anti-Black racism in medical organizations, and omission of police brutality. Altogether, the authors suggest “casting a critical lens on how organizational structures uphold racial inequities.” While these statements are well-intentioned, the authors underscore the need for meaningful action and antiracist praxis to ensure that these statements are not merely performative.

The new frontline: exploring the links between moral distress, moral resilience and mental health in healthcare workers during the COVID-19 pandemic Spilg EG, Rushton CH, Phillips JL, Kendzerska T, Saad M, Gifford W, Gautam M, Bhatla R, Edwards JD, Quilty L, Leveille C, Robillard R.BMC Psychiatry. 2022 Jan 6;22(1):19. doi: 10.1186/s12888-021-03637-w. PMID: 34991514; PMCID: PMC8734541. Dr. Cynda Hylton Rushton has been a Gold Foundation grantee and participated in a Gold Human InSight Webinar.
The ongoing COVID-19 pandemic has had major repercussions on the well-being of healthcare workers (HCWs), in part due to increased moral distress. Moral distress arises when HCWs face “moral adversity, must make a moral judgement about the most ethically justified response, and act on it in a situation where the consequences of action (or inaction) imperil their moral integrity.”  To explore the connection between moral distress and moral resilience within the context of the COVID-19 pandemic, Dr. Edward Spilg and colleagues surveyed 962 Canadian HCWs (including physicians, nurses, allied health specialists, and administrators) during the first COVID-19 wave in 2020, using the Measure of Moral Distress for Health Care Professionals (MMD-HP). They found that respondents working directly with COVID-19 patients had greater moral distress, anxiety, and depression. However, moral resilience seemed to reduce the relationship between potentially morally distressing events and moral distress. Moral resilience also correlated with lower stress, anxiety, and depression symptoms. Moral resilience was independently correlated with being male, older age, no mental disorder diagnosis, greater sleep, and higher support from employers and colleagues. The authors conclude that organizations should focus on reducing levels of moral distress to protect the mental health of healthcare workers.

Perceptions of Burnout Among Academic Hospitalists Glisch C, Yadav S, Bhandari S, Jha P. WMJ. 2021 Dec;120(4):268-272. PMID: 35025173. Free full text
Physician burnout remains a major threat to the healthcare workforce. Burnout is a work-related syndrome involving three dimensions: emotional exhaustion, depersonalization, and a sense of low personal accomplishment. Because hospitalists have a unique aspect of work-life balance and have a set of challenging clinical and non-clinical responsibilities like teaching and research, academic hospitalists may be at particular risk. Dr. Chad Glisch and colleagues surveyed 43 academic hospitalists at the Medical College of Wisconsin to understand their perceptions. 62% felt burnt out, with the most commonly cited factors for burnout being high-patient census (94%) and unrealistic workload (83%). Among all the surveyed hospitalists, 95% voiced a lack of enthusiasm and 93% voiced mental exhaustion as possible consequences of burnout. Potential solutions include improving the structure of work (88%) and incorporating respect, care, and compassion as a group culture (88%). Interestingly, burnout rates did not differ by gender, career length as a hospitalist, or satisfaction as a hospitalist. While the authors note the study’s limitation of being a single-center study, this study nevertheless helps to shine light on the unique challenges that academic hospitalists face with respect to burnout.

Race/Ethnicity Differences in COVID-19 Vaccine Uptake Among Nurses Choi K, Rondinelli J, Cuenca E, Lewin B, Chang J, Luo YX, Bronstein D, Bruxvoort K. J Transcult Nurs. 2022 Jan 6:10436596211065395. doi: 10.1177/10436596211065395. Epub ahead of print. PMID: 34989259. Free full text Dr. Emma Cuenca has been a Gold Foundation grantee.  
The availability of several safe and effective vaccines has been instrumental in helping to combat the COVID-19 pandemic. Yet there remains significant hesitancy in obtaining the COVID-19 vaccine among the general population, with variability by race/ethnicity and by health profession. To investigate the association between race/ethnicity and COVID-19 vaccine uptake among nurses, Dr. Kristen Choi conducted a survey of 1,183 nurses in Southern California. 979 (82.8%) received at least one COVID-19 vaccine dose. Compared with their white peers, East Asian, Filipino, and Hispanic/Latinx nurses had 14%, 14%, and 6% higher odds of uptake, respectively. No statistically significant differences were found among Black/African American, Hawaiian/Pacific Islander, South Asian, or Native American/Alaskan nurses. Results of this study are somewhat reassuring, given that nurses tend to have lower rates of vaccine uptake compared to physicians and that healthcare team workers from racial/ethnic minorities tend to have lower rates as well. The authors concluded that, with such high rates of uptake, nurses and nurse professional organizations can play an important role in culturally tailored outreach.

Factors that Influence End-Of-Life Decision Making Amongst Attending Physicians Pai S, Andrews T, Turner A, Merchant A, Shapiro M. Am J Hosp Palliat Care. 2021 Dec 28:10499091211063803. doi: 10.1177/10499091211063803. Epub ahead of print. PMID: 34962168.  Dr. Tracy J. Andrews has been a Gold Foundation grantee.
Physician-assisted suicide (PAS) is a controversial practice that is legal in a few states within the United States. To understand attitudes among different physician specialties, Suraj Pai and colleagues conducted an online survey of surgeons. The survey consisted of four clinical end-of-life vignettes, as well as questions regarding demographic information and subjective questions evaluating participant opinions on PAS, euthanasia, and end-of-life care. Results demonstrated support for PAS and euthanasia (57% and 48%, respectively). Religion seemed to be a factor impacting views of end-of-life care: those who identified as “other” religion were more likely to support legalizing PAS compared with those who identified as Christian, Jewish/Muslim, or Buddhist/Hindu/Sikh. Surgeons with fewer years of work experience were also more inclined to comply with a patient’s request for PAS and agree with legalization of euthanasia and PAS but were more hesitant to administer increased doses of a narcotic. Despite the small sample size and limitation to only attending physicians, results of this survey provide a richer understanding of how experiences and backgrounds of attending physicians impact their perspectives regarding end-of-life care.

Physicians’ perspectives of prognosis and goals of care discussions after hip fracture Murthy S, Clapp JT, Burson RC, Fleisher LA, Neuman MD. J Am Geriatr Soc. 2022 Jan 6. doi: 10.1111/jgs.17642. Epub ahead of print. PMID: 34990017.  Dr. Sushila Murthy has been a Gold Foundation grantee.
Hip fracture represents a major transition in health and is associated with a one-year mortality rate between 25% and 30%. Therefore, discussions about goals of care should be conducted in all patients with hip fractures. However, because surgery is recommended within 48 hours, there is a tension that may lead to conversations that are pressured and transactional. To better characterize this challenge, Dr. Sushila Murthy and colleagues conducted qualitative, semi-structured interviews with 23 orthopedic surgeons, anesthesiologists, internists, and geriatricians. Physicians agreed that there is considerable 1-year mortality and that discussions about prognostic outcomes and recovery should be conducted in line with patients’ priorities. A huge challenge for physicians is how to discuss mortality data with new patients in an acute setting and how to discuss prognostic outcomes. Two approaches were articulated: (1) iterative communication, whereby dialogue continues at key points of patient care, and (2) coordinated multidisciplinary care that focuses on patients’ goals and values. The authors concluded that these insights may empower further research into studying how iterative communication may promote personalized, efficient, compassionate care.

Patient involvement in assessment of postgraduate medical learners: A scoping review Khalife R, Gupta M, Gonsalves C, Park YS, Riddle J, Tekian A, Horsley T. Med Educ. 2022 Jan 4. doi: 10.1111/medu.14726. Epub ahead of print. PMID: 34981565.  Dr. Tanya Horsley has been a Gold Foundation grantee.
In recent years, there has been greater recognition that patient engagement within the educational spectrum can lead to greater patient-centered medical education and increased social accountability. But incorporating patients into the assessment of trainees is often challenging. To characterize published literature regarding patient involvement in the assessment of postgraduate medical learners, Dr. Roy Khalife and colleagues conducted a scoping review. From 821 records that were initially identified, 41 studies were ultimately included. Several barriers were noted: (1) how patients are represented, (2) which patients are included/excluded, (3) how to protect patient confidentiality, (4) how to collect patient assessments, (5) how patients are recruited, (6) how much patient participation is needed, (7) how patients rate and give feedback to learners, and (8) how patient assessments are perceived and received. Overall, patient engagement in assessment appears to be feasible and seems to help in contributing different perspectives and expertise in medical education. However, patient involvement is dependent on available administrative resources. Toward that end, the authors concluded that “ensuring equitable, diverse inclusion should be prioritized to ensure holistic assessments are to be fully realized.”

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Bharat Kumar, MD

Humanism in Research Assistant Editor

Updates the staff, databases, and social media about new studies around humanism in healthcare; curates and compiles the monthly Jeffrey Silver Humanism in Healthcare Research Roundup.