Jeffrey Silver Humanism in Healthcare Research Roundup – October 2021

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.

Exploring implicit influences on interprofessional collaboration: a scoping review Sukhera J, Bertram K, Hendrikx S, Chisolm MS, Perzhinsky J, Kennedy E, Lingard L, Goldszmidt M. J Interprof Care. 2021 Oct 3:1-9. doi: 10.1080/13561820.2021.1979946. Epub ahead of print. PMID: 34602007 Drs. Javeed Sukhera, Juliette Perzhinsky, Shawn Hendrix, Lorelei Lingard, Margaret S. Chisolm, and Mark Goldszmidt have been Gold Foundation grantees. In addition, Drs. Sukhera and Chisolm have been Gold Humanism Scholars at the Harvard Macy Institute and Dr. Perzhinsky has been a Picker Gold GME Challenge Grantee . This study was funded in part by The Arnold P. Gold Foundation.
In recent years, there has been increasing recognition of the importance of interprofessional collaboration (IPC) among health care team members, yet there can be tensions rooted in implicit biases that impact the quality of IPC. Dr. Javeed Sukhera and colleagues conducted a scoping review to map out what is known about implicit biases, explore what types of implicit biases exist within teams, and how they influence collaborative processes. Out of a literature search that initially identified 4,139 citations, they ultimately included 159 articles. The vast majority of articles involved physicians (81%) and nurses (72%), were conducted in the hospital setting (71%), and focused on biases involving different professions (87%). Few described age bias (9%), gender bias (4%), or racial bias (1%). Internalization of implicit biases, adaptation by healthcare team members to perceived implicit biases, and material influences on IPC were frequently described, most commonly in ways that negatively impact IPC. This scoping review helps to identify what is known about implicit biases in IPC, but the absence of literature on the topic, especially with respect to age, gender, and racial biases and in considering the longitudinal and reciprocal nature of bias, suggests that greater research is needed to address this critical knowledge gap.

TV medical dramas: health sciences students’ viewing habits and potential for teaching issues related to bioethics and professionalism Cambra-Badii I, Moyano E, Ortega I, Baños JE, Sentí M. BMC Med Educ. 2021 Sep 26;21(1):509. doi: 10.1186/s12909-021-02947-7. PMID: 34565375; PMCID: PMC8474903   Free full text
Medical dramas on television may be fictionalized depictions of healthcare settings and team members but are nevertheless a common global source of health information about professionalism and bioethics for viewers, including future healthcare team members. So how do students perceive the bioethical content of these TV shows? Dr. Irene Cambra-Badii and colleagues obtained survey responses from 355 undergraduate students studying medicine, nursing, or human biology at a Barcelona university during the 2018-2019 academic year. They found that 49.6% watched medical dramas more than once a week, with The Good Doctor, House, MD, and Grey’s Anatomy as the most-viewed shows. The students felt that doctors were portrayed as intelligent (97.3%), professionally qualified (93.6%), and competent (90.5%), and nurses were portrayed as kind (75.8%), empathic (74.5%), and caring (74.3%). The authors noted the that least-represented characteristics of TV doctors were empathy, emotional involvement, and kindness, and that the characters that the students most wanted to resemble were all doctors, not nurses, which prompted speculation of how those roles are perceived on TV. The majority of students (56.9%) felt that the series did not adequately portray the bioethical issues that they most remembered, of which the top three were medical errors, inappropriate professional behavior, and death. Although the study was relatively small and may not be generalizable to many other contexts, the authors noted that students’ widespread viewing and engagement in medical dramas help make the case that they “can be useful for teaching issues related to bioethical questions and professional practice.”

Healthcare distrust among hospitalised black patients during the COVID-19 pandemic Nguyen TC, Gathecha E, Kauffman R, Wright S, Harris CM. Postgrad Med J. 2021 Sep 29:postgradmedj-2021-140824. doi: 10.1136/postgradmedj-2021-140824. Epub ahead of print. PMID: 34588293; PMCID: PMC8483918   Free full text
The ongoing COVID-19 pandemic has revealed many underlying health disparities, including a much higher death rate among Black patients with COVID-19 compared with white COVID-19 patients. Part of these disparities may be attributed in distrust in healthcare institutions, itself rooted in a long history of ethical misconduct including the Tuskegee syphilis study, Dr. J. Marion Sims’ use of enslaved women for gynecological experimentation, and the exploitation of Henrietta Lacks’ cervical cancer cells. How does this distrust impact perceptions of COVID-19 risk? Dr. Thang Cong Nguyen and colleagues conducted a cross-sectional study at a tertiary care academic hospital in Baltimore, Maryland from November 10, 2020, to March 10, 2021, comparing 37 Black patients who reported distrust of doctors and healthcare systems with 103 who reported trusting them. None of the patients had a current or past infection of COVID-19. The authors found that patients with greater levels of distrust were less likely to (1) think that they were at high risk, (2) believe that people with underlying medical conditions were at higher risk of dying due to COVID-19, and (3) be planning to receive the COVID-19 vaccination when it became available. These results highlight the benefits of establishing trust in healthcare institutions. However, more research is needed to understand if interventions to improve patient trust may change beliefs and behaviors associated with the pandemic.

Factors influencing resilience and burnout among resident physicians – a national survey Nituica C, Bota OA, Blebea J, Cheng CI, Slotman GJ. BMC Med Educ. 2021 Sep 29;21(1):514. doi: 10.1186/s12909-021-02950-y. PMID: 34587948; PMCID: PMC8479707   Free full text
Burnout, an occupational condition defined by emotional exhaustion, depersonalization, and decreased sense of personal achievement, is highly prevalent among resident physicians, with estimates suggesting a two-fold increased level compared to those in the general working population. Resilience may help to counter this burnout because it can help residents to cope with greater stresses, including adversity and challenges of high workload. But what factors contribute to resilience among U.S. resident physicians? Dr. Cristina Nituica and colleagues conducted a cross-sectional survey of all accredited residency programs in the United States using the CD-RISC 25 (Conor-Davidson Resilience Scale 25), Abbreviated Maslach Burnout Inventory, and a socio-demographic characteristics questionnaire. Among the 682 participants who answered all the questions, they found a low level of resilience, approximately equivalent to the bottom 25th percentile of the general population. In this sample, male and upper-level trainees reported higher levels of resilience compared to their female and junior resident peers.  No significant differences were noted with respect to age, race, marital status, or training program. Overall, there were five significant factors associated with higher resilience: family support, geographic location, surgical specialties, autonomy, and agreeing with the question “Considering everything, I like my job.” Of note, the overall response rate among all ACGME resident physicians was low; however, the authors note that this sample appears to reflect national data. Nevertheless, the study helps illuminate factors that impact resilience among resident physicians so that more extensive studies can be conducted.

Suicidal ideation and attitudes toward help seeking in U.S. nurses relative to the general working population Kelsey EA, West CP, Cipriano PF, Peterson C, Satele D, Shanafelt T, Dyrbye LN. Am J Nurs. 2021 Oct 7. doi: 10.1097/01.NAJ.0000798056.73563.fa. Epub ahead of print. PMID: 34629376 Drs. Colin P. West, Tait Shanafelt, and Liselotte N. Dyrbye have been Gold Foundation grantees.
The incidence of suicide is 18% higher among nurses than the general population. This is believed to be driven by high rates of depression, burnout, and stigma in seeking help. To shine light on factors associated with suicidal ideation and help-seeking attitudes, Dr. Elizabeth A. Kelsey and colleagues sent a survey to 86,858 nurses and a sample of 5,198 U.S. workers who were not nurses. The survey included questions on suicidal ideation, burnout, depressive symptoms, individual and professional characteristics, and willingness to seek professional help. Among the 7,378 nurse respondents, 5.5% reported suicidal ideation in the past year and 84.2% indicated a willingness to seek professional help. However, nurses who reported suicidal ideation were less likely to report that they would seek such help (72.6%) compared with those without suicidal ideation (85%), which was also true for general U.S. workers. Burnout was strongly associated with suicidal ideation, but this may be an indirect effect, due to a heightened risk of depression in those with burnout. The authors concluded that “systems-based and practice-level interventions must be identified and implemented, both to address the higher prevalence of burnout and suicidal ideation in nurses and mitigate stigma among mental health problems and other barriers to seeking help.”

Parenthood in pediatric residency study consortium. Parenthood and parental Leave decisions in pediatric residency Dundon KM, Powell WT, Wilder JL, King B, Schwartz A, McPhillips H, Best JA; APPD LEARN Pediatrics. 2021 Oct;148(4):e2021050107. doi: 10.1542/peds.2021-050107. Epub 2021 Sep 28. PMID: 34584002 Jennifer A. Best has been a Gold Foundation grantee.
Approximately one-third of pediatric resident physicians are parents at the time of residency graduation. This means that a large portion need parental leave in order to balance their work and family lives. Previous literature strongly suggests that limitations in parental leave during residency postpones childbearing and may contribute to poor well-being. To better characterize parental leave policies and their effects on pediatric resident physicians’ decisions for childbearing, Dr. Kelly Dundon and colleagues sent surveys to 845 pediatric resident physicians at 13 programs, of which 639 responded. 16% were parents and 4% were pregnant or had pregnant partners. 52% reported delaying having children during residency, and 29% of those were dissatisfied by their decision to do so. The most common reasons for delaying childbearing were busy work schedules (89.7%), finances (50.9%), and desire not to extend residency (41.2%). Among the 61 parental leaves reported, 41 (67%) were dissatisfied with leave length. The length of program leave was also negatively correlated with burnout. Altogether, these data suggest that parental leave is perceived as dissatisfactory and inadequate by pediatric resident physicians. They also provide a basis for further studies on decision-making surrounding parenthood, average length of resident parental leave, breastfeeding support, and well-being.

Medical student empathy and breaking bad news communication in a simulated consultation Bukowski H, Sweeney C, Bennett D, Rizzo G, O’Tuathaigh CMP. Patient Educ Couns. 2021 Sep 15:S0738-3991(21)00626-1. doi: 10.1016/j.pec.2021.09.017. Epub ahead of print. PMID: 34593261   Free full text Dr. Deirdre Bennett has been a Gold Foundation grantee.
Breaking bad news (BBN) is a challenging but necessary competency for good patient-physician communication. But the link between BBN training programs and empathy is unclear. Dr. Henryk Bukowski and colleagues examined this relationship among 100 undergraduate medical students at an Irish medical school in a patient simulation that required BBN. The SPIKES protocol (Setting, Perception, Invitation, Knowledge, Empathy & Emotions, Summarizes) was used as a guide to score the medical students’ communication skills, and these communication scores were then correlated to the results of two surveys sent to the medical students, namely the Jefferson Scale of Physician Empathy (JSPE-S) and Empathy Quotient (EQ). They found that higher BBN scores were correlated with higher “Social Skills” EQ Subscale scores, and, to a lesser extent, with the “Standing in Patient’s Shoes” JSPE subscale. The authors acknowledged that a low response rate (24%) and social desirability in self-reporting empathy may introduce bias in the results. Nevertheless, these results help to shed light on how psychological factors contribute to BBN communication skills. Further studies on how to transfer these skills effectively in the workplace are necessary.

Dementia caregiving during the “stay-at-home” phase of COVID-19 pandemic Savla J, Roberto KA, Blieszner R, McCann BR, Hoyt E, Knight AL. J Gerontol B Psychol Sci Soc Sci. 2021 Mar 14;76(4):e241-e245. doi: 10.1093/geronb/gbaa129. PMID: 32827214; PMCID: PMC7546083   Free full text Dr. Aubrey G. Knight has been a member of the Gold Humanism Honor Society Advisory Council and is currently on the GHHS Wellness Committee.
Caregivers of persons with dementia (PwD) have reported high degrees of burden and distress even prior to the COVID-19 pandemic. So how have the increased stressors of the pandemic influenced caregivers, and how did caregivers adopt new coping strategies during the stay-at-home phase of the pandemic (March to May 2020)? Dr. Jyoti Savla and colleagues examined this through structured telephone interviews of 53 family caregivers of PwD in rural Virginia. Their findings were mixed: While many felt new stresses from the stay-at-home order, 26% felt that stay-at-home orders did not affect their lives in any major way and 11% saw advantages. There was similar heterogeneity in responses about the availability of formal and informal assistance and the ability to use coping strategies. Of note, 47% reported high levels of role overload during stay-at-home phase. These findings reveal an unmet need to cater to caregivers of PwD, particularly those in rural areas. The authors concluded by emphasizing the importance of providing home-delivered and internet-based services and expanding broadband internet services to both manage the current pandemic and to foster preparedness for future challenges.

Emotional and stigma-related experiences relative to being told one is at risk for psychosis Woodberry KA, Powers KS, Bryant C, Downing D, Verdi MB, Elacqua KM, Reuman ARL, Kennedy L, Shapiro DI, West ML, Huang D, Crump FM, Grivel MM, Blasco D, Herrera SN, Corcoran CM, Seidman LJ, Link BG, McFarlane WR, Yang LH. Schizophr Res. 2021 Sep 28;238:44-51. doi: 10.1016/j.schres.2021.09.017. Epub ahead of print. PMID: 34598105 Dr. Daniel I. Shapiro is a Gold Professor and has been a Gold Foundation grantee.
Early intervention by identifying youth at high risk for psychosis (PR) has been a promising approach to reduce further sequelae of untreated mental health issues. However, it introduces an ethical dilemma about whether the benefits of PR identification outweigh potential risks to those identified, including incorporation of harmful stigmatizing stereotypes into one’s sense of self. To explore this, Dr. Kristen Woodberry and colleagues conducted structured interviews of 54 participants identified as at PR. Participants rated their emotions about PR both before and after being told they were at PR. Additionally, participants’ responses to each question were evaluated qualitatively and assigned valence codes (positive, negative, both, or none). Overall, responses to open-ended questions suggested that most PR youth felt positive about the experience of receiving feedback, as well as a relief of negative emotions, but there was also a predominantly negative impact on how “youth saw themselves and/or expected others might view them.” This complexity of impacts means that practitioners should be mindful of disclosing PR and seek to more directly address internalized stigma that may lead to negative impacts.

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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.