Jeffrey Silver Humanism in Healthcare Research Roundup – October 2022

Black woman with stethoscope readingThe 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.

Examining the relationship between clinician communication and patient participatory behaviors in cardiology encounters Reid HW, Parente V, Gupta MD, Hantzmon S, Olsen MK, Yang H, Jackson LR 2nd, Johnson KS, Pollak KI. Patient Educ Couns. 2022 Sep 15:S0738-3991(22)00431-1. doi: 10.1016/j.pec.2022.09.010. Epub ahead of print. PMID: 36137906. 
Increasing lines of evidence suggest that patient-centered care is important for patient satisfaction, quality of life, and improved health outcomes. This may be even more important in managing chronic illnesses, such as cardiovascular disease. Through a cross-sectional analysis of a cohort study, Dr. Hadley W. Reid and colleagues examined what clinician communication styles are most associated with higher patient participation. To do so, they recruited 161 patients of 40 cardiologists. They recorded clinic encounters and examined transcripts for clinician behaviors, including open-ended questions, reflective statements, empathic statements/responses, and eliciting questions. Through statistical analysis, they found that patients who were female, clinician reflective statements, and clinician empathic statements were associated with 2.1, 0.3, and 3.7 more patient participatory behaviors, respectively. The authors acknowledged that, because both the clinicians and patients knew they were being recorded, behaviors may have been altered. Nevertheless, these findings suggest that clinicians should adopt communication styles that incorporate reflective and empathic statements in order to increase patient participation.

Imposter Phenomenon in US Physicians Relative to the US Working Population Shanafelt TD, Dyrbye LN, Sinsky C, Trockel M, Makowski MS, Tutty M, Wang H, Carlasare LE, West CP. Mayo Clin Proc. 2022 Sep 1:S0025-6196(22)00378-0. doi: 10.1016/j.mayocp.2022.06.021. Epub ahead of print. PMID: 36116974. Free full text Drs. Tait D. Shanafelt, Liselotte N. Dyrbye, and Colin P. West have been Gold Foundation grantees.
Imposter syndrome is “a psychological construct characterized by the persistent belief that one’s success is undeserved rather than due to personal effort, skill, and ability.”  Because imposter syndrome has been associated with burnout and poor well-being, characterizing imposter syndrome among those in active practice is an important step in addressing the epidemic of physician burnout. To do so, Dr. Tait D. Shanafelt and colleagues conducted a survey of 3,116 physicians that incorporated questions from the Clance Imposter Phenomenon Scale, the Maslach Burnout Inventory, Stanford Professional Fulfillment Index, and Clinician Self-valuation Scale, as well as a question on suicidal ideation. They then correlated responses to characterize how Imposter Syndrome impacts well-being. They found that, compared to those with low IP scores, the odds ratio for burnout with moderate, frequent, and intense IP was 1.28, 1.79, and 2.13, respectively. Higher IP scores were also associated with increased suicidal ideation and decreased professional fulfillment. Compared to those in other fields, physicians endorsed greater intensity of IP in response to the item “I am disappointed at time in my present accomplishments and think I should have accomplished more.”  These findings point to potential approaches to reduce IP and possibly burnout, such as instilling a growth mindset, reducing stigma associated with help-seeking, and creating a culture that is supportive of vulnerability.

Critical reflection on required service to the community propels prospective medical students toward higher empathy, compassion, and bias mitigation but are these gains sustainable? Van Winkle LJ, Thornock BO, Schwartz BD, Horst A, Fisher JA, Michels N. Front Med (Lausanne). 2022 Sep 9;9:976863. doi: 10.3389/fmed.2022.976863. PMID: 36160142; PMCID: PMC9500161. Free full text Dr. Brian D. Schwartz and Nicole Michels West have been Gold Foundation grantees.
Critical reflection on team service-learning has been shown to help foster and maintain high levels of cognitive empathy and compassion among healthcare professional students. However, it is not well-known how much critical reflections on service-learning is able to promote empathy and compassion. To investigate this, Dr. Lon J. Van Winkle and colleagues conducted a cohort study comparing 43 prospective medical students who completed a Medical Humanities course requiring critical reflection on team service-learning with 32 students who finished a similar course in which service to the community was not mandatory. Both groups completed surveys on cognitive empathy and reflective capacity before and after the courses. They found that in the mandatory service-learning group, cognitive empathy and reflective capacity both increased (effect sizes 0.5 and 0.34, respectively). While the authors caution that these results may not be generalizable from a single site, the results do suggest that critical reflection on service-learning experiences may foster well-being.

Transformative learning of medical trainees during the COVID-19 pandemic: A mixed methods study Vipler B, Snyder B, McCall-Hosenfeld J, Haidet P, Peyrot M, Stuckey H. PLoS One. 2022 Sep 16;17(9):e0274683. doi: 10.1371/journal.pone.0274683. PMID: 36112640; PMCID: PMC9481004. Free full text Drs. Paul Haidet and Heather Stuckey have been Gold Foundation grantees.
The ongoing COVID-19 pandemic has stressed healthcare institutions, including medical students and physicians-in-training. But how have these disruptions impacted the way that they learn? Guided by transformative learning theory, “an educational theory in which an individual’s worldview is fundamentally altered through conscious reflection, insights, or social reform,” Dr. Benjamin Vipler and colleagues conducted a mixed-methods analysis of 21 students and 11 housestaff physicians at Penn State University in Hershey, Pennsylvania. They used the Transformative Learning survey and qualitative content analysis of two open-ended questions (“In what ways has COVID-19 altered your life in a meaningful way?” and “Describe this experience with COVID-19. Was/how was it life changing? Who was involved? In what context did this change occur?”). They found that negative changes were more frequently mentioned in responses (67.7%) compared to positive ones. Additionally, students were more likely than housestaff to process life-changing events through social critique. While the authors acknowledged that this is a small study in a single center, they nevertheless noted that these insights can “shed light on various entry points where academic health center leadership can intervene with the hope of creating resilient learning communities and workplaces.”

The Impact of Traumatic Stress, Resilience, and Threats to Core Values on Nurses During a Pandemic Swavely D, Romig B, Weissinger G, Holtz H, Alderfer M, Lynn L, Adil T, Rushton CH. J Nurs Adm. 2022 Oct 1;52(10):525-535. doi: 10.1097/NNA.0000000000001194. PMID: 36166631; PMCID: PMC9512236. Dr. Cynda Hylton Rushton has been a Gold Foundation grantee and participated in a Gold Human InSight Webinar.
The COVID-19 pandemic has been a stressful and traumatic experience for many nurses and has required high levels of resilience. To understand the relationship between nurses’ experiences of stress, environmental and personal processes that build resilience, and experiences related to ethical challenges, Dr. Deborah Swavely and colleagues conducted a triangulated mixed methods study that used the Connor-Davidson Resilience Scale (CD-RISC 10), the Impact of Event Scale (IES-R), and the Rushton Moral Resilience Scale (RMRS), as well as open-ended interviews. From the 22 participants, they identified four themes: (1) phases of traumatic stress response to perceived risks, (2) honoring their sacrifice, (3) professional self-identity, and (4) sustaining resilience in a stressful work environment. These themes were also supported in their quantitative findings. The authors conclude that “Nurse leaders must be poised to address nurses’ traumatic stress and threats to core values, build resilience, and apply these learnings to other traumatic events in healthcare.”

The Buddy System: An Intervention to Reduce Distress and Compassion Fatigue and Promote Resilience on a Palliative Care Team During the COVID-19 Pandemic McCool N, Reidy J, Steadman S, Nagpal V. J Soc Work End Life Palliat Care. 2022 Sep 21:1-23. doi: 10.1080/15524256.2022.2122650. Epub ahead of print. PMID: 36129825. Dr. Jennifer Reidy has been a Gold Foundation grantee.
The COVID-19 pandemic has led to significant stress reactions and compassion fatigue among healthcare team members. In response to these challenges, at UMass Memorial Health’s Division of Palliative Care, a buddy system was implemented, whereby two team members are paired together to act as support for each other. Dr. McCool and colleagues evaluated the feasibility and efficacy of this approach using mixed-methods design that incorporated a qualitative online survey along with the Professional Quality of Life Scale V (ProQOL V) and Brief Resilience Scale (BRS). Post-intervention semi-structured interviews were also conducted. At the end of the intervention, they found that all 12 participants wanted to see the buddy system become a permanent part of the wellness program and that the buddy system reduced stress. The authors concluded that the buddy stem is “easy to implement and improve over time” and that “the program reduced their emotional stress by giving them a safe person and environment to express their feelings without stigma.”

The lived experience of nurses transitioning to professional practice during the COVID-19 pandemic Aukerman R, White L, Gierach M, Miller T, Wolles B. Nurs Forum. 2022 Sep;57(5):756-764. doi: 10.1111/nuf.12759. Epub 2022 Jun 11. PMID: 35690896; PMCID: PMC9350265. Free full text
The COVID-19 pandemic has been a defining aspect of nursing education over the past few years. However, little is known about how newly graduating nurses transition to professional practice during this stressful time. Dr. Ranae Aukerman and colleagues conducted semi-structured interviews with 12 frontline nurses transitioning to their new roles as registered nurses (RNs). Through analysis of transcripts using phenomenological methods, six themes emerged: (1) fear, (2) emotional conflict, (3) self-doubt, (4) alone, (5) communication barriers, and (6) finding the positive. According to the authors, “witnessing traumatic illness and death” has “an intense and deep emotional component.”  While the authors noted that this was a small study in a relatively homogeneous population of white female participants, it does provide insight into the mental well-being of nurses during a challenging time of transition and potential strategies to help support the well-being of nurses as well as the communities that they serve.

Should Physicians Disclose Their Own Health Challenges? Perspectives of Patients With Chronic Pain Chang HA, Iuliano K, Tackett S, Treisman GJ, Erdek MA, Chisolm MS. J Patient Exp. 2022 Sep 21;9:23743735221128675. doi: 10.1177/23743735221128675. PMID: 36158583; PMCID: PMC9500306. Free full text Dr. Margaret S. Chisolm has been a Gold Foundation grantee and a Gold Humanism Scholar at the Harvard Macy Institute.
Physicians often share personal information about themselves to patients as a way to build patient trust. However, it remains controversial since it may also “expand typical professional boundaries, shift focus from the patient to the physician, and lead to loss of trust in the physician.” Howard A. Chang and colleagues examined physician self-disclosure through a mixed-methods study of 934 adults with self-reported chronic pain through an online survey that included closed- and open-ended items. Quantitatively, about 60% of respondents stated that they wanted their physicians to self-disclose their own chronic pain. Among all respondents, they identified three major themes: (1) patients’ prior negative experiences, (2) perceived impact on patient-physician relationship, and (3) perceived impact on care and communication. Overall, respondents felt that “what mattered most to them was knowing that their physicians could truly empathize and understand their experience.” They emphasized that “this does not require self-disclosure, and that physicians should only self-disclose if it achieves or improves upon this chief aim.” Self-disclosure may be helpful toward that end, but, when tactless or irrelevant, it may negatively impact the patient-physician relationship. Based on these results, the authors concluded that physicians should consider the risks and benefits of self-disclosure and individualize their approach with each patient.

To receive an email update when next month’s Research Roundup is published, please sign up here and check the box for Research Roundup.

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.