Evidence Relating Health Care Provider Burnout and Quality of Care: A Systematic Review and Meta-analysis

Perspectives of Yukon's frontline health care workers during the COVID-19 pandemic

The perspectives of Yukon's nurses and physicians can determine what might mitigate burnout and strengthen the response to the COVID-19 pandemic and/or future health emergencies. The study was conducted in the Yukon Territory, Canada in two phases: completion of the Copenhagen Burnout Inventory (CBI), and in-depth oral interviews. This paper will discuss the results of the interviews. A hybrid thematic analysis of 38 interviews revealed five primary themes: personal impacts; work-related effects; client effects/patient care; perceptions of the territorial response to COVID-19; and recommendations for future pandemics. The loss of social connection and burden of childcare contributed to personal burnout. Stressful work environments, increased workload, limited resources and feeling undervalued contributed to job stress and work-related burnout. Healthcare workers ascribed meaning to their roles in improving community health , which may have mitigated client-related burnout. Systemic change is needed to ensure the healthcare workforce can maintain service delivery and respond to future pandemics. The response to COVID-19 was mounted on the backs of frontline healthcare workers who made personal sacrifices and worked to exhaustion to serve their patients. As the healthcare system and its workforce recover from the pandemic, the calls to support healthcare workers must be answered.

Enhancing Behavioral Health Implementation in a Care Coordination Program at a Federally Qualified Health Center: A Case Study Applying Implementation Frameworks

Federally Qualified Health Centers are charged with providing comprehensive health care in traditionally underserved areas, underscoring their importance in caring for and promoting health equity for the large portion of historically marginalized communities in this setting. There is a significant need to ensure Federally Qualified Health Centers are equipped to appropriately address the immense behavioral health needs common among patients served. Care coordination is an evidence-based model that is increasingly utilized in Federally Qualified Health Centers to improve care equity and outcomes. Addressing and supporting behavioral health needs is a key aspect of such care coordination models. Context-specific considerations and programmatic supports, particularly those that address the needs of care coordinators and the complex patients they serve, are needed to ensure such models can appropriately meet and address the behavioral health concerns of the diverse populations served. The goal of this study was to present a mixed-methods case study that systematically applies implementation frameworks to conduct a needs and context assessment to inform the development and testing of evidence-based practice strategies and implementation support as part of a care coordination program within a partnered Federally Qualified Health Center.

Impact of COVID-19 on Selected Nurse and Patient Outcomes in Emergency Units Across South Africa

INTRODUCTION

Worldwide, emergency nurses experience worse nurse outcomes (burnout, physical and mental health, compassion fatigue, and job and career satisfaction), further exacerbated by the coronavirus disease 2019 pandemic, although poorly reported in developing countries. Therefore, this study aimed to determine the pandemic's impact on nurse and patient outcomes in emergency units in South Africa.

METHODS

A cross-sectional correlational design was used, with data collected from 2 different groups in the public and private sectors after the second and third coronavirus disease 2019 waves using a questionnaire. Purposive sampling of 116 private sector and 27 public sector emergency units (total n = 143) and total population sampling of nurses (n = 332) were used.

RESULTS

South African emergency nurses experienced high levels of emotional exhaustion (mean = 28.03; SD = 1.08) and moderate job satisfaction (mean = 2.81; SD = 0.07), being particularly dissatisfied with salary/wages (mean = 2.15; SD = 0.07). More than a quarter (25.30%) planned to quit their jobs. Participants rated patient safety positively (mean = 2.32; SD = 0.09). Nurses responding after the third wave of the pandemic reported higher rates of compassion fatigue (odds ratio, 3.2; 95% CI, 1.01-10.1; P = .047) and dissatisfaction with both professional status (odds ratio, 2.23; 95% CI, 1.13-4.40; P = .02) and independence at work (odds ratio, 2.21; 95% CI, 1.24-3.94; P = .047, P = .01). There were practically significant correlations between job satisfaction and recommending one's workplace (r = -0.44; P < .001) and emotional exhaustion and confidence in postdischarge care (r = 0.40; P < .001).

DISCUSSION

An association between coronavirus disease 2019 and nurse and patient outcomes in South African emergency units exists, highlighting emotional exhaustion, compassion fatigue, and job dissatisfaction concerns. Significant correlations were identified between nurse and nurse-reported patient outcomes. Addressing these concerns is critical to achieving better outcomes and planning for future health emergencies.

Hospital Nurses' Professional Quality of Life Model: A Cross-Sectional Study Based on the Expanded Job Demands-Resources Model

Aim: This study aimed to develop a model that explained the factors influencing the professional quality of life (ProQoL) in hospital nurses based on the expanded job demands-resources model (JD-R model). Methods: This cross-sectional study included 296 nurses with > 1 year of experience from three general hospitals in South Korea. Data were collected via self-reported questionnaires between February 13 and 24, 2023. Job stress (JS), supportive organizational environment (SOE), psychological ownership (PO), and career commitment (CC) were exogenous variables. Compassion fatigue (CF) and satisfaction (CS), components of ProQoL, were the endogenous variables. A hypothetical model was assessed through maximum likelihood and bootstrapping via SPSS/AMOS. Results: CF was directly influenced by JS (β = 0.44, p < 0.001) and CC (β = -0.28, p < 0.001). CS was influenced by JS (β = -0.16, p=0.003), PO (β = 0.30, p=0.012), and CC (β = 0.33, p < 0.001). The model's explanatory power for CF and CS was 37.0% and 39.0%, respectively. SOE (β = -0.15 p=0.009) indirectly affected CF through PO and CC. Additionally, PO indirectly affected (β = -0.09, p=0.008) CF through CC. SOE (β = 0.34 p=0.014) indirectly affected CS through PO and CC. PO also had an indirect effect (β = 0.11, p=0.004) on CS through CC. The final model exhibited a good fit. Conclusions: The ProQoL model, based on the expanded JD-R model, is suitable for explaining and predicting the ProQoL among hospital nurses. CC is crucial in mediating the relationships between a SOE, PO, and CF or CS. These findings have implications for developing strategies to enhance nurses' ProQoL. Implication for Nursing Management: This implies the need to reduce JS through workplace improvements, appropriate compensation, and feedback while fostering PO and CC through supportive programs and participatory decision making.

Virtual reality for stress management and burnout reduction in nursing: A systematic review protocol

BACKGROUND

Burnout is a pervasive issue in the nursing profession, with detrimental consequences for nurses' well-being, patient care, and healthcare systems. Virtual reality (VR) is a promising tool for delivering immersive and engaging interventions to manage stress and reduce burnout. This systematic review aims to synthesize the evidence on the effectiveness of VR interventions for stress and burnout in nursing, characterize the specific intervention approaches, and guide future research and practice.

METHODS

We will search for published and unpublished studies in PubMed, Web of Science, Embase, CINAHL, MEDLINE, The Cochrane Library, PsycINFO, and Scopus from database inception to the present. Randomized controlled trials, quasi-experimental studies, and pre-post studies examining VR interventions for stress and/or burnout in licensed nurses will be included. Two reviewers will independently screen studies, extract data, and assess risk of bias using the Cochrane Risk of Bias 2 tool for randomized trials and the ROBINS-I tool for non-randomized studies. If appropriate, meta-analysis will be performed to estimate pooled effects on stress and burnout outcomes. Subgroup and sensitivity analyses will explore the influence of intervention characteristics and study quality. Narrative synthesis will be conducted if quantitative synthesis is not possible. The review protocol follows the PRISMA-P guidelines and is registered in PROSPERO.

DISCUSSION

This systematic review will provide a comprehensive synthesis of the evidence on VR interventions for stress and burnout management in nurses. By critically appraising the research and identifying the most promising approaches, the review will guide the development and implementation of evidence-based VR programs to support nurses' well-being and address the urgent problem of burnout. The findings will also identify gaps in the literature and directions for future research to optimize the design and delivery of VR interventions for this high-need population. Systematic review registration: PROSPERO CRD42024604179.

Perceived Quality of Care and Pediatricians' Moral Distress Caring for Children with Mental Health Conditions

OBJECTIVE

This study describes general and subspecialty pediatricians' experience of moral distress in providing care to children with mental health conditions, variation in moral distress across subspecialties, and associations between perceived care quality, practice characteristics, and moral distress.

METHODS

This study analyzed survey data collected during 2022 American Board of Pediatrics Maintenance of Certification enrollment. Questions included perceived frequency with which high quality care was provided to children with mental health conditions (with suboptimal care quality defined as the lowest 2 response options on a 5-point Likert scale) and 4 potential sources of moral distress; high moral distress was defined as a top quartile composite score. Multivariable logistic regression was used to estimate associations between perceived suboptimal care quality, practice characteristics, and high moral distress.

RESULTS

5363 eligible pediatricians (55.2%) participated in the survey, including 3254 (60.7%) general pediatricians and 2109 (39.3%) subspecialists. Overall, 1147 (22.7%) reported perceived suboptimal care quality. Composite moral distress scores were highest for emergency medicine (n=106, 45.9% in highest quartile), child abuse (n=9, 39.1% in highest quartile), and hospital medicine physicians (n=109,32.5% in highest quartile). In regression analysis, high moral distress was associated with perceived suboptimal care quality, female gender, subspecialty, rurality, public insurance in practice, and academic appointment.

CONCLUSIONS

Approximately one-in-five pediatricians perceived suboptimal care quality for children with mental health conditions; this was associated with greater moral distress and several practice characteristics. Improving mental healthcare access, resources, and pediatricians' capacities to provide high quality care may benefit clinicians as well as children.

Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2023

OBJECTIVE

To evaluate the prevalence of burnout and satisfaction with work-life integration (WLI) among physicians and US workers in 2023 relative to 2011, 2014, 2017, and 2020, as well as physicians in 2021.

PARTICIPANTS AND METHODS

Between October 19, 2023, and March 3rd, 2024, we surveyed US physicians and a probability-based sample of the US working population using methods similar to previous studies. Burnout and WLI were measured using standard tools.

RESULTS

Demographic characteristics of the 7643 survey participants were similar to those of practicing US physicians (N=936,074), although participants were more likely to be women (39.6% vs 37.9%). Nonresponder analysis suggested participants were representative of US physicians with regard to burnout and satisfaction with WLI. Overall, 45.2% of physicians reported at least 1 symptom of burnout in 2023 compared with 62.8% in 2021 (P<.001), 38.2% in 2020 (P<.001), 43.9% in 2017 (P=.16), 54.4% in 2014 (P≤.001), and 45.5% in 2011 (P=.49). Overall, 42.2% of physicians (n=2732) were satisfied with WLI in 2023, compared with 30.3% in 2021 (P<.001), 46.1% in 2020 (P<.001), 42.8% in 2017 (P=.02), 40.9% in 2014 (P<.001), and 48.5% in 2011 (P <.001). On multivariable analysis of 2023 participants, physicians were at increased risk for burnout (odds ratio=1.82; 95% CI, 1.63 to 2.05) and were less likely to be satisfied with WLI (odds ratio=0.59; 95% CI, 0.53 to 0.66) than other US workers.

CONCLUSION

Burnout among US physicians improved between 2021 and 2023 and is currently at levels similar to 2017. However, US physicians remain at higher risk for burnout relative to other US workers.

Actionable Areas of Distress Among Pediatric Cardiology Fellows

OBJECTIVE

To quantify burnout and identify specific stressors among a national sample of pediatric cardiology fellows.

STUDY DESIGN

We invited program directors at all 61 Accreditation Council for Graduate Medical Education-accredited pediatric cardiology training programs to distribute a 40-item survey to their categorical (year 1-3) fellows from February to April 2023. The survey included the Stanford Professional Fulfillment Index and ratings of key stressors to understand levels of burnout and associated stressors.

RESULTS

In total, 67% (261/391) of contacted pediatric cardiology fellows completed the survey, representing 50% of all categorical fellows in the US. Of these, 42% reported symptoms of burnout. Fellows without children were found to have increased odds of experiencing burnout symptoms compared with those with children (OR 2.03). 13 of 15 stressors were associated with increased burnout scores, of which "excessive number of work hours," "challenges to prioritizing self-care," and "mistreatment from supervisors" were the top 3.

CONCLUSION

This national study of pediatric cardiology fellows shows a high prevalence of burnout. The modifiable stressors identified in this study offer opportunities to improve the well-being of this group of trainees.

Implementation of an Organization-Based Couples Health Promotion Program to Improve Physician Well-Being

Importance

Physicians work long, often unpredictable hours and experience multiple work-related stressors, which may adversely affect their personal relationships.

Objective

To assess the associations of a couples' workshop for physicians and their partners with burnout, self-valuation, and impact of work on personal relationships (IWPR).

Design, Setting, and Participants

In this cohort study, participants were grouped into an immediate intervention group and a delayed intervention control group, which were later compared. The participants in the intervention group gathered at a resort near Stanford University in October 2022, whereas the participants in the control group were invited to participate in a May 2023 workshop. Invited participants included Stanford Medicine physicians and their partners. Eligible physicians worked in a department or division considered frontline during the COVID-19 pandemic or had unfavorable IWPR scores on an institution-wide survey. The data were analyzed from June 14, 2024, to October 1, 2024.

Intervention

The intervention group participated in a 2-day workshop for couples and were offered 3 evening sessions. All sessions emphasized positive psychology principles and incorporated didactic, reflection, and unstructured content focused on strengthening relationships.

Main Outcomes and Measures

The main outcome was IWPR score, measured at baseline (immediately preceding the workshop for the intervention group and at registration for the control group) and 6 months later. IWPR was measured with a survey asking 4 questions about how work had affected personal relationships during the past year, and the responses included not at all true, somewhat true, moderately true, very true, and completely true (with scores assigned as 0, 1, 2, 3, and 4, respectively). Other outcome measures included burnout and self-valuation (with a lower score being favorable for burnout and a higher score being favorable for self-valuation).

Results

Of 47 intervention group participants and 69 control group participants, 22 (46.8%) and 40 (57.9%), respectively, were women (P = .32). Paired assessments (at baseline and 6 months) were completed by 38 of 47 (80.9%) physicians in the intervention group and 53 of 69 (76.8%) in the control group. Between baseline and 6-month follow-up, participants in the intervention group showed a mean (SD) improvement of 1.59 (2.66) points (Cohen d = 0.54 [95% CI, 0.23-0.85]; P < .001) in IWPR, 1.22 (1.47) points (Cohen d = 0.68 [95% CI, 0.39-0.98]; P < .001) in burnout, and -1.25 points (2.09) (Cohen d = 0.68 [95% CI, -0.97 to -0.25]; P < .001) in self-valuation. Statistically significant changes in these measures were not observed in the control participants. In mixed-effects modeling comparing the intervention and control groups, being in the intervention group was associated with a 1.25-point improvement in IWPR (Glass d = -0.45 [95% CI, -0.12 to -0.79]; P = .01), a 1.24-point improvement in burnout (Glass d = -0.70 [95% CI, -0.37 to -1.03]; P < .001), and a 0.97-point improvement in self-valuation (Glass d = 0.47 [95% CI, 0.09-0.86]; P = .02).

Conclusions and Relevance

In this cohort study of an organizationally sponsored intervention consisting of a couples' workshop designed to mitigate the adverse IWPR for physicians, participation was associated with statistically significant improvements in IWPR, burnout, and self-valuation. Further development of interventions to mitigate adverse IWPR among physicians is warranted.

Caring to care: Nurturing ICU healthcare professionals' wellbeing for enhanced patient safety

Healthcare professionals working in the Intensive Care Unit (ICU) care for patients suffering from a critical illness and their relatives. Working within a team of people with different personalities, competencies, and specialties, with constraints and demands might contribute to a working environment that is prone to conflicts and disagreements. This highlights that the ICU is a stressful place that can threaten healthcare professionals' wellbeing. This article aims to address the concept of wellbeing by describing how the stressful ICU work-environment threatens the wellbeing of health professionals and discussing how this situation jeopardizes patient safety. To promote wellbeing, it is imperative to explore actionable interventions such as improve communication skills, educational sessions on stress management, or mindfulness. Promoting ICU healthcare professionals' wellbeing through evidence-based strategies will not only increase their personal resilience but might contribute to a safer and more efficient patient care.

Burnout in modern-day health care: Where are we, and how can we markedly reduce it? A meta-narrative review from the EUREKA* project

BACKGROUND

Burnout is disrupting the health care workforce, threatening the livelihoods of health care workers and the probability of safe and effective patient care.

PURPOSES

The aims of this study were to describe the evolution and gaps in burnout research and identify next steps to advance the field and reduce burnout.

METHODOLOGY/APPROACH

We formed a learning community of burnout scholars and Chief Wellness Officers, sought recent review articles for a meta-narrative synthesis of themes on health care worker burnout, and conducted focus groups with learning community members.

RESULTS

In 1,425 systematic burnout studies found in a Medline database search of systematic reviews published since 2018, 68 were retained for analysis. Many focused on individual interventions (e.g., mindfulness), paying inconsistent attention to (a) what comprises burnout, (b) prevalence and contributors, (c) theories underlying it, (d) presence in marginalized populations, and (e) innovative research methods. There was consensus that burnout poses a global crisis, but there was no agreement on how to address it. Focus group participants noted that although burnout research is now "mainstream," health systems commit insufficient resources to addressing it. They proposed that emphasizing organizational finances and patient safety may make burnout a priority for health systems.

PRACTICE IMPLICATIONS

Despite burnout's progressing unabated, many organizations do not employ known burnout indicators (worker dissatisfaction or turnover) as wellness metrics. Research into organizational contributors to burnout, rigorous evaluation of interventions, and organizational adoption of research findings into systemic action are urgently needed. A well-supported international research agenda is required to quickly move the field ahead and reduce or ultimately eliminate burnout.

LGBTQ+ Inclusive Policies, Nurse Job Outcomes, and Quality of Care in Hospitals

Importance

Despite emphasis on the establishment of inclusive hospital policies, the impact of these policies on employees and organizations remains unknown.

Objective

To evaluate the association between inclusive policies for lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender minority (LGBTQ+) and nurse job outcomes as well as nurse-reported quality of care.

Design, Setting, and Participants

This cross-sectional study analyzed 4 survey datasets from 2021: the RN4CAST-NY/IL, including registered nurses from New York and Illinois, and the Healthcare Equality Index (HEI) data. The HEI evaluates and scores US health care facilities that voluntarily participate based on their LGBTQ+ inclusivity in policies, such as nondiscrimination policies and LGBTQ+ inclusive clinical services. The study used American Hospital Association Annual Survey data for hospital characteristics and Magnet organization data to classify hospitals by Magnet status. Data analyses were performed in December 2024.

Main Outcomes and Measures

Nurse job outcomes included burnout and job dissatisfaction. Quality of care outcomes included nurses' perceptions of care quality and their likelihood of recommending their hospital. The independent variable was LGBTQ+ Healthcare Equality Leader (HEI Leader) status, which signified hospitals with the highest levels of LGBTQ+ inclusion. Multilevel logistic regression models included nurse-level (age, race and ethnicity, gender, and years of experience at the current hospital) and hospital-level (Magnet status, size, teaching status, specialized service capability, and ownership) covariates.

Results

A total of 7343 nurses (mean [SD] age, 44.9 [13.4] years; 6584 [89.6%] women) from 111 hospitals were included in the study. Nurses in hospitals with HEI Leader status had lower odds of high burnout (adjusted odds ratio [AOR], 0.69; 95% CI, 0.52-0.92) and lower odds of job dissatisfaction (AOR, 0.62; 95% CI, 0.45-0.86) compared with those in hospitals without the status. They also had higher odds of reporting excellent or good quality of care (AOR, 1.83; 95% CI, 1.23-2.73) and higher odds of recommending their hospital (AOR, 1.72; 95% CI, 1.19-2.50).

Conclusions and Relevance

In this cross-sectional study, nurses in hospitals with high LGBTQ+ inclusion reported more favorable job outcomes and care quality. Hospitals should understand that implementing LGBTQ+ inclusive policies goes beyond compliance or diversity; it is essential for improving the work climate, enhancing staff well-being, and optimizing care delivery.

Exploration of What Pediatric Residents Find Most Helpful From Their Programs in Facilitating Well-Being

OBJECTIVE

Burnout is highly prevalent among residents, and although many studied interventions have targeted burnout by trying to promote well-being, it remains a substantial problem. This study utilized data from the Pediatric Resident Burnout-Resilience Study Consortium (PRB-RSC) Annual Burnout Survey to determine which program interventions categorical and noncategorical (medicine-pediatrics and combined programs) pediatric residents found most helpful to promote well-being.

METHODS

We conducted a secondary analysis of an open-ended question on the PRB-RSC Annual Burnout Survey in 2019 and 2020: "What is the most helpful thing that your program provides you for wellness?" We performed thematic and content analysis on open-ended responses and compared distribution of themes and subthemes between years using a Chi-square test.

RESULTS

In 2019, 1401 (44%) of 3159 residents from 44 programs responded to the open-ended question, with 771 (49%) of 1563 residents from 21 programs responding in 2020. Residents found wellness interventions within 5 themes to be the most helpful. Promotes positive work environment and Optimizes scheduling were mentioned most frequently, but residents also valued when a program Facilitates traditional wellness interventions, Offers financial benefits, and Prioritizes education. Themes and subthemes were mentioned with the same frequency in both 2019 and 2020.

CONCLUSIONS

The results of this study show which institutional interventions residents have found to be most helpful to their well-being. Program leaders can use these data as a framework to discuss interventions with their residents, allowing them to tailor wellness programs and use limited available resources for what residents believe is most impactful.

Exploring rural Scottish GPs' migration decisions: a secondary qualitative analysis considering burnout

BACKGROUND

The challenges of recruiting and retaining rural GPs are well described. UK data suggest high levels of burnout, characterised by detachment, exhaustion, and cynicism, plays a role in GP turnover. The contrast is engagement with work. There is limited evidence examining the relationship between work engagement and recruitment and retention in rural areas.

AIM

To qualitatively investigate GPs decisions to move or stay in rural areas through exploring areas that can promote work engagement.

DESIGN AND SETTING

This was a secondary analysis of qualitative data with Scottish GPs.

METHOD

A secondary analysis of 44 semi-structured interviews with GPs from across Scotland was undertaken. Data were analysed thematically and the Areas of Worklife Scale was used to structure data.

RESULTS

Factors associated with burnout were identified and experienced as barriers to moving or staying rurally. Fear of dealing with pre-hospital emergency cases, clinical isolation, and rural training were concerns. Personal factors such as lack of partner employment played a key role in migration decisions. Factors associated with engagement were identified and experienced as facilitators for moving or staying rurally. Professional networks reduced professional isolation and rural GPs valued increased autonomy and time. Many felt being a rural GP was more aligned with their professional values and highly valued the rural lifestyle for themselves and their families.

CONCLUSION

Our data suggest that factors associated with engagement and burnout can contribute to rural GPs' migration decisions. We highlight four areas that could promote desirable work environments by mitigating burnout and promoting engagement at work.

Effective remediation for advanced practice providers with lowest patient experience: The power of relational resources

OBJECTIVES

Healthcare providers with low patient experience scores may provide suboptimal care and experience burnout. Communication skills training (CST) can be effective, but remedial programs may be poorly received. We aimed to create a program to support advanced practice providers (APPs) with lowest patient experience ratings.

METHODS

Our communication skills program included individual and community-building support, strengths inventory, a foundational CST workshop, and coaching. Participants assessed program components and completed pre/post-intervention surveys regarding professional fulfillment, wellness, and communication self-efficacy. Provider communication during direct patient care was observed and scored pre/post CST.

RESULTS

Participants expressed satisfaction with the overall program and would recommend it to colleagues. Participants were most receptive to program interventions of professional coaching and CST. In addition, communication skills observed during direct patient care after CST demonstrated a statistically significant positive change. There were no changes in well-being or professional fulfillment indices.

CONCLUSIONS

Relational, anti-deficit interventions, focused on anticipated participant benefit, were well-received and improved self-assessed and observed patient engagement.

PRACTICE IMPLICATIONS

A scaffolded approach to remediation of low patient experience scores, leveraging participant strengths and goals, yielded improvements in communicating with patients.

Association of impostor phenomenon and burnout among Swiss residents and junior anaesthesiologists: results of a cross-sectional survey

BACKGROUND

Imposter phenomenon (IP) can impact professional performance and has been described as a risk factor for burnout within healthcare workers. We hypothesize that IP and burnout are prevalent among Swiss anaesthesiology residents and junior anaesthesiologists, and that specific risk factors are significantly associated with these conditions.

METHODS

We conducted a cross-sectional web-based survey of anaesthesiologists working in regions of Switzerland. The survey included demographic questions, the Clance Impostor Phenomenon Scale (CIPS), and the Maslach Burnout Inventory for Medical Personnel (MBI-HSS-MP). Descriptive statistics and logistic regression were used to identify demographic variables predictive of IP and burnout and to examine the association between IP and burnout.

RESULTS

A total of 318 people were eligible to participate. Of those, 136 (42.8%) participants completed the CIPS, and 127 (39.9%) completed the MBI-HSS-MP. Among CIPS respondents, 55% (75/136) identified as women, and 59% (80/136) were Swiss nationals. The prevalence of IP was 56% (76/136) and burnout was 10.2% (13/127). Women were more at risk of IP and burnout (p = 0.037). Independent covariates associated with IP were woman gender (p = 0.015) and Swiss nationality (p = 0.023). Additionally, the presence of IP was correlated with an increased likelihood of burnout (p = 0.04).

CONCLUSIONS

IP was correlated with the presence of burnout in anaesthesiologists in training. Additionally, IP affected more than half of the participants. Two risk factors were identified for IP: being a woman and a Swiss national. The rates of IP and its concerning association with burnout among resident and junior anaesthesiologists needs to be addressed.

TRIAL REGISTRATION

NCT06097325, https://www.

CLINICALTRIALS

gov/study/NCT06097325.

Self-Reported Medical Errors and Primary Care Physicians' Performance and Confidence in Delivering Care: A Multilevel Empirical Study in China

Background/Objectives: Patient safety is fundamental to primary healthcare, and medical errors impose a considerable burden on patients globally. However, the impact of medical errors on primary healthcare physicians remains understudied, especially in developing countries. This study aimed to examine the associations between self-reported medical errors and physicians' performance and confidence in Chinese primary care practice. Methods: A cross-sectional survey was conducted from November 2021 to May 2022 with 224 primary care physicians from 38 community health centers (CHCs) across four large cities in China. The quality of clinical and preventative care, and confidence in managing commonly occurring diseases, multimorbidity, and common mental health disorders served as indicators of performance and confidence, respectively. Hierarchical linear regression and linear regression with cluster-robust standard errors were employed. Results: Clinical care quality (β = -0.159, SE = 0.075, p < 0.05), preventive care quality (β = -0.165, SE = 0.068, p < 0.05), confidence in managing multimorbidity (β = -0.175, SE = 0.074, p < 0.05), and confidence in managing common mental health disorders (β = -0.189, SE = 0.076, p < 0.05) were negatively associated with self-reported medical errors, with scores of 4.08 (SD 0.95), 3.59 (SD 0.87), 3.63 (SD 1.04), and 3.10 (SD 1.21) out of 5 (where 5 represents the best possible score), respectively. The association between self-reported medical errors and confidence in managing commonly occurring diseases (β = -0.063, SE = 0.075, p > 0.05) was not statistically significant, with a score of 3.81 (SD 1.00) out of 5 (where 5 represents the best possible score). Conclusions: This study offers new insight into the associations between self-reported medical errors and primary healthcare physicians' performance and confidence. It is crucial for CHCs to be aware of the impact of self-reported medical errors on physicians' performance in delivering clinic and preventative care, and confidence in managing multimorbidity and common mental health disorders. Strategies such as strengthening organizational support should be developed to maintain performance and rebuild confidence in delivering care for physicians who were involved in medical errors.

Electronic Health Record Use Patterns Among Well-Being Survey Responders and Nonresponders: Longitudinal Observational Study

Background

Physician surveys provide indispensable insights into physician experience, but the question of whether responders are representative can limit confidence in conclusions. Ubiquitously collected electronic health record (EHR) use data may improve understanding of the experiences of survey nonresponders in relation to responders, providing clues regarding their well-being.

Objective

The aim of the study was to identify EHR use measures corresponding with physician survey responses and examine methods to estimate population-level survey results among physicians.

Methods

This longitudinal observational study was conducted from 2019 through 2020 among academic and community primary care physicians. We quantified EHR use using vendor-derived and investigator-derived measures, quantified burnout symptoms using emotional exhaustion and interpersonal disengagement subscales of the Stanford Professional Fulfillment Index, and used an ensemble of response propensity-weighted penalized linear regressions to develop a burnout symptom prediction model.

Results

Among 697 surveys from 477 physicians with a response rate of 80.5% (697/866), always responders were similar to nonresponders in gender (204/340, 60% vs 38/66, 58% women; P=.78) and age (median 50, IQR 40-60 years vs median 50, IQR 37.5-57.5 years; P=.88) but with higher clinical workload (median 121.5, IQR 58.5-184 vs median 34.5, IQR 0-115 appointments; P<.001), efficiency (median 5.2, IQR 4.0-6.2 vs median 4.3, IQR 0-5.6; P<.001), and proficiency (median 7.0, IQR 5.4-8.5 vs median 3.1, IQR 0-6.3; P<.001). Survey response status prediction showed an out-of-sample area under the receiver operating characteristics curve of 0.88 (95% CI 0.77-0.91). Burnout symptom prediction showed an out-of-sample area under the receiver operating characteristics curve of 0.63 (95% CI 0.57-0.70). The predicted burnout prevalence among nonresponders was 52%, higher than the observed prevalence of 28% among responders, resulting in an estimated population burnout prevalence of 31%.

Conclusions

EHR use measures showed limited utility for predicting burnout symptoms but allowed discrimination between responders and nonresponders. These measures may enable qualitative interpretations of the effects of nonresponders and may inform survey response maximization efforts.

Final results of the National Oncology Mentorship Program 2023 and its impact on burnout and professional fulfilment

BACKGROUND AND AIMS

Significant burnout and low professional fulfilment are noted among medical oncologists and trainees. The National Oncology Mentorship Programme (NOMP23) was designed to evaluate the impact of a 1-year mentorship program between oncology trainees (mentees) and consultants (mentors) on improving professional fulfilment and burnout.

METHODS

NOMP23 was a single-arm, prospective cohort study. One hundred twelve participants (56 mentors and 56 mentees) across Australia were recruited. Mentee/mentor pairs were orientated to the program virtually and met at least three times throughout 2023. The primary outcome was improvement in professional fulfilment as assessed using the Stanford Professional Fulfilment Index at conclusion of NOMP23 compared to baseline.

RESULTS

A total of 112 participants enrolled. Eighty-six (77%) completed the baseline and 63 (56%) completed the end-of-program survey. At baseline, 82% of mentees and 77% of mentors were classified as burnt out, which reduced to 57% and 51% at the conclusion of NOMP23; a reduction of 25% and 26% (P < 0.01). Baseline professional fulfilment was 0% and 5% for mentees and mentors respectively, which improved to 21% and 34% at the end of NOMP23 (P < 0.01). However, significant reduction in feelings of regret towards oncology as a profession was seen for mentees and mentors between baseline and the conclusion of NOMP23 (40% vs 14% and 29% vs 0% respectively, P < 0.01).

CONCLUSIONS

NOMP23 demonstrated that a centrally coordinated, low-cost mentorship program could be feasible and was of high value. Mentorship programs, alongside multifactorial institutional, state-based and national interventions to improve well-being, can help ensure a sustainable workforce.

Burnout in New Zealand resident doctors: a cross-sectional study of prevalence and risk factors

OBJECTIVE

Burnout syndrome, characterised by emotional exhaustion, depersonalisation and decreased personal accomplishment, is well documented in the medical workforce. This study aimed to investigate the prevalence of burnout in New Zealand resident doctors (doctors who have yet to complete their specialty training).

DESIGN

Cross-sectional survey study of resident doctors in New Zealand.

SETTING

Distributed by email.

PARTICIPANTS

509 resident doctors currently working in New Zealand. Doctors not currently working or those who have completed their specialty training (consultants) were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants were asked about a number of demographic and work-related factors and to complete the Maslach Burnout Inventory, which measures the three dimensions of burnout: 'Emotional Exhaustion', 'Depersonalisation' and low 'Personal Accomplishment'.

RESULTS

409/509 (80%) of respondents had scores indicating high burnout on at least one dimension. 163 (32%) had high burnout on one dimension, 111 (22%) on two dimensions and 135 (26%) on all three dimensions. Feeling well supported protected against burnout in all three dimensions: emotional exhaustion (OR 0.34, CI 0.19 to 0.60), depersonalisation (OR 0.52, CI 0.31 to 0.86) and decreased personal accomplishment (OR 0.51, CI 0.29 to 0.78). Having a manageable workload protected against emotional exhaustion (OR 0.23, CI 0.13 to 0.37) and depersonalisation (OR 0.39, CI 0.24 to 0.61). Increasing weekly exercise was protective for personal accomplishment (OR 0.846, CI 0.73 to 0.98). Having children was protective for depersonalisation (OR 0.7, CI 0.53 to 0.90). A personal history of depression or anxiety was associated with burnout on all three dimensions: emotional exhaustion (OR 2.86, CI 1.67 to 5.00), depersonalisation (OR 1.66, CI 1.01 to 2.73) and decreased personal accomplishment (OR 1.71, CI 1.05 to 2.80). Alcohol misuse was associated with an increased risk of depersonalisation (OR 1.68, CI 1.08 to 2.62), and feeling inadequately remunerated was associated with emotional exhaustion (OR 2.27, CI 1.28 to 4.17). Qualitative data revealed concerns about poor staffing, inadequate remuneration, a focus on service provision over education, slow career progression and difficulty balancing work and specialty examinations.

CONCLUSIONS

Burnout has a high prevalence in New Zealand's resident doctor workforce. Several associations and qualitative themes were identified. These findings may aid in the development of interventions to mitigate burnout in the medical workforce.

The relationship between impostor phenomenon and emotional exhaustion among Chinese nurses: the mediating role of bi-directional work-family conflict

Aims

The study aims to explore the relationship between impostor phenomenon and emotional exhaustion among nurses and to examine the potential mediating role of bi-directional work-family conflict.

Methods

A cross-sectional survey using convenience sampling was conducted from January to April 2023, involving 4,088 Chinese nurses. Of those, 3,977 nurses across 43 public hospitals completed the web-based survey that included a sociodemographic information questionnaire, the short Clance Impostor Phenomenon Scale, the Bi-directional Scale of Work-Family Conflict, and the Emotional Exhaustion Scale. SPSS with Hayes's PROCESS v4.2 Macro was employed to examine the mediation model using bootstrap techniques.

Results

After controlling for confounding factors, impostor phenomenon was found to have a direct positive effect on emotional exhaustion (𝛽 = 0.134, 95% CI [0.122 to 0.145]); the two dimensions of work-family conflict, work interfering with family (𝛽 = 0.099, 95% CI [0.090 to 0.109]) and family interfering with work (𝛽 = 0.017, 95% CI [0.012 to 0.022]), served as parallel mediators in the relationship between impostor phenomenon and emotional exhaustion. Compared to family interfering with work, impostor phenomenon had a greater influence on emotional exhaustion through the mediation of work interfering with family, with a difference in the mediating effects of 0.082 (95% CI [0.073 to 0.096]). (The symbol β denotes the regression coefficient, estimated through mediation analysis using a bias-corrected bootstrapping procedure. CI represents the confidence interval for the specified parameter).

Conclusion

This study reveals that impostor phenomenon not only directly affects emotional exhaustion but also exerts parallel mediation effects through bi-directional work-family conflict, with work interfering with family exerting a stronger mediating effect than family interfering with work. The findings elucidate the complex interplay between impostor phenomenon, an intrapersonal psychological factor, and work-family conflict, an interpersonal stressor, in contributing to emotional exhaustion among Chinese nurses, providing valuable insights to guide efforts aimed at safeguarding nurses' mental health and well-being.

Intersectionality and diversity, equity, and inclusion in the healthcare and scientific workforces

Enhancing diversity, equity, and inclusion (DEI) in the scientific and healthcare workforces∗ promotes research innovation and equitable access to quality healthcare. Efforts to advance DEI within the global scientific and healthcare workforces have assumed a new urgency given the strain caused by the COVID-19 pandemic, the aging of the global population, and the persistent shortages in the healthcare workforce, particularly in low- and middle-income countries. Yet, these fields continue to struggle to promote DEI. Considering the impact of intersectionality-how multiple identities interact to create unique experiences of privilege and power-within these workforces will enhance efforts to promote DEI. This series explores the impact of intersectionality on scientific and healthcare workforce DEI and how prominent institutional and structural factors (e.g., sexism and racism), as well as their interpersonal manifestations, can create barriers for workers with multiple intersecting marginalised identities. This paper, the first in a three-part series, describes how intersecting identities interact with workplace inequities and suggests ways to incorporate intersectionality into DEI efforts within the scientific and healthcare workforces. ∗We use the phrase scientific and healthcare workforces throughout this article to broadly encompass individuals associated with the biomedical, clinical, behavioral, and population science workforce.

The number of patient scheduled hours resulting in a 40-hour work week by physician specialty and setting: a cross-sectional study using electronic health record event log data

OBJECTIVE

To quantify how many patient scheduled hours would result in a 40-h work week (PSH40) for ambulatory physicians and to determine how PSH40 varies by specialty and practice type.

METHODS

We calculated PSH40 for 186 188 ambulatory physicians across 395 organizations from November 2021 through April 2022 stratified by specialty.

RESULTS

Median PSH40 for the sample was 33.2 h (IQR: 28.7-36.5). PSH40 was lowest in infectious disease (26.2, IQR: 21.6-31.1), geriatrics (27.2, IQR: 21.5-32.0) and hematology (28.6, IQR: 23.6-32.6) and highest in plastic surgery (35.7, IQR: 32.8-37.7), pain medicine (35.8, IQR: 32.6-37.9) and sports medicine (36.0, IQR: 33.3-38.1).

DISCUSSION

Health system leaders and physicians will benefit from data driven and transparent discussions about work hour expectations. The PSH40 measure can also be used to quantify the impact of variations in the clinical care environment on the in-person ambulatory patient care time available to physicians.

CONCLUSIONS

PSH40 is a novel measure that can be generated from vendor-derived metrics and used by operational leaders to inform work expectations. It can also support research into the impact of changes in the care environment on physicians' workload and capacity.

Caregiving During COVID and Beyond: The Experience of Workplace Stress and Chaplain Care Among Healthcare Workers

Healthcare workers (HCWs) experience occupational stressors that negatively impact emotional well-being and exacerbate turnover intentions. In the wake of the COVID-19 pandemic, the resultant acute care turnover rates have reached an all-time high. In addition, occupational stressors lead to psychological stress, including moral distress, defined as the dissonance between perceiving what the right course of action is and encountering an obstacle to acting accordingly. This qualitative descriptive study explored the perceptions of patient-facing HCWs in acute care hospital settings regarding the workplace stressors they encountered and the role of hospital-based chaplains in addressing emotional well-being and stress with 33 interviews. Findings suggest that HCW frequently experience work-related moral distress and seek relief by interacting with hospital chaplains. Chaplain care, common in American healthcare facilities for the spiritual care of patients, is an easily accessible resource to HCWs. Facilitating chaplain-HCW interactions may be an effective strategy for responding to moral distress and improving healthcare workers' well-being.

Maintaining essential healthcare services in Addis Ababa during COVID-19: A qualitative study

BACKGROUND

Worldwide, health systems have been challenged by the overwhelming demands of the COVID-19 pandemic. In Ethiopia, maintaining essential health services during the COVID-19 pandemic is critical to preventing severe outcomes and protecting the gains made over the past years in the health sector. This project aims to explore the health system's response to maintaining essential healthcare services in Addis Ababa, Ethiopia.

METHODS

A total of 60 key informant interviews were conducted by purposively selecting key stakeholders from Federal Ministry of Health, Addis Ababa Regional Health Bureau, Sub-city Health Offices, and frontline healthcare providers. Interviews were transcribed verbatim and coded using Open Code. Thematic analysis was employed to analyze the data.

RESULT

COVID-19 affected the delivery of essential health services in several ways, namely: decline in health service utilization, fear of infection among healthcare providers, stigma towards healthcare providers, and perceived decrease in quality-of-service provision. However, the health system actors made efforts to sustain services while responding to the pandemic by enacting changes in the service delivery modality. The most significant service delivery changes included repurposing health centers and prolonged prescriptions (multi-month medication dispensing). The primary challenges encountered were burnout of the health workforce and a shortage of personal protective equipment.

CONCLUSION

COVID-19 has affected the delivery of essential health services in multifaceted ways. System actors have accordingly made efforts to sustain services while responding to the pandemic.

Validity evidence for a French version of the Stigma of Occupational Stress Scale for Doctors (SOSS-D)

OBJECTIVES

Physicians demonstrate low rates of help seeking for psychiatric disorders, occupational stress, and burnout due to perceived stigma. The Stigma of Occupational Stress Scale for Doctors (SOSS-D) is a brief standardized tool designed to measure stigma (personal, perceived other, and perceived structural) in physicians. The aim of this study was to gather validity evidence for a French version of the SOSS-D.

METHODS

The SOSS-D was translated into French and piloted with 12 physicians. The scale was administered to physicians at the Geneva University Hospitals. We computed descriptive statistics and internal consistency coefficients. Construct validity was analyzed using exploratory (EFA) and confirmatory factor (CFA) analyses.

RESULTS

In total, 323 physicians participated in the survey. The internal consistency coefficient for the French SOSS-D was 0.72, 0.55 for the personal stigma subscale, 0.66 for the perceived other stigma subscale, and 0.65 for the perceived structural stigma subscale. CFA indicated a marginal fit. EFA revealed three factors: personal, perceived other, and perceived structural stigma.

DISCUSSION

Our findings support the hypothesis that stigma is a multi-dimensional construct. However, the French version of the SOSS-D scale did demonstrate some differences when compared to its English version. Identifying stigmatization beliefs among physicians may allow for increased identification of physicians at risk, and increased communication concerning preventive actions. Moreover, being aware of and fighting stigma can reduce barriers to help seeking and increased access to care resources for burnt-out physicians.

CONCLUSION

The results provide evidence of the validity and reliability of the French version of the SOSS-D indicating its suitability for use in a French-speaking physician population.

Enhancing provider-patient connection through low-effort interventions: a scoping review protocol

INTRODUCTION

Nudges, or low-effort interventions aimed at influencing behaviour, can improve provider medical decision-making through promoting adherence to practice guidelines. Strengthening provider-patient humanistic connection through nudges may increase provider satisfaction, mitigate burnout and improve patient satisfaction and outcomes. This scoping review aims to map the literature investigating provider-directed, low-effort interventions aimed at enhancing the provider-patient connection.

METHODS AND ANALYSIS

The authors conducted a preliminary search to identify terms that will be used in the final search strategy. The search follows Joanna Briggs Institute guidelines and will be used to query Ovid MEDLINE, Embase, PsycINFO and Cochrane databases. Two authors will work independently to screen abstracts and full text. We will summarise the findings using descriptive statistics and narrative synthesis and will use SEIPS 2.0 as the anchoring framework.

ETHICS AND DISSEMINATION

As a secondary analysis of published data, this study does not require ethics approval. The results will be submitted to relevant academic peer-reviewed journals and conferences. We anticipate that the interventions surveyed in this scoping review will have the potential to be incorporated into clinical practice at an individual and systemic level with the goal of enhancing providers' sense of meaning connected to their work, mitigating burnout and improving the patient experience.

Palliative Care Consults for Clinician Distress: Part of the Job?

Clinician distress is common in serious illness care. Palliative specialists are often consulted for cases involving significant distress among primary teams. Consults involving clinician distress can be challenging to navigate when it feels like 1) palliative specialists do not have the right skills to be helpful or 2) palliative specialists are being asked to 'fix' difficult situations that would require changing other people's attitudes, beliefs, or behaviors, or healthcare systems writ large. This article uses three composite cases to illustrate types of clinician distress and examine the benefits and risks of palliative specialist involvement. We conclude with a discussion of potential impacts of palliative care consults for clinician distress on the field of palliative care and consider next steps in critically important efforts to support and sustain the entire workforce-both palliative specialists and nonspecialists alike-when caring for patients with serious illness and their family caregivers.

The Influence of Hospital Physician Integration on Culture of Patient Safety

BACKGROUND

Medical errors are responsible for a large number of deaths every year in the Unites States. Hospitals use various strategies including leadership, staffing, and structural changes to deal with this concerning issue. Hospital physician integration is a structural strategy to possibly improve patient safety. Using the conceptual lens of Donabedian's Structure Process Outcome model, this study aims to investigate how hospital physician integration affects organizational, management, and communication attributes of patient safety culture.

METHODS

A pooled cross sectional study design using the Hospital Survey on Patient Safety Culture, the American Hospital Association data, and Area Health Resource File was used to analyze the relationship between hospital physician integration and organizational and management patient safety culture attributes. The dataset comprised of hospital level data from 2021 and 2022 for patient safety culture and hospital characteristics and contained a final sample of 205 observations. The independent variable was levels of integration across five levels. Three attributes of safety culture were chosen-positive perceptions of communication openness, organizational learning, and hospital management support for patient safety. The control variables were organizational characteristics. Multivariable linear regression was used as the analytic method.

RESULTS

Findings demonstrated a statistically significant correlation between higher level of hospital physician integration and positive perceptions of hospital management support for patient safety. There are 0.063 higher positive perceptions of hospital management support for patient safety for higher levels of integration compared with lower levels of integration ( P < 0.05). Perceptions of communication openness and organizational learning did not demonstrate a statistically significant correlation with any level of hospital physician integration.

CONCLUSIONS

Hospital physician integration and hospital management support for patient safety were moderately but significantly related. Hospital physician integration allows resources to become available for physician. As physicians take on management roles management of resources and eventually performance can improve, there is a need for future research in this area to examine if integration is a step in the right direction to overcome the challenges of patient safety and if investments in resources and training can be beneficial to safety culture.

Organizational Climate Related to Patient-Perpetrated Sexual Harassment: VA Primary Care Provider Perceptions

BACKGROUND

Patient-perpetrated sexual harassment toward health care providers is common and adversely affects provider well-being, workforce outcomes, and patient care. Organizational climate for sexual harassment-shared perceptions about an organization's practices, policies, and procedures-is one of the strongest predictors of harassment prevalence. We conducted a pilot survey assessing provider perceptions of the Veterans Health Administration (VA)'s climate related to patient-perpetrated sexual harassment.

RESEARCH DESIGN

Responding providers completed a survey assessing: (1) experiences with patient-perpetrated sexual harassment; (2) beliefs about VA's responses to patient-perpetrated sexual harassment of staff; and (3) perceptions of VA's organizational climate related to sexual harassment for each of 4 perpetrator-target pairings (patient-perpetrated harassment of staff, patient-perpetrated harassment of patients, staff-perpetrated harassment of staff, and staff-perpetrated harassment of patients).

SUBJECTS

Respondents included 105 primary care providers (staff physicians, nurse practitioners, and physician assistants) at 15 facilities in the VA Women's Health Practice-Based Research Network.

RESULTS

Seventy-one percent of responding providers reported experiencing patient-perpetrated sexual harassment in the past 6 months. Respondent perceptions of VA's responses to patient-perpetrated harassment of staff were mixed (eg, indicating that VA creates an environment where harassment is safe to discuss but that it fails to offer adequate guidance for responding to harassment). Respondents rated organizational climate related to patient-perpetrated harassment of staff as significantly more negative compared with climate related to other perpetrator-target pairings.

CONCLUSIONS

Future work with representative samples is needed to corroborate these findings, which have potential ramifications for VA's ongoing efforts to create a safe, inclusive environment of care.

Changing Medical Student Perceptions of Mental Illness Through a Psychiatry Clinical Clerkship: A Longitudinal Qualitative Study

OBJECTIVE

This study sought to understand whether perceptions of mental illness change during the course of students' psychiatry clerkships, and what facilitates such change.

METHODS

Using a longitudinal qualitative study design, the authors followed up 14 medical students, interviewing them before, during, and after their psychiatric clerkship.

RESULTS

Prior to clerkships, students perceived psychiatric patients to be dangerous, fragile, hard to treat, and to exert a disproportionate emotional toll on clinicians. Stigma was reinforced by safety measures including the provision of alarms, but this improved following "real life" engagement with patients. Students experienced little emotional distress from clinical contacts, particularly those where they led the consultation. Pre-existing beliefs about mental illness being hard to "fix" showed less change over time. Although uncommon, when staff referred to patients using pejorative language, students emulated these negative attitudes.

CONCLUSIONS

Among medical students, direct patient contact plays an important role in counteracting pre-existing negative attitudes towards mental illness. This can be facilitated by supportive supervisors, clinical teams allocating students a clear practical role, involving patients in teaching, and roleplay to alleviate potential concerns about seeing patients.

Looking Across the Drape: A Novel Quality Improvement Approach to Understanding Surgeon and Anesthesiologist Burnout

OBJECTIVE

To identify well-being threats for surgeons and anesthesiologists and develop interventions using the quality of life improvement (QOLI) approach.

BACKGROUND

Developing feasible perioperative well-being interventions requires identifying shared and specialty-specific well-being needs. The QOLI framework integrates human-centered design, implementation science, and quality improvement to address well-being needs.

METHODS

Anesthesia and surgery faculty in 8 perioperative departments at an academic medical center completed cross-sectional surveys containing validated measures of well-being and workplace satisfaction, and open-ended questions about professional motivations, pain points, strategies for improvement, and well-being priorities. Using template analysis, we analyzed open-ended survey data and presented resulting themes at a joint-specialty town hall for live voting to identify well-being priorities.

RESULTS

One hundred four perioperative faculty completed the survey. Across specialties, higher Mental Health Continuum-Short Form scores (representative of individual global well-being) were associated with higher satisfaction with workplace control, values, decision latitude, and social support. Anesthesiologists reported lower satisfaction and control than surgeons across multiple domains. Template analysis yielded 5 areas for intervention: (1) work culture, (2) work environment/resources, (3) sources of fulfillment, (4) work/life harmony, and (5) financial compensation. Surgeons and anesthesiologists both prioritized high-quality patient care but differed in their other top priorities. The most frequently cited well-being threats for surgeons were operating room inefficiencies/delays and excessive workload, whereas anesthesiologists cited understaffing and unpredictable work hours.

CONCLUSIONS

Surgeons and anesthesiologists share many needs and priorities, with pain points that are often negatively synergistic. Applying the QOLI approach across specialties allows for well-being interventions that honor complexity and promote the development of feasible solutions.

Emotional intelligence training among the healthcare workforce: a systematic review and meta-analysis

Background

The healthcare sector is acknowledged as a complex and challenging field. Increasingly, research highlights the importance of healthcare workers' internal social and emotional skills in managing their well-being and enhancing their capacity to provide patient care and support to colleagues. Emotional Intelligence (EI) has been identified as a key factor in improving the health and performance of healthcare workers, leading to the implementation of numerous programs aimed at enhancing EI.

Objective

This meta-analysis aims to evaluate the effectiveness of EI training interventions among healthcare workers, focusing on various intervention designs and their impact on EI improvement.

Methods

The review encompassed 17 longitudinal studies, each implementing EI training interventions for healthcare workers aged 18 and over. The studies employed a variety of research designs.

Results

All studies demonstrated an increase in EI following the intervention. However, methodological limitations within these studies might have led to an overestimation of the actual effects of the interventions.

Conclusion

While the reviewed studies indicate a positive trend in EI enhancement post-intervention, the potential overestimation of effects due to methodological flaws necessitates caution. The findings underline the need for future research to explore the optimal duration and delivery methods for EI training in healthcare settings.

Systematic review registration

The systematic review and meta-analysis have been pre-registered with PROSPERO [CRD42023393760]. Further details can be accessed at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023393760.

Post-traumatic growth, moral sensitivity and service behaviour among healthcare workers in the post-pandemic era of COVID-19 in mainland China: a cross-sectional study

OBJECTIVES

To investigate how post-traumatic growth (PTG) and moral sensitivity influence service behaviour among healthcare workers (HCWs) in mainland China post-COVID-19, with a focus on the mediating role of moral sensitivity.

DESIGN

Cross- sectional survey design.

SETTING

This study was conducted in 27 provinces across mainland China, from 16 March to 2 April 2023.

PARTICIPANTS

1,193 HCWs, including 378 physicians and 815 nurses, were selected using convenience and snowball sampling methods.

METHODS

The survey included the Post-traumatic Growth Inventory-Chinese version (PTGI-C), the Moral Sensitivity Questionnaire-Revised Chinese Version (MSQ-R-CV) and a service behaviour scale. Structural equation modelling was employed to analyse the data, focusing on the associations between PTG, moral sensitivity, and service behaviours.

RESULTS

The study found significant associations between PTG and moral sensitivity (r=0.49, p<0.01), with both factors positively influencing HCWs' service behaviours. Specifically, PTG had a direct effect on service behaviours (β=0.172, p<0.01) and an indirect effect through moral sensitivity (β=0.333, p<0.01), with moral sensitivity mediating 65.8% of PTG's impact on service behaviours. The model explained 56.0% of the variance in service behaviours, indicating a substantial influence of these psychological factors on professional conduct.

CONCLUSIONS

The findings highlight the significant role of PTG and moral sensitivity in shaping the service behaviours of HCWs in the aftermath of the COVID-19 pandemic. The study suggests that enhancing PTG and moral sensitivity through targeted interventions could improve HCWs' service delivery and resilience, emphasising the importance of incorporating psychological and ethical training into healthcare practices to prepare for future public health crises.

Physician perspectives of clinical performance feedback and impact on well-being: a qualitative exploration

OBJECTIVES

Providing clinical performance feedback to physicians is an established method to improve care, but the impact on physician well-being is unclear. This evaluation aimed to better understand physician perspectives on clinical feedback and its potential impact on well-being.

DESIGN

A qualitative design using semi-structured interviews was undertaken. Data were analysed via consensus coding using an inductive-deductive approach informed by Clinical Performance Feedback Intervention Theory. Findings were used to develop a novel framework describing the relationship between feedback and well-being.

SETTING

Interviews were conducted in a large academic medical centre from June-September 2021.

PARTICIPANTS

We conducted 25 semi-structured interviews with general outpatient and inpatient paediatricians and internists.

RESULTS

Physicians felt that feedback supported well-being based on its perceived purpose (intended to promote professional growth vs serving an alternative purpose), which they discerned based on feedback content (aligned with physician priorities vs not aligned), validity (accurate vs inaccurate), actionability (specific vs not, within a physician's sphere of control vs not) and delivery (supportive vs punitive). The Clinical Performance Feedback Well-Being Model is presented to understand how feedback and recipient variables impact well-being.

CONCLUSIONS

Attention to the process and content of physician clinical performance feedback may advance both the quality of care and physician well-being.

Factors affecting healthcare workers burnout and their conceptual models: scoping review

BACKGROUND

The occupational stress that contributes to the development of burnout syndrome remains one of the greatest scientific challenges. Despite years of research into burnout and its determinants, burnout continues to attract the attention of researchers, and healthcare workers (HCWs) continue to experience burnout in large numbers. Burnout has a significant impact on both the mental and physical well-being of HCWs and reduces patient-centered healthcare. This review aims to identify the factors affecting healthcare workers' burnout (FAHCWB) and their conceptual models.

METHODS

The review was conducted according to Arksey and O'Malley's framework using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Searches were conducted in PubMed, Scopus, Wiley, ProQuest, Sage, Science Direct, and EBSCO using the following keywords: healthcare professionals, burnout, and internal/external factors. Empirical, qualitative, quantitative, and mixed-design research articles published in English with full-text access in peer-reviewed journals that investigated the FAHCWB were included. For an in-depth analysis of the included articles, the authors developed a data synthesis table, and thematic analysis was applied to the analysis.

RESULTS

According to the inclusion criteria, 38 articles were selected for further data analysis. Six main themes were identified: (1) FAHCWB; (2) conceptual models of FAHCWB; (3) research tools for studying FAHCWB; (4) findings on FAHCWB in the context of different models; (5) differences between findings from different models; (6) what is known and not known about FAHCWB. The results of the review show that most researchers conduct research on factors affecting burnout (FAB) based on factors related to the work environment, with fewer studies based on individual factors, including personality factors. Most of the research is based on the model developed by Maslach et al. The Maslach Burnout Inventory (MBI) has been used in most studies.

CONCLUSIONS

Despite years of research, burnout continues to evolve rapidly, indicating that scientific research needs to be re-focused. Research should be conducted using different conceptual models and new research tools that allow the syndrome to be studied from a multidimensional perspective, including both the work environment and individual factors.

Nurse Burnout and Patient Safety, Satisfaction, and Quality of Care: A Systematic Review and Meta-Analysis

Importance

Occupational burnout syndrome is characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment and is prevalent among nurses. Although previous meta-analyses have explored the correlates of nurse burnout, none have estimated their association with health care quality and safety and patient morbidity and mortality.

Objective

To evaluate the magnitude and moderators of the association between nurse burnout and patient safety, patient satisfaction, and quality of care.

Data Source

The Web of Science, Scopus, MEDLINE, Embase, PsycINFO, CINAHL, and ProQuest databases were searched from January 1, 1994, to February 29, 2024.

Study Selection

Two reviewers independently identified studies that reported a quantifiable association between nurse burnout and any of the outcomes of patient safety, patient satisfaction, or quality of health care.

Data Extraction and Synthesis

The PRISMA 2020 guideline was followed. Two reviewers independently extracted the standardized mean difference (SMD) (Cohen d) estimates for a random-effects meta-analysis. Subgroup analyses and meta-regressions were conducted using prespecified variables.

Main Outcomes and Measures

Any measure of patient safety, patient satisfaction, or quality of health care previously associated with nurse burnout.

Results

A total of 85 studies (81 cross-sectional and 4 longitudinal) involving 288 581 nurses from 32 countries (mean [SD] age, 33.9 (2.1) years; 82.7% female; mean [SD] burnout prevalence rate with study-specific ascertainments, 30.7% [9.7%]) were included. Nurse burnout was associated with a lower safety climate or culture (SMD, -0.68; 95% CI, -0.83 to -0.54), lower safety grade (SMD, -0.53; 95% CI, -0.72 to -0.34), and more frequent nosocomial infections (SMD, -0.20; 95% CI, -0.36 to -0.04), patient falls (SMD, -0.12; 95% CI, -0.22 to -0.03), medication errors (SMD, -0.30; 95% CI, -0.48 to -0.11), adverse events or patient safety incidents (SMD, -0.42; 95% CI, -0.76 to -0.07), and missed care or care left undone (SMD, -0.58; 95% CI, -0.91 to -0.26) but not with the frequency of pressure ulcers. Nurse burnout was also associated with lower patient satisfaction ratings (SMD, -0.51; 95% CI, -0.86 to -0.17) but not with the frequencies of patient complaints or patient abuse. Finally, nurse burnout was associated with lower nurse-assessed quality of care (SMD, -0.44; 95% CI, -0.57 to -0.30) but not with standardized mortality rate. The associations were consistent across nurses' age, sex, work experience, and geography and persistent over time. For patient safety outcomes, the association was smaller for the low personal accomplishment subcomponent of burnout than for emotional exhaustion or depersonalization, as well as for nurses with a college education.

Conclusions and Relevance

In this systematic review and meta-analysis, nurse burnout was found to be associated with lower health care quality and safety and lower patient satisfaction. This association was consistent across nurse and study characteristics.

Examining the experience of healthcare workers who led staff wellness rounding during the COVID-19 pandemic

Objective Staff wellness rounding (SWR) is a process in which healthcare leaders have real-time conversations with healthcare workers (HCW) to identify safety and wellness issues. This study examined the experience of multidisciplinary healthcare leaders, who were not trained in psychology, who delivered SWR during the surge phase of the COVID-19 pandemic. Methods A mixed methods approach was used. Phase 1 included a survey of HCW who participated in SWR during July-October 2021. Phase 2 included semi-structured interviews of leaders who delivered SWR. Results There were 403 respondents to the survey, with 169 participants (41.9%) being eligible for the study. More than 67% of eligible respondents would recommend SWR to other colleagues, and 77.5% reported that SWR provided an opportunity to escalate issues or concerns about COVID-19. Eleven SWR leaders were interviewed about their experience of leading SWR. Four key themes were identified: SWR (1) offered a defined process for communication between executive leaders and HCW; (2) enabled escalation and actioning of issues to and from executive teams in the organisation; (3) required flexible scheduling to meet varied work schedules of HCW; and (4) required the leaders to have a core set of skills and competencies. Conclusion This study examined the contribution that an SWR intervention can make to support HCW wellbeing during crisis-type events. The model facilitated interactions between executive leaders, managers and frontline staff. It fostered collegiality with peers, managers and leaders, supported recognition and acknowledgment of peers and used available resources effectively to support staff wellness during the surge phase of the COVID-19 pandemic.

A Pilot Study Comparing a Community of Practice Program with and without Concurrent Ketamine-Assisted Therapy

The prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) has increased among healthcare providers, while the effectiveness of conventional treatments remains limited. Ketamine-assisted therapy offers a promising alternative; however, few have integrated ketamine with a group-based therapeutic modality. We report a retrospective, secondary analysis of a 12-week pilot of a Community of Practice (CoP) oriented group therapy program with optional, adjunct ketamine for depression, anxiety, and PTSD in a sample of 57 healthcare providers. All participants moved through the treatment as one group, with 38 electing to also receive three adjunct ketamine sessions in addition to the weekly CoP. Symptoms were assessed at baseline and pilot completion with the PHQ-9 for depression, GAD-7 for anxiety, and PCL-5 for PTSD. We observed significant reductions in the mean change among all participants, suggesting that benefit was derived from the CoP component, with or without ketamine as an adjunct. PHQ-9 scores decreased by 6.79 (95% CI: 5.09-8.49, p < .001), GAD-7 scores decreased by 5.57 (CI: 4.12-7.00, p < .001), and PCL-5 scores decreased by 14.83 (CI: 10.27-19.38, p < .001). Reductions were larger, but statistically nonsignificant, among those receiving ketamine. Further research is required to assess the impact of ketamine as an adjunct in group-based therapies.

Validation of the Turkish Version of the Professional Fulfillment Index

Introduction

Clinician burnout represents a significant occupational hazard among physicians, with a notably high prevalence among emergency physicians. The Stanford Professional Fulfillment Index (PFI) was developed to comprehensively assess various aspects of doctors' work experiences, including professional fulfillment. In this study we aimed to validate the Turkish version of the PFI (T-PFI), a 16-item instrument designed to measure physicians' professional fulfillment and burnout.

Methods

In this cross-sectional study, we validated the T-PFI in two phases. The initial phase involved translating and culturally adapting the original PFI into Turkish. We evaluated the content validity of the translated version using item and scale content validity indices (I-CVI and S-CVI, respectively). The validated T-PFI was then distributed among a broad cohort of emergency physicians via an online survey to further assess its reliability and validity. The assessment tools included Cronbach α, confirmatory factor analysis, and content validity indices.

Results

Of 1,434 physicians who were sent the survey, 425 fully completed it (29.6%). There was an almost equal distribution of 215 females and 210 males. Only 9.6% of the participants reported high levels of professional fulfillment, whereas a significant majority (79.1%) were susceptible to burnout. The Cronbach α values for the professional fulfillment and overall burnout scales were 0.87 and 0.90, respectively. The content validity was confirmed by I-CVI values exceeding 0.80 and an S-CVI/average relevance of 0.92. The confirmatory factor analysis demonstrated an acceptable model fit after adjustments.

Conclusion

The T-PFI is a reliable and valid tool for assessing professional fulfillment and burnout among emergency physicians in Turkey. Effective interventions to mitigate burnout are essential to improve physician well-being in Turkish healthcare settings.

The aftermath of COVID-19: generalized anxiety disorder and burnout among radiology practitioners and interns in Saudi Arabia

Background

The coronavirus disease (COVID-19) pandemic has presented unprecedented stressors and difficulties for healthcare professionals. This study explored the prevalence of generalized anxiety disorders and burnout among radiology practitioners and interns in various hospitals in Saudi Arabia after the end of the COVID-19 global public health emergency.

Methods

A cross-sectional survey of 230 radiology practitioners and interns was conducted between October and November 2023. This study utilized the Generalized Anxiety Disorder 7-item (GAD-7) scale and Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS-MP) 22-item questionnaire, employing a non-probability convenience sampling method. The average scores of the individual components constituting the GAD-7 scale and each burnout scale were calculated, and statistical analyses were conducted using the Mann-Whitney U and Kruskal-Wallis H nonparametric tests.

Results

Of 382 radiology practitioners and interns, 230 (60.2%) responded to the survey. Notably, 42.6% of the participants reported experiencing GAD. Regarding burnout, 82.3% were at moderate-to-high risk for emotional exhaustion, 93.5% for depersonalization, and 52.1% for personal achievement. The 31-40 years age group showed significantly higher burnout rates (p = 0.001) compared with the other age groups. Those with more than three years of experience had notably higher emotional exhaustion scores (p = 0.002) and a nearly significant increase in depersonalization scores (p = 0.051) than those with less experience.

Discussion

Our study revealed that 42.6% of radiology practitioners and interns experienced GAD, with the majority facing significant burnout. Furthermore, our research indicates a decline in GAD levels among radiology practitioners and interns compared with the peak COVID-19 pandemic period. It also showed a significant increase in both the incidence and severity of burnout, surpassing pre-pandemic levels in a comparable cohort. These findings emphasize the pressing challenges of GAD and burnout among healthcare workers, especially radiology professionals.

Burnout amongst chiropractic faculty, practitioners, and trainees: a scoping review

OBJECTIVE

The purpose of this scoping review was to summarize the literature pertaining to burnout and chiropractic.

METHODS

A literature review was performed in accordance with Preferred Reporting of Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). A literature review was performed by combining the term "chiropractic" with terms relevant to professional burnout (e.g., "work-related stress," "emotional exhaustion"). We included all publications addressing burnout within the chiropractic profession, including all study designs in only peer-reviewed literature.

RESULTS

Our search yielded 126 citations and 10 met the inclusion criteria. The studies identified consisted of eight surveys and two narrative reviews published from 2011 to 2024. Six of the studies utilized the Maslach Burnout Inventory to assess burnout. Chiropractic students reported greater burnout than the general population. Factors reported to increase burnout risk include higher workload, insurance mandates, and physical demands of daily practice. Factors reported to be protective against burnout included longer duration in clinical practice and philosophy-based practices.

CONCLUSIONS

Research on burnout within the chiropractic profession is limited and may not be generalizable. However, the reported factors contributing to burnout are well-documented. Future research should be conducted to improve understanding of the prevalence and causes of burnout in chiropractic.

Family medicine and general practitioner supervisor wellbeing: a literature review

BACKGROUND

Research examining general practice supervisor wellbeing has often been conducted within the context of trainee wellbeing and educational outcomes.

AIM

To consolidate the current literature regarding the wellbeing of GP supervisors through a 'supervisor-wellbeing' lens.

DESIGN & SETTING

Literature review of original research studies on Embase, Ovid MEDLINE, and Ovid PsycINFO from inception to December 2022.

METHOD

The Embase, Ovid MEDLINE, and Ovid PsycINFO databases were systematically searched from inception to December 2022. Original research studies were eligible if they explored any aspect of wellbeing or burnout (that is, construct conceptualisations, risk and protective factors, implications, or interventions) among GPs involved in educating GP trainees. Reporting quality of included studies was assessed using the QualSyst tool. Results from included studies were narratively synthesised.

RESULTS

Data from 26 independent samples were reviewed. Burnout was generally conceptualised using the Leiter and Maslach model. Wellbeing was poorly defined in the literature, largely being conceptualised in personal psychological terms and, to a lesser extent, professional satisfaction. Risk and protective factors were identified and grouped as individual (for example, satisfaction with capacity to teach) and external (for example, autonomy, collegial relationships, resource availability) factors. GP supervisors' wellbeing appeared to affect their job performance and retention. This review identified only two studies evaluating interventions to support GP supervisors' wellbeing.

CONCLUSION

The present review highlights a lack of conceptual clarity and research examining interventions for GP supervisor wellbeing. It provides guidance for future research designed to maximise the wellbeing of GP supervisors and support the wellbeing of trainees.

Accounting for taste: preferences mediate the relationship between documentation time and ambulatory physician burnout

OBJECTIVES

Physician burnout in the US has reached crisis levels, with one source identified as extensive after-hours documentation work in the electronic health record (EHR). Evidence has illustrated that physician preferences for after-hours work vary, such that after-hours work may not be universally burdensome. Our objectives were to analyze variation in preferences for after-hours documentation and assess if preferences mediate the relationship between after-hours documentation time and burnout.

MATERIALS AND METHODS

We combined EHR active use data capturing physicians' hourly documentation work with survey data capturing documentation preferences and burnout. Our sample included 318 ambulatory physicians at MedStar Health. We conducted a mediation analysis to estimate if and how preferences mediated the relationship between after-hours documentation time and burnout. Our primary outcome was physician-reported burnout. We measured preferences for after-hours documentation work via a novel survey instrument (Burden Scenarios Assessment). We measured after-hours documentation time in the EHR as the total active time respondents spent documenting between 7 pm and 3 am.

RESULTS

Physician preferences varied, with completing clinical documentation after clinic hours while at home the scenario rated most burdensome (52.8% of physicians), followed by dealing with prior authorization (49.5% of physicians). In mediation analyses, preferences partially mediated the relationship between after-hours documentation time and burnout.

DISCUSSION

Physician preferences regarding EHR-based work play an important role in the relationship between after-hours documentation time and burnout.

CONCLUSION

Studies of EHR work and burnout should incorporate preferences, and operational leaders should assess preferences to better target interventions aimed at EHR-based contributors to burnout.

Parental leave and family building experiences among head and neck surgeons in the United States: Career impact and opportunities for improvement

BACKGROUND

The availability of paid parental leave is an important factor for retention and wellness. The experiences of head and neck surgeons with parental leave have never been reported.

METHODS

A survey was electronically distributed to head and neck subspecialty surgeons in the United States. Responses were collected and analyzed.

RESULTS

Male surgeons had more children and took significantly less parental leave than women. Thirty percent of respondents reported that parental leave negatively impacted compensation, and 14% reported a delay in promotion due to leave, which impacted women more than men. The vast majority reported they are happy or neutral about covering those on leave. Most respondents utilized paid childcare, and approximately one quarter of respondents spending 11%-20% of their income on childcare.

CONCLUSIONS

This study illuminates the current disparities regarding parental leave-taking within the subspecialty of head and neck surgery in the United States. Women surgeons are more likely to be impacted professionally and financially.

Association of depressive symptoms with incidence and mortality rates of COVID-19 over 2 years among healthcare workers in 20 countries: multi-country serial cross-sectional study

BACKGROUND

Long-term deterioration in the mental health of healthcare workers (HCWs) has been reported during and after the COVID-19 pandemic. Determining the impact of COVID-19 incidence and mortality rates on the mental health of HCWs is essential to prepare for potential new pandemics. This study aimed to investigate the association of COVID-19 incidence and mortality rates with depressive symptoms over 2 years among HCWs in 20 countries during and after the COVID-19 pandemic.

METHODS

This was a multi-country serial cross-sectional study using data from the first and second survey waves of the COVID-19 HEalth caRe wOrkErS (HEROES) global study. The HEROES study prospectively collected data from HCWs at various health facilities. The target population included HCWs with both clinical and non-clinical roles. In most countries, healthcare centers were recruited based on convenience sampling. As an independent variable, daily COVID-19 incidence and mortality rates were calculated using confirmed cases and deaths reported by Johns Hopkins University. These rates represent the average for the 7 days preceding the participants' response date. The primary outcome was depressive symptoms, assessed by the Patient Health Questionnaire-9. A multilevel linear mixed model (LMM) was conducted to investigate the association of depressive symptoms with the average incidence and mortality rates.

RESULTS

A total of 32,223 responses from the participants who responded to all measures used in this study on either the first or second survey, and on both the first and second surveys in 20 countries were included in the analysis. The mean age was 40.1 (SD = 11.1), and 23,619 responses (73.3%) were from females. The 9323 responses (28.9%) were nurses and 9119 (28.3%) were physicians. LMM showed that the incidence rate was significantly and positively associated with depressive symptoms (coefficient = 0.008, standard error 0.003, p = 0.003). The mortality rate was significantly and positively associated with depressive symptoms (coefficient = 0.049, se = 0.020, p = 0.017).

CONCLUSIONS

This is the first study to show an association between COVID-19 incidence and mortality rates with depressive symptoms among HCWs during the first 2 years of the outbreak in multiple countries. This study's findings indicate that additional mental health support for HCWs was needed when the COVID-19 incidence and mortality rates increase during and after the early phase of the pandemic, and these findings may apply to future pandemics.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT04352634.

Exploring transitions in care among patients with head and neck CANCER: a multimethod study

BACKGROUND

Patients with head and neck cancers (HNC) experience many transitions in care (TiC), occurring when patients are transferred between healthcare providers and/or settings. TiC can compromise patient safety, decrease patient satisfaction, and increase healthcare costs. The evidence around TiC among patients with HNC is sparse. The objective of this study was to improve our understanding of TiC among patients with HNC to identify ways to improve care.

METHODS

This multimethod study consisted of two phases: Phase I (retrospective population-based cohort study) characterized the number and type of TiC that patients with HNC experienced using deterministically linked, population-based administrative health data in Alberta, Canada (January 1, 2012, to September 1, 2020), and Phase II (qualitative descriptive study) used semi-structured interviews to explore the lived experiences of patients with HNC and their healthcare providers during TiC.

RESULTS

There were 3,752 patients with HNC; most were male (70.8%) with a mean age at diagnosis of 63.3 years (SD 13.1). Patients underwent an average of 1.6 (SD 0.7) treatments, commonly transitioning from surgery to radiotherapy (21.2%). Many patients with HNC were admitted to the hospital during the study period, averaging 3.3 (SD 3.0) hospital admissions and 7.8 (SD 12.6) emergency department visits per patient over the study period. Visits to healthcare providers were also frequent, with the highest number of physician visits being to general practitioners (average = 70.51 per patient). Analysis of sixteen semi-structured interviews (ten patients with HNC and six healthcare providers) revealed three themes: (1) Navigating the healthcare system including challenges with the complexity of HNC care amongst healthcare system pressures, (2) Relational head and neck cancer care which encompasses patient expectations and relationships, and (3) System and individual impact of transitions in care.

CONCLUSIONS

This study identified challenges faced by both patients with HNC and their healthcare providers amidst the frequent TiC within cancer care, which was perceived to have an impact on quality of care. These findings provide crucial insights that can inform and guide future research or the development of health interventions aiming to improve the quality of TiC within this patient population.