1
|
Ko G, Naganathan G, Reel E, Cleland J, Covelli A, Wright FC, Cil TD. The Impact of COVID-19 on Breast Cancer Care: A Qualitative Analysis of Surgeons' Perspectives. Clin Breast Cancer 2024:S1526-8209(24)00111-3. [PMID: 38806320 DOI: 10.1016/j.clbc.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION While studies have documented delays in breast cancer (BC) care during the COVID-19 pandemic due to healthcare restrictions, there have been no studies on the experiences, and, particularly, the challenges with providing care faced by breast surgeons during this unprecedented time. This paper aims to understand the perspectives of breast surgeons regarding the impact of the COVID-19 pandemic on BC care. METHODS We used purposeful and snowball sampling to identify breast surgeons in Ontario, Canada. One-on-one qualitative semi-structured interviews were conducted exploring the impact of the pandemic on BC treatment, psychosocial well-being of patients and providers, and the future state of BC care. Audio-recorded interviews were transcribed verbatim and analyzed using Thematic Analysis. RESULTS A total of 10 breast surgeons (5 community and 5 academic) were interviewed. Breast surgeons reported that the pandemic led to increased multidisciplinary collaboration and innovations in delivery of BC surgery (e.g., increased use of regional anesthesia). Multiple surgeons identified that the pandemic created disparities in BC care based geographic location and that existing disparities in care based on ethnicity or marginalization were exacerbated. Last, surgeons identified that virtual care improved, but also created some challenges to how BC care was delivered, with many hoping for this to be continued after the pandemic was over. CONCLUSIONS In this study, breast surgeons identified unique challenges and solutions to BC care delivery during the pandemic. Concerns regarding disparities in care based on geographic location and marginalized patients require further study to improve future BC care.
Collapse
Affiliation(s)
- Gary Ko
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gayathri Naganathan
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Emma Reel
- Division of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Jordan Cleland
- Division of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Andrea Covelli
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Frances C Wright
- Division of Surgical Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Tulin D Cil
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Surgical Oncology, University Health Network, Toronto, Ontario, Canada.
| |
Collapse
|
2
|
Keyworth C, Conner M, Johnson J, Epton T, Vogt KS, Armitage CJ. Impacts of the COVID-19 public health emergency on healthcare professional delivery of opportunistic behaviour change interventions: a retrospective cohort study. BMC Health Serv Res 2024; 24:167. [PMID: 38317160 PMCID: PMC10845453 DOI: 10.1186/s12913-023-10522-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/23/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The public health policy "Making Every Contact Count" (MECC) compels healthcare professionals to deliver health behaviour change interventions during routine consultations. As healthcare systems continue their recovery from the impacts of the COVID-19 public health emergency, supporting people to modify health behaviours is more important now than when the policy was introduced. The present study aims to: (a) examine changes in healthcare professionals' awareness of, and engagement with the policy over a five-year period, (b) examine the psychosocial drivers associated with delivering behaviour change interventions, and (c) identify targets to increase healthcare professionals' delivery of interventions. METHODS Comparison of data from two independent representative surveys of NHS healthcare professionals working in the UK. In both surveys (July-September 2017; N = 1387, and February-March 2022; N = 1008), participants were asked to report: (1) awareness of the MECC policy, (2) the prevalence of MECC-related practice (perceived patient benefit, how often interventions were delivered, and time spent delivering interventions), and (3) perceptions of capabilities, opportunities and motivations to deliver behaviour change interventions. T- tests (independent-samples), MANOVA, multiple linear regression, and chi-square analyses were used to generate comparisons between the surveys. RESULTS Awareness of the policy increased from 2017 (31.4%) to 2022 (52.0%). However, in 2022 compared with 2017, healthcare professionals reported (a) fewer patients would benefit from behaviour change interventions (49.1% versus 55.9%), (b) they delivered behaviour change interventions to a lower proportion of patients (38.0% versus 50.0%), and (c) they spent a lower proportion of the consultation time delivering interventions (26.5% versus 35.3%). Further, in 2022, compared with 2017, healthcare professionals reported fewer physical opportunities, fewer social opportunities, and fewer psychological capabilities to deliver behaviour change interventions. In the 2022 survey, perceptions of patient benefit and delivery of interventions was associated with greater perceptions of opportunities and motivations. CONCLUSIONS Health behaviour change interventions remain an important part of routine healthcare in the continued recovery from COVID-19 public health emergency, however reported engagement with MECC-related practices appears to have reduced over time. Future research should consider how healthcare professionals identify patients who might benefit from opportunistic behaviour change interventions, and to increase capabilities, opportunities, and motivations to deliver interventions during routine consultations.
Collapse
Affiliation(s)
- Chris Keyworth
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK.
| | - Mark Conner
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK
| | - Judith Johnson
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK
| | - Tracy Epton
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, M13 9PL, Manchester, UK
| | - Katharina S Vogt
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, M13 9PL, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, M13 9PL, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, M13 9PL, Manchester, UK
| |
Collapse
|
3
|
Fronteira I, Mathews V, Dos Santos RLB, Matsumoto K, Amde W, Pereira A, de Oliveira APC, Craveiro I, Chança R, Boniol M, Ferrinho P, Poz MRD. Impacts for health and care workers of Covid-19 and other public health emergencies of international concern: living systematic review, meta-analysis and policy recommendations. HUMAN RESOURCES FOR HEALTH 2024; 22:10. [PMID: 38273317 PMCID: PMC10809470 DOI: 10.1186/s12960-024-00892-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Health and care workers (HCW) faced the double burden of the SARS-CoV-2 pandemic: as members of a society affected by a public health emergency and as HWC who experienced fear of becoming infected and of infecting others, stigma, violence, increased workloads, changes in scope of practice, among others. To understand the short and long-term impacts in terms of the COVID-19 pandemic and other public health emergencies of international concern (PHEICs) on HCW and relevant interventions to address them, we designed and conducted a living systematic review (LSR). METHODS We reviewed literature retrieved from MEDLINE-PubMed, Embase, SCOPUS, LILACS, the World Health Organization COVID-19 database, the ClinicalTrials.org and the ILO database, published from January 2000 until December 2021. We included quantitative observational studies, experimental studies, quasi-experimental, mixed methods or qualitative studies; addressing mental, physical health and well-being and quality of life. The review targeted HCW; and interventions and exposures, implemented during the COVID-19 pandemic or other PHEICs. To assess the risk of bias of included studies, we used the Johanna Briggs Institute (JBI) Critical Appraisal Tools. Data were qualitatively synthetized using meta-aggregation and meta-analysis was performed to estimate pooled prevalence of some of the outcomes. RESULTS The 1013 studies included in the review were mainly quantitative research, cross-sectional, with medium risk of bias/quality, addressing at least one of the following: mental health issue, violence, physical health and well-being, and quality of life. Additionally, interventions to address short- and long-term impact of PHEICs on HCW included in the review, although scarce, were mainly behavioral and individual oriented, aimed at improving mental health through the development of individual interventions. A lack of interventions addressing organizational or systemic bottlenecks was noted. DISCUSSION PHEICs impacted the mental and physical health of HCW with the greatest toll on mental health. The impact PHEICs are intricate and complex. The review revealed the consequences for health and care service delivery, with increased unplanned absenteeism, service disruption and occupation turnover that subvert the capacity to answer to the PHEICs, specifically challenging the resilience of health systems.
Collapse
Affiliation(s)
- Inês Fronteira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal.
- National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University of Lisbon, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.
| | - Verona Mathews
- School of Public, Health University of the Western Cape, South Africa, Private Bag X17, Bellville, 7535, Republic of South Africa
| | - Ranailla Lima Bandeira Dos Santos
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Osvaldo Cruz, Rua Leopoldo Bulhões, 1480 - Manguinhos, Rio de Janeiro, Brazil
| | - Karen Matsumoto
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524 - 7º andar, Blocos D e E - Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
| | - Woldekidan Amde
- School of Public, Health University of the Western Cape, South Africa, Private Bag X17, Bellville, 7535, Republic of South Africa
| | - Alessandra Pereira
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524 - 7º andar, Blocos D e E - Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
| | - Ana Paula Cavalcante de Oliveira
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524 - 7º andar, Blocos D e E - Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
| | - Isabel Craveiro
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal
| | - Raphael Chança
- Instituto Nacional de Cancer, Ministério da Saúde, Rua Marquês de Pombal, 125, Centro, Rio de Janeiro, RJ, 20230240, Brazil
| | - Mathieu Boniol
- Health Workforce Department, World Health Organization, Av. Appia 20, 1202, Geneva, Switzerland
| | - Paulo Ferrinho
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal
| | - Mario Roberto Dal Poz
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524 - 7º andar, Blocos D e E - Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
| |
Collapse
|
4
|
Samsudin EZ, Yasin SM, Ruslan NH, Abdullah NN, Noor AFA, Hair AFA. Socioeconomic impacts of airborne and droplet-borne infectious diseases on industries: a systematic review. BMC Infect Dis 2024; 24:93. [PMID: 38229063 PMCID: PMC10792877 DOI: 10.1186/s12879-024-08993-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/08/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Recent pandemics have had far-reaching effects on the world's largest economies and amplified the need to estimate the full extent and range of socioeconomic impacts of infectious diseases outbreaks on multi-sectoral industries. This systematic review aims to evaluate the socioeconomic impacts of airborne and droplet-borne infectious diseases outbreaks on industries. METHODS A structured, systematic review was performed according to the PRISMA guidelines. Databases of PubMed, Scopus, Web of Science, IDEAS/REPEC, OSHLINE, HSELINE, and NIOSHTIC-2 were reviewed. Study quality appraisal was performed using the Table of Evidence Levels from Cincinnati Children's Hospital Medical Center, Joanna Briggs Institute tools, Mixed Methods Appraisal Tool, and Center of Evidence Based Management case study critical appraisal checklist. Quantitative analysis was not attempted due to the heterogeneity of included studies. A qualitative synthesis of primary studies examining socioeconomic impact of airborne and droplet-borne infectious diseases outbreaks in any industry was performed and a framework based on empirical findings was conceptualized. RESULTS A total of 55 studies conducted from 1984 to 2021 were included, reporting on 46,813,038 participants working in multiple industries across the globe. The quality of articles were good. On the whole, direct socioeconomic impacts of Coronavirus Disease 2019, influenza, influenza A (H1N1), Severe Acute Respiratory Syndrome, tuberculosis and norovirus outbreaks include increased morbidity, mortality, and health costs. This had then led to indirect impacts including social impacts such as employment crises and reduced workforce size as well as economic impacts such as demand shock, supply chain disruptions, increased supply and production cost, service and business disruptions, and financial and Gross Domestic Product loss, attributable to productivity losses from illnesses as well as national policy responses to contain the diseases. CONCLUSIONS Evidence suggests that airborne and droplet-borne infectious diseases have inflicted severe socioeconomic costs on regional and global industries. Further research is needed to better understand their long-term socioeconomic impacts to support improved industry preparedness and response capacity for outbreaks. Public and private stakeholders at local, national, and international levels must join forces to ensure informed systems and sector-specific cost-sharing strategies for optimal global health and economic security.
Collapse
Affiliation(s)
- Ely Zarina Samsudin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Siti Munira Yasin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia.
| | - Nur-Hasanah Ruslan
- Faculty of Sports Science and Recreation, Universiti Teknologi MARA, Shah Alam, Malaysia
| | - Nik Nairan Abdullah
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Ahmad Faiz Azhari Noor
- Occupational Health Division, Department of Occupational Safety and Health, Putrajaya, Malaysia
| | | |
Collapse
|
5
|
O'Connor DB, Wilding S, Ferguson E, Cleare S, Wetherall K, McClelland H, Melson AJ, Niedzwiedz C, O'Carroll RE, Platt S, Scowcroft E, Watson B, Zortea T, Robb KA, O'Connor RC. Effects of COVID-19-related worry and rumination on mental health and loneliness during the pandemic: longitudinal analyses of adults in the UK COVID-19 mental health & wellbeing study. J Ment Health 2023; 32:1122-1133. [PMID: 35579054 DOI: 10.1080/09638237.2022.2069716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/21/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The lasting effects of the coronavirus disease 2019 pandemic are likely to be significant. AIMS This study tracked worry and rumination levels during the pandemic and investigated whether periods with higher COVID-related worry and rumination were associated with more negative mental health and loneliness. METHODS A quota survey design and a sampling frame that permitted recruitment of a national sample were employed. Findings for waves 1 (March 2020) to 6 (November 2020) are reported (N = 1943). RESULTS Covid-related worry and rumination levels were highest at the beginning of the first lockdown, then declined but increased when the UK returned to lockdown. Worry levels were higher than rumination levels throughout. High levels of COVID-related worry and rumination were associated with a five- and ten-fold increase in clinically meaningful rates of depression and anxiety (respectively) together with lower well-being and higher loneliness. The effects of COVID-related worry on depression and anxiety levels were most marked and clinically meaningful in individuals living with a pre-existing mental health condition. CONCLUSIONS Psychological interventions should include components that specifically target COVID-related worry and rumination. Individuals with pre-existing mental health conditions should be prioritised as we emerge from the current pandemic and in any future public health crises.
Collapse
Affiliation(s)
| | - Sarah Wilding
- School of Psychology, University of Leeds, Leeds, England
| | | | - Seonaid Cleare
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Karen Wetherall
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Heather McClelland
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Ambrose J Melson
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Claire Niedzwiedz
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | | | - Steve Platt
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | | | - Billy Watson
- Scottish Association for Mental Health, Glasgow, Scotland
| | - Tiago Zortea
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Kathryn A Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| |
Collapse
|
6
|
Lackman Zeman L, Roy S, Surnis PP, Wasserman JA, Duchak K, Homayouni R, Mulhem E. Paradoxical experiences of healthcare workers during COVID-19: a qualitative analysis of anonymous, web-based, audio narratives. Int J Qual Stud Health Well-being 2023; 18:2184034. [PMID: 36861313 PMCID: PMC9987722 DOI: 10.1080/17482631.2023.2184034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 02/20/2023] [Indexed: 03/03/2023] Open
Abstract
PURPOSE To gain a deeper understanding of healthcare workers experiences during COVID-19 using an anonymous, web-based, audio narrative platform. METHODS Data were collected from healthcare workers in the midwestern United States using a web-enabled audio diary approach. Participant recordings were analysed using a narrative coding and conceptualization process derived from grounded theory coding techniques. RESULTS Fifteen healthcare workers, in direct patient care or non-patient care roles, submitted 18 audio narratives. Two paradoxical themes emerged: 1) A paradox of distress and meaningfulness, where a harsh work environment resulted in psychological distress while simultaneously resulting in new rewarding experiences, sense of purpose and positive outlooks. 2) A paradox of social isolation and connection, where despite extreme isolation, healthcare workers formed intense and meaningful interpersonal connections with patients and colleagues in new ways. CONCLUSIONS A web-enabled audio diary approach provided an opportunity for healthcare workers to reflect deeper on their experiences without investigator influence, which led to some unique findings. Paradoxically, amid social isolation and extreme distress, a sense of value, meaning and rewarding human connections emerged. These findings suggest that interventions addressing healthcare worker burnout and distress might be enhanced by leveraging naturally occurring positive experiences as much as mitigating negative ones.
Collapse
Affiliation(s)
- Lori Lackman Zeman
- Department of Family Medicine, Beaumont Health, Troy, MI, USA
- Department of Family Medicine and Community Health, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Sujoy Roy
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Pranjali P. Surnis
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Department of Computer Science and Engineering, Oakland University, Rochester, MI, USA
| | - Jason Adam Wasserman
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Kathleen Duchak
- Department of Family Medicine, Beaumont Health, Troy, MI, USA
| | - Ramin Homayouni
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Elie Mulhem
- Department of Family Medicine, Beaumont Health, Troy, MI, USA
- Department of Family Medicine and Community Health, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| |
Collapse
|
7
|
Hamid M, Mirtorabi N, Ghumman A, Khalid A, Noormohamed MS, Kapoulas S, Singhal R, Nijjar R, Richardson M, Wiggins T. Tackling a Post-COVID-19 Cholecystectomy Waiting List: Are We Meeting the Challenge? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1872. [PMID: 37893590 PMCID: PMC10608591 DOI: 10.3390/medicina59101872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/27/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: The COVID-19 pandemic has led to a tremendous backlog in elective surgical activity. Our hospital trust adopted an innovative approach to dealing with elective waiting times for cholecystectomy during the recovery phase from COVID-19. This study aimed to evaluate trends in overall cholecystectomy activity and the effect on waiting times. Materials and Methods: A prospective observational study was undertaken, investigating patients who received a cholecystectomy at a large United Kingdom hospital trust between February 2021 and February 2022. There were multiple phased strategies to tackle a 533-patient waiting list: private sector, multiple sites including emergency operating, mobile theatre, and seven-day working. The correlation of determination (R2) and Kruskal-Wallis analysis were used to evaluate trends in waiting times across the study period. Results: A total of 657 patients underwent a cholecystectomy. The median age was 49 years, 602 (91.6%) patients had an ASA of 1-2, and 494 (75.2%) were female. A total of 30 (4.6%) patients were listed due to gallstone pancreatitis, 380 (57.8%) for symptomatic cholelithiasis, and 228 (34.7%) for calculous cholecystitis. Median waiting times were reduced from 428 days (IQR 373-508) to 49 days (IQR 34-96), R2 = 0.654, p < 0.001. For pancreatitis specifically, waiting times had decreased from a median of 218 days (IQR 139-239) to 28 (IQR 24-40), R2 = 0.613, p < 0.001. Conclusions: This study demonstrates the methodology utilised to safely and effectively tackle the cholecystectomy waiting list locally. The approach utilised here has potential to be adapted to other units or similar operation types in order to reduce elective waiting times.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tom Wiggins
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Birmingham B9 5SS, UK
| |
Collapse
|
8
|
Prudenzi A, Graham CD, Rogerson O, O'Connor DB. Mental health during the COVID-19 pandemic: exploring the role of psychological flexibility and stress-related variables. Psychol Health 2023; 38:1378-1401. [PMID: 35073803 DOI: 10.1080/08870446.2021.2020272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Understanding the impact of the COVID-19 pandemic on mental health and the psychological factors associated can help inform subsequent interventions to protect psychological health. In particular, psychological flexibility has been shown to be an important target for intervention. The current study aimed to investigate associations between protective factors (state mindfulness, values and self-compassion) and risk factors (COVID-19 stress, worry and rumination) for mental health during the early stages of the COVID-19 pandemic. DESIGN 439 participants completed three online surveys during the 1st wave of the pandemic in the UK: Time 1 (April 1-5th 2020), Time 2 (April 15-19th April), Time 3 (May 13-17th 2020). MAIN OUTCOME MEASURES Measures of wellbeing, burnout and life satisfaction. RESULTS Psychological health outcome measures were found to be lower (worse) than normative comparison data during the early stages of the UK lockdown, while COVID-19 stress and worry reduced over time. Multilevel models found that higher levels of trait and state measures of psychological flexibility and self-compassion were associated with better psychological health across time points. Higher levels of COVID-19 stress, worry and rumination were also associated with poorer psychological health. CONCLUSION The results showed that mindfulness, values and self-compassion are potential targets for intervention.
Collapse
|
9
|
Vitous CA, Suwanabol PA. Qualitative Research and Applications in Colorectal Surgery. Clin Colon Rectal Surg 2023; 36:271-278. [PMID: 37223229 PMCID: PMC10202540 DOI: 10.1055/s-0043-1762927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Traditionally employed in medical anthropologic and sociologic literature, qualitative methods are emerging as an essential component of clinical research as surgeons and researchers strive to optimize care informed by patient perspectives. Qualitative methods in health care-related research may be used to understand subjective experiences, beliefs, and concepts that are not captured using quantitative analyses and to gain in-depth knowledge of a specific context or culture. A qualitative approach may also be employed to explore under-researched problems and generate new ideas. Here, we provide an overview of aspects to consider when designing and conducting a qualitative research study.
Collapse
Affiliation(s)
- C. Ann Vitous
- Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Pasithorn A. Suwanabol
- Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
10
|
Browne A, Jenkins T, Berlinger N, Buchbinder L, Buchbinder M. The impact of health inequities on physicians' occupational well-being during COVID-19: A qualitative analysis from four US cities. J Hosp Med 2023; 18:595-602. [PMID: 37070735 PMCID: PMC10783652 DOI: 10.1002/jhm.13107] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/16/2023] [Accepted: 03/31/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE The aim of this study is to describe frontline physicians' perceptions of the impact of racial-ethnic and socioeconomic disparities in COVID-19 infection and mortality on their occupational well-being. METHODS One hundred and forty-five qualitative, semistructured interviews were conducted between February 2021 and June 2022 with hospital medicine, emergency medicine, pulmonary/critical care, and palliative care physicians caring for hospitalized COVID-19 patients in four US cities. RESULTS Physicians reported encountering COVID-related health disparities and inequities at the societal, organizational, and individual levels. Encountering these inequities, in turn, contributed to stress among frontline physicians, whose concerns revealed how structural conditions both shaped COVID disparities and constrained their ability to protect populations at risk from poor outcomes. Physicians reported feeling complicit in the perpetuation of inequities or helpless to mitigate observed inequities and experienced feelings of grief, guilt, moral distress, and burnout. CONCLUSIONS Health inequities are an under-acknowledged source of physicians' occupational stress that requires solutions beyond the clinical context.
Collapse
Affiliation(s)
- Alyssa Browne
- Department of Sociology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tania Jenkins
- Department of Sociology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Liza Buchbinder
- Center for Social Medicine and Humanities and Semel Institute, UCLA, Los Angeles, California, USA
| | - Mara Buchbinder
- Department of Social Medicine, Center for Bioethics, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
11
|
Johnson J, Pointon L, Keyworth C, Wainwright N, Moores L, Bates J, Hinsby K. Evaluation of a training programme for critical incident debrief facilitators. Occup Med (Lond) 2023; 73:103-108. [PMID: 36516291 PMCID: PMC10016050 DOI: 10.1093/occmed/kqac125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Critical incident debriefs are a commonly used occupational health tool for supporting staff after traumatic work incidents. However, there is a dearth of literature evaluating training programmes for debrief facilitators. AIMS To evaluate a 5-day training programme to equip healthcare, social care and voluntary, community and social enterprise sector staff to act as post-incident peer supporters and debrief facilitators. METHODS A mixed-methods, single-arm, before-and-after study. Data were collected at baseline and post-training. The quantitative outcome measure was 'Confidence'; the sum of two items measuring confidence in (i) supporting peers after critical incidents and (ii) facilitating post-incident structured team discussions. At post-training, quantitative and qualitative feedback regarding experiences and perceptions of the training was also gathered. RESULTS We recruited 45 participants between October 2021 and January 2022. Confidence in supporting peers following incidents and facilitating post-incident structured team discussions increased significantly following the training, t(35) = -6.77, P < 0.001. A majority of participants reported they would do things differently because of the training and that they found the training relevant, useful and engaging. Summative content analysis of qualitative feedback indicated that participants (i) believed the role plays were an important learning tool and (ii) thought it was important that the trainer was engaging. Some participants would have preferred in-person delivery. CONCLUSIONS Participants valued training in post-incident peer support and debriefing skills. Organizations implementing post-incident support pathways could usefully include this training and ensure optimal uptake and engagement by (i) providing in-person and online delivery options and (ii) including role play as a learning technique.
Collapse
Affiliation(s)
- J Johnson
- School of Psychology, Lifton Place, University of Leeds, Leeds LS29JT, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford BD96RJ, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2033, Australia
| | - L Pointon
- School of Psychology, Lifton Place, University of Leeds, Leeds LS29JT, UK
| | - C Keyworth
- School of Psychology, Lifton Place, University of Leeds, Leeds LS29JT, UK
| | - N Wainwright
- Mid-Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK
| | - L Moores
- Mid-Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK
| | - J Bates
- Mid-Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK
| | - K Hinsby
- Leeds and York Partnership NHS Foundation Trust, Leeds LS73JX, UK
| |
Collapse
|
12
|
Teoh K, Singh J, Medisauskaite A, Hassard J. Doctors' perceived working conditions, psychological health and patient care: a meta-analysis of longitudinal studies. Occup Environ Med 2023; 80:61-69. [PMID: 36635099 DOI: 10.1136/oemed-2022-108486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/17/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Studies have demonstrated an association between doctors' perceived working conditions, and their psychological well-being and patient care. However, few have examined inter-relationships among these three domains, and even fewer using longitudinal designs. Using meta-analytical structural equation modelling, we tested longitudinal relationships among doctors' perceived working conditions, their psychological well-being and patient care. We further tested if doctors' psychological well-being mediates the relationship between perceived working conditions and patient care. METHODS We carried out a systematic review using Academic Search Premier, Business Source Premier, PsycInfo, PsycArticles and Medline for the 20-year period between January 2000 and the start of the pandemic (January 2020). We included studies with practising doctors as participants, and that reported a quantifiable bivariate effect size between at least two of the three constructs of interest-perceived working conditions (ie, job demands, job resource), psychological well-being (ie, emotional exhaustion, work engagement) and patient care (ie, clinical care, patient safety). We pooled relationship effect sizes using random-effects meta-analysis, before testing for indirect effects using two-stage structural equation modelling. RESULTS Twenty-three samples from 11 countries representing 7275 doctors were meta-analysed. The results indicated that job resources predicted work engagement (ρ=0.18; 95% CI 0.11 to 0.24) and emotional exhaustion (ρ=-0.21; 95% CI -0.31 to -0.11), while job demands predicted emotional exhaustion (ρ=0.27; 95% CI 0.17 to 0.36). Better clinical care was also associated with higher levels of job resources (ρ=0.16; 95% CI 0.04 to 0.29), and lower levels of emotional exhaustion (ρ=-0.21; 95% CI -0.37 to -0.12) and job demands (ρ=-0.27; 95% CI -0.43 to -0.10). Both factors of the work environment were associated with clinical care through doctors' emotional exhaustion, but there were insufficient studies to test the indirect effects for work engagement or patient safety. CONCLUSION Our results demonstrate the need for a systems perspective to address working conditions to support both doctors' psychological well-being and patient care. Interventions should target doctors' job resources as they are more strongly associated with psychological well-being. However, given that job demands were strongly associated with emotional exhaustion, and in turn, clinical care, there is a need to better manage doctors' workload, conflict and pressure to support the current psychological well-being crises among this occupational group. PROSPERO REGISTRATION NUMBER CRD42020189070.
Collapse
Affiliation(s)
- Kevin Teoh
- Department of Organizational Psychology, Birkbeck University of London, London, UK
| | - Jasmeet Singh
- Psychology Department, Nottingham Trent University, Nottingham, UK
| | | | - Juliet Hassard
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| |
Collapse
|
13
|
Cogan N, McGibbon M, Gardiner A, Morton L. Understanding the Mental Health Impacts of the COVID-19 Pandemic on Railway Workers: Risks and Protective Factors. J Occup Environ Med 2023; 65:172-183. [PMID: 36109012 PMCID: PMC9897125 DOI: 10.1097/jom.0000000000002711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Railway workers have provided an essential service throughout the COVID-19 pandemic. This study explored the effects of COVID-19 on the mental well-being of railway workers (N = 906) in the United Kingdom during the third lockdown period. METHOD The online survey included measures of COVID-19-related risk factors (perceived risk, stress, burnout, trauma) and protective factors (resilience coping, team resilience, general help seeking) associated with mental well-being. Responses were analyzed using multiple regression and content analysis. RESULTS COVID-19-related risk factors negatively predicted well-being. Higher scores on adaptive resilience, intentions to seek help, and team resilience significantly predicted higher mental well-being scores. Mental health decline throughout the COVID-19 pandemic and concerns for the future were reported. CONCLUSIONS Building a resilient railway workforce requires attention to staff mental well-being and to ensuring that support systems are robust and accessible.
Collapse
|
14
|
Baryeh K, Bradley A, Cotzias C. The recovery of training and education post-COVID-19: the importance of supporting the consultant workforce. Br J Hosp Med (Lond) 2023; 84:1-9. [PMID: 36708341 DOI: 10.12968/hmed.2022.0471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND/AIMS Since the COVID-19 pandemic began, training and education have been significantly disrupted, causing an incalculable effect on trainees. However, the consultant workforce is crucial to the success of training recovery. The motivation of the consultant workforce to assist in training recovery, in a context of significant workload and increasing pressures on resources, is currently unknown. METHODS This survey gathered the consultant workforce's views on assisting training recovery at one site of a large NHS foundation trust. RESULTS There was reduced motivation to engage in training and education when compared to pre-pandemic levels, widespread indicators of burnout, and changes in attitude towards reducing their working hours and early retirement. CONCLUSIONS These findings demonstrate a worrying trend that is likely to be replicated nationwide, which highlights the need to support consultants to avoid further disruption to training recovery.
Collapse
Affiliation(s)
- Kwaku Baryeh
- Department of Medical Education, West Middlesex University Hospital, Isleworth, UK
| | - Anna Bradley
- Department of Medical Education, West Middlesex University Hospital, Isleworth, UK
| | - Christina Cotzias
- Department of Medical Education, West Middlesex University Hospital, Isleworth, UK
| |
Collapse
|
15
|
Buchbinder M, Browne A, Jenkins T, Berlinger N, Buchbinder L. Hospital Physicians' Perspectives on Occupational Stress During COVID-19: a Qualitative Analysis from Two US Cities. J Gen Intern Med 2023; 38:176-184. [PMID: 36329231 PMCID: PMC9633020 DOI: 10.1007/s11606-022-07848-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND US physicians are at risk for high rates of occupational stress and burnout, which the COVID-19 pandemic has intensified. As approaches targeting physicians' individual resilience have fallen short, researchers are increasingly calling for studies that investigate organizational drivers of stress and burnout. OBJECTIVE To understand the multi-dimensional systems factors shaping hospital physicians' occupational stress during the pandemic. DESIGN Qualitative, semi-structured interviews conducted in February-October 2021. SETTING Hospitals in New York City and New Orleans. PARTICIPANTS A purposive snowball sample of attending physicians and fellows in hospital medicine, emergency medicine, pulmonary critical care, and palliative care who spent at least 4 weeks providing inpatient COVID-19 care beginning in March 2020 was selected. The sample included 40 physicians from 14 hospitals in New York City and 39 physicians from nine hospitals in New Orleans. APPROACH Descriptive analysis of participants' self-reported perceptions of occupational stress. KEY RESULTS Participants identified multiple factors shaping their occupational stress including individual-level factors such as age, work experience, and life stage; institutional-level factors such as resource disparities, institutional type and size, and policies; professional-level factors such as informal rationing and medical uncertainty; and societal-level factors such as the federal response, COVID politics, and social inequalities. Stressors within and across these four levels worked in combination to shape physicians' perceptions of occupational stress at the individual level. CONCLUSIONS This article contributes to an emergent literature on systems-based approaches to occupational stress and burnout among physicians by demonstrating the intersections among societal conditions, professional cultures, institutional work environments, and individual stress. Findings from semi-structured interviews suggest that interventions to reduce physician stress and burnout may be more effective if they target systems factors and stressors at multiple levels.
Collapse
Affiliation(s)
- Mara Buchbinder
- Department of Social Medicine and Center for Bioethics, UNC-Chapel Hill, 333 S. Columbia Street, 341A MacNider CB 7240, Chapel Hill, NC, 27599, USA.
| | - Alyssa Browne
- Department of Sociology, UNC-Chapel Hill, Chapel Hill, USA
| | - Tania Jenkins
- Department of Sociology, UNC-Chapel Hill, Chapel Hill, USA
| | | | - Liza Buchbinder
- Center for Social Medicine and Humanities and Semel Institute, UCLA, Los Angeles, USA
| |
Collapse
|
16
|
Keyworth C, Alzahrani A, Pointon L, Hinsby K, Wainwright N, Moores L, Bates J, Johnson J. Barriers and enablers to accessing support services offered by staff wellbeing hubs: A qualitative study. Front Psychol 2022; 13:1008913. [DOI: 10.3389/fpsyg.2022.1008913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022] Open
Abstract
BackgroundInternational efforts have been made to develop appropriate interventions to support the mental health needs of healthcare professionals in response to COVID-19. However, fewer staff have accessed these than expected, despite experiencing elevated levels of mental distress since the onset of the pandemic. Consequently, we aimed to examine the barriers and enablers for healthcare professionals in accessing interventions offered by a Staff Mental Health and Wellbeing Hub.MethodsTwenty-five semi-structured interviews were conducted with healthcare, social care and voluntary, community and social enterprise (VCSE) sector staff. Data were analysed using thematic analysis.ResultsFour key themes were identified: (1) Environment and Atmosphere in the Workplace; (2) The Impacts of COVID-19; (3) Confidentiality; and (4) Awareness and Communication of Resources. Organisational environments were perceived as an important enabler of accessing the hub services for mental health and wellbeing support. This included the importance of recognising and responding to the ongoing pressures of COVID-19- specific challenges. Ensuring and communicating aspects of confidentiality, and ensuring clear and consistent communication of the benefits of the Hub may encourage help-seeking for mental health challenges among healthcare professionals.DiscussionOur findings highlight important considerations to increase uptake and engagement with services to support the mental health and wellbeing of healthcare professionals and associated staff and volunteers. Organisations aiming to increase employee uptake of these services should regularly circulate consistent and clear emails about what these services offer, provide training and information for managers so they can support staff to access these services and ensure access is confidential.
Collapse
|
17
|
Wilding S, O'Connor DB, Ferguson E, Wetherall K, Cleare S, O'Carroll RE, Robb KA, O'Connor RC. Information seeking, mental health and loneliness: Longitudinal analyses of adults in the UK COVID-19 mental health and wellbeing study. Psychiatry Res 2022; 317:114876. [PMID: 36215778 PMCID: PMC9526871 DOI: 10.1016/j.psychres.2022.114876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 01/05/2023]
Abstract
Information seeking has generally been seen as an adaptive response to the COVID-19 pandemic. However, it may also result in negative outcomes on mental health. The present study tests whether reporting COVID-related information seeking throughout the pandemic is associated with subsequently poorer mental health outcomes. A quota-based, non-probability-sampling methodology was used to recruit a nationally representative sample. COVID-related information seeking was assessed at six waves along with symptoms of depression, anxiety, mental wellbeing and loneliness (N = 1945). Hierarchical linear modelling was used to assess the relationship between COVID-related information seeking and mental health outcomes. Information seeking was found to reduce over time. Overall, women, older and higher socioeconomic group individuals reported higher levels of information seeking. At waves 1-4 (March-June 2020) the majority of participants reported that they sought information on Covid 1-5 times per day, this decreased to less than once per day in waves 5 and 6 (July-November 2020). Higher levels of information seeking were associated with poorer mental health outcomes, particularly clinically significant levels of anxiety. Use of a non-probability sampling method may have been a study limitation, nevertheless, reducing or managing information seeking behaviour may be one method to reduce anxiety during pandemics and other public health crises.
Collapse
Affiliation(s)
- Sarah Wilding
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Daryl B. O'Connor
- School of Psychology, University of Leeds, Leeds, United Kingdom,Corresponding author
| | - Eamonn Ferguson
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Karen Wetherall
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Seonaid Cleare
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Ronan E. O'Carroll
- Division of Psychology, University of Stirling, Stirling, United Kingdom
| | - Kathryn A. Robb
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Rory C. O'Connor
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
18
|
Shaikh CF, Palmer Kelly E, Paro A, Cloyd J, Ejaz A, Beal EW, Pawlik TM. Burnout Assessment Among Surgeons and Surgical Trainees During the COVID-19 Pandemic: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2022; 79:1206-1220. [PMID: 35659443 PMCID: PMC9091165 DOI: 10.1016/j.jsurg.2022.04.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/22/2022] [Accepted: 04/30/2022] [Indexed: 05/07/2023]
Abstract
BACKGROUND The objective of the current study was to summarize current research on burnout among surgical trainees and surgeons during the COVID-19 pandemic. METHODS PubMed, SCOPUS, Embase, and Psych INFO were systematically searched for studies that evaluated burnout during the COVID-19 pandemic among surgical trainees and surgeons. RESULTS A total of 29 articles met inclusion criteria, most of which originated from the United States (n = 18, 62.1%). Rates of burnout ranged from 6.0% to 86.0%. Personal factors responsible for burnout were fear of contracting/transmitting COVID-19 (8 studies, 27.6%), female gender (8, 27.6%), and younger age (5, 17.2%). Professional factors contributing to burnout included increased COVID-19 patient clinical load (6, 20.7%), limited work experience (6, 20.7%), reduction in operative cases (5, 17.2%) and redeployment to COVID-19 wards (4, 13.8%). The COVID-19 pandemic negatively impacted surgical education due to reduced number of operative cases (11, 37.9%), decreased hands-on experience (4, 13.8%), and not being able to complete case requirements (3, 10.34%). The shift of didactics to virtual formats (3, 10.3%), increased use of telemedicine (2, 6.9%), and improved camaraderie among residents (1, 3.4%) were viewed as positive consequences. CONCLUSION COVID-19 related burnout was reported in as many as 1 in 2 surgical trainees and attending surgeons. Intrinsic- (i.e., gender, age), family- (i.e., family/being married/having children or being single/not having children), as well as work-related extrinsic- (i.e., work-force deployment, risk of infection/spread, changes in educational format) factors were strongly associated with risk of burnout. These factors should be considered when designing interventions to ameliorate burnout among surgical trainees and surgeons.
Collapse
Affiliation(s)
- Chanza Fahim Shaikh
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Elizabeth Palmer Kelly
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Alessandro Paro
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Eliza W Beal
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio.
| |
Collapse
|
19
|
Jaffry Z, Raj S, Sallam A, Lyman S, Negida A, Yiu CFA, Sobti A, Bua N, Field RE, Abdalla H, Hammad R, Qazi N, Singh B, Brennan PA, Hussein A, Narvani A, Jones A, Imam MA. Global impact of COVID-19 on surgeons and team members (GlobalCOST): a cross-sectional study. BMJ Open 2022; 12:e059873. [PMID: 36378650 PMCID: PMC9361744 DOI: 10.1136/bmjopen-2021-059873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To investigate the impact of COVID-19 on the well-being of surgeons and allied health professionals as well as the support provided by their institutions. DESIGN This cross-sectional study involved distributing an online survey through medical organisations, social media platforms and collaborators. SETTING It included all staff based in an operating theatre environment around the world. PARTICIPANTS 1590 complete responses were received from 54 countries between 15 July and 15 December 2020. The average age of participants was 30-40 years old, 64.9% were men and 32.5% of a white ethnic background. 79.5% were surgeons with the remainder being nurses, assistants, anaesthetists, operating department practitioners or classified other. MAIN OUTCOME MEASURES Participants that had experienced any physical illness, changes in mental health, salary or time with family since the start of the pandemic as well as support available based on published recommendations. RESULTS 32.0% reported becoming physically ill. This was more likely in those with reduced access to personal protective equipment (OR 4.62; CI 2.82 to 7.56; p<0.001) and regular breaks (OR 1.56; CI 1.18 to 2.06; p=0.002). Those with a decrease in salary (29.0%) were more likely to have an increase in anxiety (OR 1.50; CI 1.19 to 1.89; p=0.001) and depression (OR 1.84; CI 1.40 to 2.43; p<0.001) and those who spent less time with family (35.2%) were more likely to have an increase in depression (OR 1.74; CI 1.34 to 2.26; p<0.001). Only 36.0% had easy access to occupational health, 44.0% to mental health services, 16.5% to 24/7 rest facilities and 14.2% to 24/7 food and drink facilities. Fewer measures were available in countries with a low Human Development Index. CONCLUSIONS This work has highlighted a need and strategies to improve conditions for the healthcare workforce, ultimately benefiting patient care.
Collapse
Affiliation(s)
| | | | - Asser Sallam
- Suez Canal University Hospitals, Ismailia, Egypt
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ali Narvani
- Ashford and St Peter's Hospitals, Surrey, UK
| | - Adrian Jones
- Norfolk and Norwich University Hospitals, Norwich, UK
| | - Mohamed A Imam
- Ashford and St Peter's Hospitals, Surrey, UK
- University of East London, London, UK
| |
Collapse
|
20
|
Field RE. Long Covid - a cause of concern for surgical training. J Hip Preserv Surg 2022; 9:143-144. [PMID: 35992025 PMCID: PMC9389907 DOI: 10.1093/jhps/hnac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Richard E Field
- Editor-in-Chief, Journal of Hip Preservation Surgery, Oxford University Press
| |
Collapse
|
21
|
Al-Ghunaim T, Johnson J, Biyani CS, O'Connor DB. Burnout in surgeons: A qualitative investigation into contributors and potential solutions. Int J Surg 2022; 101:106613. [PMID: 35421612 DOI: 10.1016/j.ijsu.2022.106613] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/04/2022] [Accepted: 04/07/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Poor wellbeing affects the performance of all types of workers. Surgeons are particularly at risk of suffering from burnout, but minimal qualitative research has examined the causes of burnout and potential solutions in this group. Understanding this could inform the development of future burnout interventions. PURPOSE This study aimed to explore the main factors that lead to surgeon burnout and to examine how surgeons cope with burnout at work. SETTING Surgical departments in the United Kingdom's National Health Service (NHS). MATERIALS Telephone interview and face-to-face interview. METHODS This qualitative study was conducted using semi-structured interviews with 14 surgeons from diverse specialisations. The interview consisted of two sections. The first addressed the main reasons for burnout. The second explored how surgeons manage burnout. RESULTS A thematic analysis identified several factors that can lead to surgeon burnout, captured in the themes of: rising to the challenge of surgical work; interpersonal conflict at work; greater demands than resources; the challenge of work-life balance; and the devastating impact of errors and poor patient outcomes. The study also revealed various strategies that surgeons employed to cope with burnout, namely: cognitive restructuring; seeking social support; stepping aside or down from the job; and prioritising personal health. Additionally, the study found some surgeons used maladaptive coping. CONCLUSION Healthcare organisations, surgeons, and psychological experts should work together to provide more and improved interventions to help surgeons, which might lead to a reduction in the number of surgeons who leave the profession and help improve patient outcomes.
Collapse
Affiliation(s)
- Tmam Al-Ghunaim
- School of Psychology University of Leeds, Leeds, LS2 9JT, UK.
| | - Judith Johnson
- School of Psychology University of Leeds, Leeds, LS2 9JT, UK; Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, BD96RJ, UK; School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Chandra Shekhar Biyani
- Department of Urology, St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | | |
Collapse
|
22
|
Houdmont J, Daliya P, Theophilidou E, Adiamah A, Hassard J, Lobo DN. Burnout Among Surgeons in the UK During the COVID-19 Pandemic: A Cohort Study. World J Surg 2022; 46:1-9. [PMID: 34704146 PMCID: PMC8547303 DOI: 10.1007/s00268-021-06351-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND Surgeon burnout has implications for patient safety and workforce sustainability. The aim of this study was to establish the prevalence of burnout among surgeons in the UK during the COVID-19 pandemic. METHODS This cross-sectional online survey was set in the UK National Health Service and involved 601 surgeons across the UK of all specialities and grades. Participants completed the Maslach Burnout Inventory and a bespoke questionnaire. Outcome measures included emotional exhaustion, depersonalisation and low personal accomplishment, as measured by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). RESULTS A total of 142 surgeons reported having contracted COVID-19. Burnout prevalence was particularly high in the emotional exhaustion (57%) and depersonalisation (50%) domains, while lower on the low personal accomplishment domain (15%). Burnout prevalence was unrelated to COVID-19 status; however, the greater the perceived impact of COVID-19 on work, the higher the prevalence of emotional exhaustion and depersonalisation. Degree of worry about contracting COVID-19 oneself and degree of worry about family and friends contacting COVID-19 was positively associated with prevalence on all three burnout domains. Across all three domains, burnout prevalence was exceptionally high in the Core Trainee 1-2 and Specialty Trainee 1-2 grades. CONCLUSIONS These findings highlight potential undesirable implications for patient safety arising from surgeon burnout. Moreover, there is a need for ongoing monitoring in addition to an enhanced focus on mental health self-care in surgeon training and the provision of accessible and confidential support for practising surgeons.
Collapse
Affiliation(s)
- Jonathan Houdmont
- Centre for Organisational Health and Development, School of Medicine, University of Nottingham, Yang Fujia Building, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK
| | - Prita Daliya
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Elena Theophilidou
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Alfred Adiamah
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Juliet Hassard
- Centre for Organisational Health and Development, School of Medicine, University of Nottingham, Yang Fujia Building, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK
| | - Dileep N Lobo
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
- MRC/ARUK Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| | | |
Collapse
|
23
|
Identifying Psychosocial Risks and Protective Measures for Workers’ Mental Wellbeing at the Time of COVID-19: A Narrative Review. SUSTAINABILITY 2021. [DOI: 10.3390/su132413869] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The spread of the SARS-CoV-2 virus has caused crucial changes in the workplace. Almost two years after the start of the COVID-19 era, new and old psychosocial risks in the workplace threaten workers’ mental wellbeing and represent an occupational health challenge. The aim of this review is to identify the most relevant psychosocial factors, negative or protective, contributing to occupational stress during the current pandemic. A literature search was conducted in PubMed, EMBASE, Cochrane Library, Web of Science, Google Scholar and PsycINFO and a total of 51 articles were deemed suitable for inclusion in the review. Analysis of the retrieved articles revealed five main topics related to psychosocial wellbeing in the workplace: 1. Support from colleagues and organizations; 2. Home–work interface and balance; 3. Changes in workload and work demand; 4. Job competence and appropriate training; 5. Job insecurity and financial stress. All five themes were associated with occupational stress and poor mental outcomes, like anxiety, depression, and burnout symptoms. Peer and organizational support seem to have a major impact on workers’ mental wellbeing. Recognizing these factors and projecting interventions that mitigate their effects or boost their efficacy is a fundamental step towards dealing with COVID-19 in the workplace, or any such future emergencies.
Collapse
|
24
|
Oliveira A, Gowda V, Jordan SG. It Takes a Village: A Multimodal Approach to Addressing Radiologist Burnout. Curr Probl Diagn Radiol 2021; 51:289-292. [PMID: 34980509 DOI: 10.1067/j.cpradiol.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/04/2021] [Accepted: 11/07/2021] [Indexed: 11/22/2022]
Abstract
Burnout is a significant issue confronting the medical profession, to which radiology is no exception. Addressing burnout demands a full-spectrum response, in keeping with its complexity, prevalence, and significance. This manuscript brings together key techniques at the individual, peer, and institutional levels to offer a multifaceted approach to ameliorating radiologist burnout. Such an approach would begin by equipping physicians with the skillset necessary to identify signs of burnout in themselves and others. Institutions can work to validate the radiologists they employ and work toward mitigating the impact of occupational stressors. Lastly, engaging in conversations about burnout throughout the course of one's medical career can affect a sea change in the way burnout is envisioned, and treated.
Collapse
Affiliation(s)
- Amy Oliveira
- Department of Radiology, University of Massachusetts Medical School-Baystate, Springfield, MA.
| | - Vrushab Gowda
- UNC School of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Sheryl G Jordan
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC
| |
Collapse
|
25
|
Sabetkish N, Rahmani A. The overall impact of COVID-19 on healthcare during the pandemic: A multidisciplinary point of view. Health Sci Rep 2021; 4:e386. [PMID: 34622020 PMCID: PMC8485600 DOI: 10.1002/hsr2.386] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/21/2021] [Accepted: 08/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS The Coronavirus disease 2019 (COVID-19) pandemic globally changed the priorities of medical and surgical procedures. It has caused many healthcare systems to stop performing their routine screenings. Altering medical clinics to COVID-19 referral centers, lockdowns, and the public fear to refer to medical centers caused a significant reduction in the referral rate; especially in the elderly. This short review article highlights the transform in clinical practice during the post-COVID era and the need for future medical revolutions. METHODS A comprehensive literature search was separately performed by both authors. The articles published between 2019 and August 2021 were included in this study and selected according to a quality appraisal method. RESULTS We have summarized the possible corresponding changes in the diagnosis and treatment of all fields of medical care including internal medicine, surgical, and minor subcategories after the COVID-19 pandemic. We have also discussed the potential impacts of the pandemic on all these different categories and subcategories of medicine, including the outpatient setting and clinical work. We do believe that the lack of routine check-ups has led to an increase in the stage of disease in patients with a previously diagnosed problem. On the other hand, the dramatic change in the lifestyle of the population including restricted mobility and increased consumption of unhealthy food has caused metabolic syndrome and other new diseases that have not been diagnosed and properly managed. CONCLUSION Our findings revealed the urgent need for public health awareness. It indicated the need to carry out both psychological and screening approaches in the post-COVID era to not miss patients with a chronic disease and new cases who were undiagnosed during the COVID pandemic.
Collapse
Affiliation(s)
- Nastaran Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical CenterTehran University of Medical SciencesTehranIran
- ImmunologyAsthma and Allergy Research Institute, Tehran University of Medical SciencesTehranIran
| | - Alireza Rahmani
- Research Center for Prevention of Cardiovascular DiseaseInstitute of Endocrinology & Metabolism, Iran University of Medical SciencesTehranIran
| |
Collapse
|
26
|
The Experience of a Single NHS England Trust on the Impact of the COVID-19 Pandemic on Junior and Middle-Grade Doctors: What Is Next? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910413. [PMID: 34639712 PMCID: PMC8507795 DOI: 10.3390/ijerph181910413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/25/2021] [Accepted: 09/29/2021] [Indexed: 11/23/2022]
Abstract
The COVID-19 pandemic has undoubtedly affected all national healthcare systems at different levels. In countries heavily hit by the pandemic, it was reported that healthcare workers were asked to work long hours, had increased workload, were faced with difficult decisions, and that the resources were stretched. As such, the COVID-19 pandemic would create the perfect storm for burnout in healthcare workers. Within this context, we conducted a survey in a district general hospital in Southeast England. We focused on doctors in training, in different specialties. This survey included parts of the Maslach Burnout Inventory for healthcare professionals, along with other relevant questions, such as the financial impact and seeking of psychological support. The results showed moderate levels of emotional exhaustion, but high levels of personal satisfaction, a positive impact on doctors finances and very low levels of seeking support.
Collapse
|
27
|
Johnson J, Al-Ghunaim TA, Biyani CS, Montgomery A, Morley R, O’Connor DB. Burnout in Surgical Trainees: a Narrative Review of Trends, Contributors, Consequences and Possible Interventions. Indian J Surg 2021; 84:35-44. [PMID: 34341627 PMCID: PMC8319710 DOI: 10.1007/s12262-021-03047-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 02/03/2023] Open
Abstract
Surgical disciplines are popular and training places are competitive to obtain, but trainees report higher levels of burnout than either their non-surgical peers or attending or consultant surgeons. In this review, we critically summarise evidence on trends and changes in burnout over the past decade, contributors to surgical trainee burnout, the personal and professional consequences of burnout and consider the evidence for interventions. There is no evidence for a linear increase in burnout levels in surgeons over the past decade but the impact of the COVID-19 pandemic has yet to be established and is likely to be significant. Working long hours and experiencing stressful interpersonal interactions at work are associated with higher burnout in trainees but feeling more supported by training programmes and receiving workplace supervision are associated with reduced burnout. Burnout is associated with poorer overall mental and physical well-being in surgical trainees and has also been linked with the delivery of less safe patient care in this group. Useful interventions could include mentorship and improving work conditions, but there is a need for more and higher quality studies.
Collapse
Affiliation(s)
- Judith Johnson
- School of Psychology, University of Leeds, Leeds, LS29JT UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, BD96RJ UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052 Australia
| | | | - Chandra Shekhar Biyani
- Department of Urology, St James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
- Cadaveric Simulation Programme, Anatomy Department, School of Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Anthony Montgomery
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
| | - Roland Morley
- Imperial College Healthcare NHS Trust, London, W2 1NY UK
| | | |
Collapse
|