Burnout syndrome in healthcare professionals who care for patients with prolonged disorders of consciousness: a cross-sectional survey

Transcutaneous auricular vagal nerve stimulation for consciousness recovery in patients with prolonged disorders of consciousness (TAVREC): study protocol for a multicenter, triple-blind, randomized controlled trial in China

INTRODUCTION

Prolonged disorders of consciousness (pDoC) are a catastrophic condition following brain injury with few therapeutic options. Transcutaneous auricular vagal nerve stimulation (taVNS), a safe, non-invasive intervention modulating thalamo-cortical connectivity and brain function, is a possible treatment option of pDoC. We developed a protocol for a randomised controlled study to evaluate the effectiveness of taVNS on consciousness recovery in patients with pDoC (TAVREC).

METHODS AND ANALYSIS

The TAVREC programme is a multicentre, triple-blind, randomised controlled trial with 4 weeks intervention followed by 4 weeks follow-up period. A minimum number of 116 eligible pDoC patients will be recruited and randomly receive either: (1) conventional therapy plus taVNS (30 s monophasic square current of pulse width 300 μs, frequency of 25 Hz and intensity of 1 mA followed by 30 s rest, 60 min, two times per day, for 4 weeks); or (2) conventional therapy plus taVNS placebo. Primary outcome of TAVREC is the rate of improved consciousness level based on the Coma Recovery Scale-Revised (CRS-R) at week 4. Secondary outcomes are CRS-R total and subscale scores, Glasgow Coma Scale score, Full Outline of UnResponsiveness score, ECG parameters, brainstem auditory evoked potential, upper somatosensory evoked potential, neuroimaging parameters from positron emission tomography/functional MRI, serum biomarkers associated with consciousness level and adverse events.

ETHICS AND DISSEMINATION

This study was reviewed and approved by the Research Ethics Committee of the First Affiliated Hospital of Nanjing Medical University (Reference number: 2023-SR-392). Findings will be disseminated in a peer-reviewed journal and presented at relevant conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2300073950.

Evaluation of burnout levels among healthcare staff in anesthesiology departments in Greece - Is there a connection with anxiety and depression?

Introduction

Healthcare workers in anesthesiology departments often experience burnout syndrome, which may be combined with anxiety and depression.

Aim

The study aimed to assess the levels of burnout among nurses and physicians working in anesthesiology departments in public hospitals in Attica and to investigate a possible correlation between burnout, anxiety, and depression.

Methodology

A cross-sectional study was conducted on physicians and nurses working in anesthesiology departments in public hospitals in Attica, Greece. A questionnaire was distributed electronically using the snowball sampling method, including questions about demographic characteristics, burnout, anxiety, and depression.

Results

Physicians and nurses in anesthesiology departments were found to have moderate levels of burnout, and normal/low levels of anxiety and depression. More specifically, it was found that 2% of physicians and 14.4% of nurses had extremely elevated levels of burnout. On the other hand, 6.1% of physicians and 23.7% of nurses had high anxiety, while 6.1% of physicians and 15.5% of nurses had elevated levels of depression. Females (p = 0.008), staff aged 45-55 (p = 0.021), lower educational level (p = 0.025), nurses (p = 0.001), more than 21 years of service (p = 0.001), and having children (p = 0.008) were determinants of greater levels of personal burnout. Work-related burnout correlated with having children (p = 0.017), whereas client-related burnout was significantly higher for nurses (p = 0.002). In addition, a correlation was found between anxiety, depression, and increased levels of burnout (p = 0.000).

Conclusions

As physicians and nurses working in anesthesiology departments have stressful jobs and work long hours, it is important to further study their physical, emotional, and mental exhaustion as well as psychological resilience levels.

Burnout study during the COVID-19 pandemic in Thailand: psychometric evaluation of the Maslach Burnout Inventory-Human Services Survey for Medical Personnel

Objectives

This study aimed (1) to determine the psychometric properties of a Thai version of the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS [MP]) and (2) to examine the mean scores of burnout and associated factors during the COVID-19 pandemic.

Methods

Forward and back translations of the MBI-HSS (MP) questionnaire were performed. The Thai version was subsequently completed by 682 Thai physicians and nurses who worked during the COVID-19 pandemic. Exploratory factor analysis was performed on the first subsample (n = 341) by conducting Kaiser Mayer-Olkin sampling adequacy measurement and Bartlett's test of sphericity whereas confirmatory factor analysis (CFA) was performed on the second subsample (n = 341) using fit indices of the normed chi-square (χ2/df), the comparative fit index, the Tucker-Lewis index, and the root mean square error of approximation. This version's internal consistency was investigated using Cronbach's alpha coefficient. Demographic profiles were evaluated with descriptive and analytical statistics.

Results

The Thai version of the MBI-HSS (MP) displayed good psychometric characteristics, as the Cronbach's alpha values of the 3 burnout factors ranged from 0.843 to 0.945. The CFA also showed good fit indices (χ2/df = 4.473; P < 0.001; RMSEA = 0.075 (95%CI = 0.055-0.079); CFI = 0.946; and TLI = 0.936). The physicians' mean EE, DP, and PA scores were 25.28 ± 13.27, 7.15 ± 6.11, and 36.83 ± 8.13, respectively, whereas The nurses' mean EE, DP, and PA scores were 23.10 ± 14.14, 4.43 ± 5.06, and 35.67 ± 10.24, respectively. Healthcare professionals who were younger, single, had fewer years of practice, and had more working hours per week tended to express more burnout scores.

Conclusions

The Thai version of the MBI-HSS (MP) demonstrates good psychometric properties in assessing burnout among healthcare professionals. Several factors may be pivotal in intensifying burnout.

Is there any relationship between nurses' perceived organizational justice, moral sensitivity, moral courage, moral distress and burnout?

AIM

The present study is an attempt to investigate the relationship between Corley's model variables in mental health nurses.

BACKGROUND

Based on Corley's model, burnout and moral distress in nurses are, in retrospect, the consequences of the interplay of organizational and individual factors such as perceived organizational justice, moral sensitivity, and moral courage. The relationship between two variables or three variables of Corley's moral distress model has been investigated, but the test of Corley's moral distress model with more variables has not been done. Therefore, this research was proposed with the aim of investigating the relationship between the variables of moral courage and moral sensitivity (as characteristics of nurses), perceived organizational justice (as an antecedent), moral distress, and job burnout (as consequences of moral distress).

METHODS

The study was conducted as a descriptive correlational study involving 500 nurses working in the mental health wards of hospitals. Data collection was conducted using perceived organizational justice scale, moral sensitivity scale, moral courage scale, moral distress scale, and burnout inventory.

RESULTS

The results showed a significant relationship between perceived organizational justice, moral sensitivity, moral courage, and moral distress (< 0.05). Moreover, perceived organizational justice and moral distress had an inverse relationship. Moral sensitivity and moral courage had a direct relationship with moral distress (< 0.05). Furthermore, the results showed inadequate model fitness.

CONCLUSIONS

This study adds to the existing knowledge about the experiences of mental health nurses and their interactions with both organizational and individual factors. It highlights that the connections between perceived organizational justice, moral sensitivity, moral courage, moral distress, and burnout are intricate and multifaceted. As we deepen our understanding of these relationships, it opens the door for the development of interventions and strategies to enhance nurses' well-being and the quality of care they deliver in mental health settings. Moreover, future research and ongoing refinement and expansion of Corley's model will be crucial in addressing the complex challenges within the healthcare sector.

International variability in the diagnosis and management of disorders of consciousness

This manuscript explores the international variability in the diagnosis and management of disorders of consciousness (DoC). The identification, evaluation, intervention, exploration, prognostication and limitation of therapy for patients with DoC is reviewed through an international lens. The myriad factors that impact the diagnosis and management of DoC including 1) financial, 2) legal and regulatory, 3) cultural, 4) religious and 5) psychosocial considerations are discussed. As data comparing patients with DoC internationally are limited, findings from the general critical care or neurocritical care literature are described when information specific to patients with DoC is unavailable. There is a need for improvements in clinical care, education, advocacy and research related to patients with DoC worldwide. It is imperative to standardize methodology to evaluate consciousness and prognosticate outcome. Further, education is needed to 1) generate awareness of the impact of the aforementioned considerations on patients with DoC and 2) develop techniques to optimize communication about DoC with families. It is necessary to promote equity in access to expertise and resources for patients with DoC to enhance the care of patients with DoC worldwide. Improving understanding and management of patients with DoC requires harmonization of existing datasets, development of registries where none exist and establishment of international clinical trial networks that include patients in all phases along the spectrum of care. The work of international organizations like the Curing Coma Campaign can hopefully minimize international variability in the diagnosis and management of DoC and optimize care.

Burnout, Resilience, Supervisory Support, and Quitting Intention among Healthcare Professionals in Saudi Arabia: A National Cross-Sectional Survey

Although personal resilience and supervisory support are known to reduce the impact of burnout and quitting intention, there is limited data available to explore these relationships among healthcare professionals (HCPs) in Saudi Arabia. This study aimed to assess the prevalence of burnout and explore its association with resilience, supervisory support, and intention to quit among Saudi Arabian HCPs.

METHODS

A cross-sectional survey was distributed to a convenience sample of HCPs between April and November 2022. Participants responded to socio-demographic questions, the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS (MP)), the Connor-Davidson resilience scale 10 (CD-RISC 10), and the Perceived of Supervisor Support Scale (PSS). Descriptive, inferential, correlation, and logistic regression tests were performed for data analyses.

RESULTS

Of the 1174 HCPs included in the analysis, 77% were presented with high burnout levels: 58% with emotional exhaustion (EE), 72% with depersonalization (DP), and 66% with low personal accomplishment (PA). Females were associated with increased odds of burnout (OR: 1.47; 95% CI: 1.04-2.06) compared to males. Burnout and its subscales were associated with higher intention to leave practice, with 33% of HCPs considering quitting their jobs. Furthermore, HCPs reported a low resilience score overall, and negative correlations were found between EE (r = -0.21; p < 0.001) and DP (r = -0.12; p < 0.01), and positive correlation with low PA (r = 0.38; p < 0.001). In addition, most HCPs perceived supervisory support as low, and it is associated with increased burnout and quitting intention.

CONCLUSION

Burnout is common among HCPs across all clinical settings and is associated with higher intention to quit and low resilience and supervisory support. Workplace management should provide a supportive workplace to reduce burnout symptoms and promote resiliency.

Managing healthcare employees' burnout through micro aspects of corporate social responsibility: A public health perspective

Background

Globally, an increasing number of healthcare workers (HCW) suffer from the issue of burnout (BO) annually. The critical issue of BO undermines the capacity of HCW to deliver superior healthcare services on the one end, it negatively affects the mental health of HCW on the other hand. Although HCW in developed and developing countries face the risk of BO, however, this issue is more critical in developing countries due to poor infrastructure, resources and social inequalities. The BO syndrome has recently been recognized as a public health concern, and new approaches are required to manage this epic, especially in healthcare management, effectively. In this respect, past research recognizes the role of corporate social responsibility (CSR) in influencing employee outcomes. Especially the micro aspects of CSR (MCSR) have recently received growing attention from academicians and practitioners. However, most existing MCSR investigations relate to the positive aspects of individual psychology, leaving the terrain unattended on how MCSR can help employees in reducing negative work outcomes for example, BO. To close this critical gap, the basic aim of this study is to investigate the relationship between MCSR and BO. Further, to understand the underlying mechanism of how and why MCSR may reduce employees' BO, this study introduces two mediators, work engagement (WE) and intrinsic motivation (IM) and one moderator, compassion at work (CW).

Method

The data for the current study were gathered randomly from HCW serving in different hospitals of a developing country. Specifically, we collected the data in three separate waves. A self-administered questionnaire was used as a data collection instrument by following a paper-pencil methodology. The response rate in this study remained close to 64%. Both male and female HCW participated in this study. We validated the hypothesized relationships with the help of structural equation modeling in AMOS software.

Results

The results confirmed that MCSR negatively predicts BO, and WE and IM mediated this relationship. Moreover, the moderating effect of CW was also confirmed.

Conclusion

The findings of this study help healthcare administrators to mitigate the epic of BO among HCW by carefully planning and executing MCSR policies.

The relationship between burnout and empathy in physiotherapists: a cross-sectional study

BACKGROUND

There have been few studies carried out into empathy in physiotherapists. Burnout can debilitate the quality of care and the efficacy of treatment as the empathetic capacity of the professional diminishes.

OBJECTIVE

The objective of the study was to examine the association between the construct burnout, empathy and sociodemographic aspects in Spanish physiotherapists.

METHODS

A cross-sectional electronic survey including the Maslach Burnout Inventory (for burnout assessment), the Interpersonal Reactivity Index (for empathy assessment) and sociodemographic data was answered by 461 Spanish physical therapists. A descriptive, bivariate and lineal regression analysis was performed.

RESULTS

There was an association between burnout and empathy. Specifically, higher levels of burnout are associated with lower levels of empathy, whilst years of work experience is associated with lower levels of burnout.

CONCLUSIONS

The results of this study contribute to a greater understanding of the relationship between the level of burnout and the dimensions of empathy in physiotherapists. The influence of burnout, which causes difficulties in the mobilization of the professional towards the establishment of a quality therapeutic relationship, is highlighted.KEY MESSAGESEmotional exhaustion is associated to greater personal discomfort and less empathy.The depersonalization is associated to personal discomfort and less empathy.Depersonalization is negatively associated to the lack of perspective.

Burnout and Resilience among Respiratory Therapy (RT) Students during Clinical Training in Saudi Arabia: A Nationwide Cross-Sectional Study

BACKGROUND

The epidemic of burnout has been widely documented among health discipline students. However, there is limited information available on the prevalence of burnout and its association with resilience among clinical-level respiratory therapy (RT) students.

METHODS

Between March 2022 and May 2022, a descriptive, cross-sectional study using a convenience sample of RT students and interns was conducted. A total of 559 RT students and interns from 15 RT programs responded to socio-demographic questions and the Maslach Burnout Inventory (MBI) and the Brief Resilience Scale (BRS) questionnaires. The data were analyzed using descriptive, inferential, and correlation tests.

RESULTS

Of the 559 respondents, 78% reported a high level of burnout. Within the three subscales of burnout, 52% reported emotional exhaustion (EE), 59% reported depersonalization (DP), and 55% reported low personal achievement (PA). The prevalence of burnout increased as students proceeded to senior years (p = 0.006). In addition, participants with higher grade point averages (GPA) reported a higher level of burnout. Only 2% of the respondents reported a high level of resiliency. Further, there were negative correlations between resilience and EE (r = -41, p < 0.001) and DP (r = -32, p = 0.03), and a positive correlation with low PA (r = 0.56, p = 0.002).

CONCLUSION

The findings showed a high prevalence of burnout among RT students and interns during clinical training in Saudi Arabia. Resilience was associated with all domains of burnout and is likely to play a protective role. Therefore, there is a need for collaborative interventions to promote resiliency during clinical training to alleviate and overcome burnout symptoms.

Burnout among doctors in China through 2020: A systematic review and meta-analysis

Objective

To analyze surveys measuring the prevalence of burnout among Chinese doctors and reveal the overall prevalence, characteristics, timeline, and factors related to burnout.

Methods

A comprehensive search was conducted on China National Knowledge Infrastructure, WANFANG, PubMed, EMBASE, PsycINFO and Cochrane Library databases from their inception to 28 February 2021. Random-effects meta-analyses, meta-regression and planned subgroup analyses were performed, and the standardized mean difference was adopted for comparisons between subgroups. Egger’s and Begg’s tests were performed to evaluate publication bias. Heterogeneity across the studies was tested using the I² statistic. The study protocol was registered on PROSPERO (CRD42018104249).

Results

In total, 3,210 records were reviewed; 64 studies including 48,638 Chinese doctors were eligible for meta-analysis. The prevalence of burnout increased continuously from 2008 to 2017 and decreased significantly from 2018 to 2020, a little increase from 2020 to 2021. The overall prevalence of burnout was 75.48% (95% CI, 69.20 to 81.26; I² = 99.23%, P < 0.001), and high burnout was 9.37% (95% CI, 4.91 to 15.05, I² = 98.88%, P < 0.001). The prevalence of emotional exhaustion was 48.64% (95% CI, 38.73 to 58.59; I² = 99.53%, P < 0.001), depersonalization was 54.67% (95% CI, 46.95 to 62.27; I² = 99.20%, P < 0.001), and reduced personal accomplishment was 66.53% (95% CI, 58.13 to 74.44; I² = 99.37%, P < 0.001). Gender, marriage, professional title and specialty all influenced burnout.

Conclusions

The results showed that the total prevalence of doctor burnout in China is very high. The prevalence of burnout varies by location. Gender, marital status and professional title all affect burnout scores.

Impact of Psychological capital on Organizational citizenship behavior among nurses: Mediating effect of work engagement

AIMS

To examine relationships between psychological capital, work engagement and organizational citizenship behavior among nurses.

BACKGROUND

Psychological capital, work engagement and organizational citizenship behavior are all positive variables associated with work. Clarifying the relationship between the variables can help nursing managers implement tailored and effective intervention strategies to improve individual and organizational performance and quality of care. Design A quantitative cross-sectional study was designed.

METHODS

The study was carried out from June 2021 to September 2021 in Sichuan Province, China. A total of 606 nurses working at six tertiary hospitals were selected with convenience sampling. Participants were investigated using demographic, work-related information questionnaire, Psychological Capital questionnaire, Utrecht Work engagement scale and Organizational citizenship behavior questionnaire.

RESULTS

The scores of psychological capital, work engagement and organizational citizenship behavior were 102.56 ± 15.47, 67.96 ± 21.71 101.57 ± 11.57, respectively. The multiple linear regression model explained 7.3% of the total variance in organizational citizenship behavior related to demographic and work-related factors. There was a significant positive correlation between psychological capital, work engagement and nurses' organizational citizenship behavior. Additionally, structural equation modelling showed that work engagement mediated the relationship between psychological capital and organizational citizenship behavior with the partial mediating effect was 0.093. The final model explained 28% of organizational citizenship behavior.

CONCLUSION

Our results suggest that both psychological capital and work engagement are facilitators for organizational citizenship behavior in nurses. Managers can increase nurses' organizational citizenship behavior through developing psychological capital and improving the work engagement. Implications for Nursing Management This study indicates that both psychological capital and work engagement are protective factors of organizational citizenship behavior, which provide proof for optimizing human resources management from a positive psychology perspective. Our finding can help managers correctly understand the mechanism of the relationship among work engagement, psychological capital and organizational citizenship behavior, and adopt effective intervention strategies to promote nurses' organizational citizenship behavior.

A cross-sectional survey of burnout in a sample of resident physicians in Sudan

Background

Resident physicians in Sudan face a variety of physical and psychological stressors. Nevertheless, the prevalence of burnout syndrome among this critical population remains unknown. The purpose of this study was to estimate the prevalence rate of burnout and its associated factors in a sample of resident physicians in Sudan.

Methods

A cross-sectional design was used to assess the burnout syndrome among resident physicians at the teaching hospitals of Wad-Medani in Gezira state, east-central Sudan. Three hundred resident physicians at the dermatology, general surgery, pediatrics, obstetrics and gynecology, psychiatry, ear, nose and throat (ENT), oncology, urology, and internal medicine departments, were approached and invited to participate in the study. The Arabic version of the Maslach Burnout Inventory was distributed to respondents from July to October 2021.

Results

From the 300 resident physicians, 208 (69.3%) responded. The average age of the study population was 29.99 ± 3.01 years, with more than half were females (56.7%), single (59.6%), and with more than three years of residency experience (50.5%). In total, 86.1% met the criteria for burnout in at least one dimension and 13.9% in all three dimensions. On the dimension of emotional exhaustion (EE), 70.7% reported high levels of burnout. While, 44.2% reported high levels of depersonalization (DP), and 73.1% experienced a sense of decreased professional accomplishment (PA). There were significant differences in burnout, EE, and DP levels among different specialties, with the pediatrics-specialty trainees reported higher levels. Burnout syndrome was associated with the working hours per single duty; participants who reported working for more than 24 hours had experienced higher levels of burnout, EE, and DP.

Conclusion

Large-scale studies are required to assess the determinants of burnout syndrome among resident physicians in Sudan. In addition, Stakeholders should urgently implement effective remedies to protect the mental health of resident physicians.

Pattern and Sociodemographic Correlates of Job Stress among Staff in a Nigerian Psychiatric Hospital

CONTEXT

Globalization and technological advances are associated with rapid social and economic changes which are accompanied by increased pressures in the work environment. Job stress is a hidden pandemic, especially in developing countries where it remains largely unaddressed.

AIMS

The objective is to determine the pattern and sociodemographic correlates of job stress among staff in a Nigerian psychiatric hospital using the Health and Safety Executive (HSE) indicator tool.

METHODS AND MATERIAL

This is a cross-sectional study conducted among 292 full-time staff who were randomly selected across hospital units. Informed consent was obtained and the study questionnaires which included a sociodemographic questionnaire and the HSE indicator tool were administered. Statistical analysis was done using IBM SPSS version 22 and the level for statistical significance was set at P < 0.05.

RESULTS

The study sample comprised of 133 (45.5%) men and 159 (54.5%) women. The mean age was 35.03 and (SD = 7.45). A high level of stress (<20^th percentile) was found in the demands, control, and relationships domains. Sociodemographic correlates of stress in domain analysis included age, marital status, staff level, parenthood, and being a clinical worker.

CONCLUSIONS

This study demonstrates a high level of stress in domains of the HSE indicator among respondents. More research is needed to further examine the stress levels of hospital workers.

Psychological immune competency predicts burnout syndrome among the high-risk healthcare staff: A cross-sectional study

BACKGROUND

Burnout and psychological immune competency have not been investigated together among employees of high-risk specializations such as emergency medicine, intensive care or surgery.

AIM

In this study we aim to examine the prevalence of burnout among high-risk clinical staff and explore whether the strength of psychological immune competency predict burnout.

DESIGN

A cross-sectional design utilizing a self-administrated questionnaire was used to collect data from the participants (n = 216). Nurses (n = 145) and physicians (n = 71) from emergency medicine, intensive care and surgery departments participated in the study.

METHOD

Burnout syndrome was measured using the Maslach Burnout Inventory, while psychological immune competency was measured using the Psychological Immune Competency Questionnaire. The data collection started in June of 2018 and was finished in March of 2019.

RESULTS

Participants with higher psychological immune competency reported lower levels of burnout: emotional exhaustion (r = -0.478; p < 0.001), depersonalization (r = -0.459; p < 0.001) and personal accomplishment (r = 0.543; p < 0.001). Multiple linear stepwise regression analysis revealed the psychological immune competency to be a stable predictor of burnout on all three scales.

CONCLUSION

Psychological immune competency shows a strong relationship with scales of burnout syndrome and as such should be further examined due to development of successful intervention and prevention programs.

Assessing the Mental Impact and Burnout among Physicians during the COVID-19 Pandemic: A Developing Country Single-Center Experience

Health-care workers are on the front line to combat the peculiar coronavirus disease-19 (COVID-19) pandemic and are susceptible to acquiring this infection. This study is aimed at documenting the effect of "coronaphobia" on mental well-being and to report burnout among physicians. The study was conducted as a cross-sectional survey between November 17, 2020 and January 1, 2021 via a Google form distributed among the physicians of a tertiary care hospital, in Karachi, Pakistan. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) was used to assess the mental well-being of physicians. Burnout was documented by using the Maslach Burnout Inventory Human Services Survey for Medical Personnel. Eighty-seven physicians participated in the survey (mean age, 30.9 ± 7.3 years). The mean WEMWBS score of the study participants was 51.6 ± 10.8. Regarding the WEMWBS, emotional exhaustion was observed in 54% (N = 47) of participants, depersonalization in 77% (N = 67), and low personal accomplishment was reported in 31% (N = 27) of participants. The results of the survey further highlight that depersonalization, emotional exhaustion, and low personal accomplishment were associated significantly with a history of COVID-19 infection and COVID-19 postings. Hence, immediate measures are required to reduce the burnout among physicians while battling the second wave of the pandemic.

Intensive neurorehabilitation for patients with prolonged disorders of consciousness: protocol of a mixed-methods study focusing on outcomes, ethics and impact

BACKGROUND

Prolonged disorders of consciousness (PDOC) are amongst the severest sequelae of acquired brain injury. Evidence regarding epidemiology and rehabilitation outcomes is scarce. These knowledge gaps and psychological distress in families of PDOC patients may complicate clinical decision-making. The complex PDOC care and associated moral dilemmas result in high workload in healthcare professionals. Since 2019, all PDOC patients in the Netherlands have access to intensive neurorehabilitation up to 2 years post-injury provided by one rehabilitation center and four specialized nursing homes. Systematic monitoring of quantitative rehabilitation data within this novel chain of care is done in a study called DOCTOR. The optimization of tailored PDOC care, however, demands a better understanding of the impact of PDOC on patients, their families and healthcare professionals and their views on rehabilitation outcomes, end-of-life decisions and quality of dying. The True Outcomes of PDOC (TOPDOC) study aims to gain insight in the qualitative outcomes of PDOC rehabilitation and impact of PDOC on patients, their families and healthcare professionals.

METHODS

Nationwide multicenter prospective cohort study in the settings of early and prolonged intensive neurorehabilitation with a two-year follow-up period, involving three study populations: PDOC patients > 16 years, patients' family members and healthcare professionals involved in PDOC care. Families' and healthcare professionals' views on quality of rehabilitation outcomes, end-of-life decisions and dying will be qualitatively assessed using comprehensive questionnaires and in-depth interviews. Ethical dilemmas will be explored by studying moral deliberations. The impact of providing care to PDOC patients on healthcare professionals will be studied in focus groups.

DISCUSSION

To our knowledge, this is the first nationwide study exploring quality of outcomes, end-of-life decisions and dying in PDOC patients and the impact of PDOC in a novel chain of care spanning the first 24 months post-injury in specialized rehabilitation and nursing home settings. Newly acquired knowledge in TOPDOC concerning quality of outcomes in PDOC rehabilitation, ethical aspects and the impact of PDOC will enrich quantitative epidemiological knowledge and outcomes arising from DOCTOR. Together, these projects will contribute to the optimization of centralized PDOC care providing support to PDOC patients, families and healthcare professionals.