Bateman Marjorie E, Hammer Rachel, Byrne Abigail, Ravindran Nithya, Chiurco Jennifer, Lasky Sasha, Denson Rebecca, Brown Margo, Myers Leann, Zu Yuanhao, Denson Joshua L
Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA.
Department of Psychiatry, Tulane University School of Medicine, New Orleans, LA, USA.
Trials. 2020 Dec 11;21(1):1019. doi: 10.1186/s13063-020-04929-4.
Burnout is an occupational syndrome that leads to mental health problems, job turnover, and patient safety events. Those caring for critically ill patients are especially susceptible due to high patient mortality, long hours, and regular encounters with trauma and ethical issues. Interventions to prevent burnout in this population are needed. Preliminary studies suggest debriefing sessions may reduce burnout. This study aims to assess whether participation in regular debriefing can prevent burnout in intensive care unit (ICU) clinicians.
A randomized controlled trial will be conducted in two large academic medical centers. Two hundred ICU clinicians will be recruited with target enrollment of 100 physicians and 100 non-physicians (nurses, pharmacists, therapists). Participants must have worked in the ICU for the equivalent of at least 1 full time work week in the preceding 4 weeks. Enrolled subjects will be randomized to virtually attend biweekly debriefing sessions facilitated by a psychotherapist for 3 months or to a control arm without sessions. Our debriefs are modeled after Death Cafés, which are informal discussions focusing on death, dying, loss, grief, and illness. These sessions allow for reflection on distressing events and offer community and collaboration among hospital employees outside of work. The primary outcome is clinician burnout as measured by the Maslach Burnout Inventory (MBI) Score. Secondary outcomes include depression and anxiety, as measured by the Patient Health Questionnaire 8 (PHQ-8) and Generalized Anxiety Disorder 7-item scale (GAD-7), respectively. Questionnaires will be administered prior to the intervention, at 1 month, at 3 months, and at 6 months after enrollment. These values will be compared between groups temporally. Qualitative feedback will also be collected and analyzed.
With ICU clinician burnout rates exceeding 50%, Death Café debriefing sessions may prove to be an effective tool to avert this debilitating syndrome. With COVID-19 limiting social interactions and overloading ICUs worldwide, the virtual administration of the Death Café for ICU clinicians provides an innovative strategy to potentially mitigate burnout in this vulnerable population.
ClinicalTrials.gov NCT04347811 . Registered on 15 April 2020.
职业倦怠是一种职业综合征，会导致心理健康问题、工作变动以及患者安全事件。由于患者死亡率高、工作时间长以及经常面临创伤和伦理问题，照顾重症患者的人员尤其容易出现职业倦怠。因此，需要采取干预措施来预防这一人群的职业倦怠。初步研究表明，汇报交流会可能会减轻职业倦怠。本研究旨在评估定期参加汇报交流会是否能预防重症监护病房（ICU）临床医生的职业倦怠。
将在两家大型学术医疗中心进行一项随机对照试验。将招募200名ICU临床医生，目标招募人数为100名医生和100名非医生（护士、药剂师、治疗师）。参与者在过去4周内必须在ICU工作至少相当于1个全职工时的时间。入选的受试者将被随机分配，虚拟参加由心理治疗师主持的每两周一次的汇报交流会，为期3个月，或分配到不参加汇报交流会的对照组。我们的汇报交流会仿照“死亡咖啡馆”模式，即围绕死亡、临终、丧失、悲伤和疾病展开的非正式讨论。这些会议能让人反思令人痛苦的事件，并在医院员工工作之余提供交流和合作的机会。主要结局指标是通过马氏职业倦怠量表（MBI）评分衡量的临床医生职业倦怠。次要结局指标包括分别通过患者健康问卷8项版（PHQ - 8）和广泛性焦虑障碍7项量表（GAD - 7）衡量的抑郁和焦虑。问卷将在干预前、入组后1个月、3个月和6个月进行发放。将对这些数值在不同组之间进行时间上的比较。还将收集和分析定性反馈。
鉴于ICU临床医生的职业倦怠率超过50%，“死亡咖啡馆”汇报交流会可能是避免这种使人衰弱的综合征的有效工具。由于新冠疫情限制了社交互动并使全球各地的ICU不堪重负，为ICU临床医生虚拟举办“死亡咖啡馆”提供了一种创新策略，有可能减轻这一弱势群体的职业倦怠。
ClinicalTrials.gov NCT04347811。于2020年4月15日注册。
