基于正念的干预措施对减轻医生职业倦怠和压力的影响：一项系统评价和荟萃分析。

Mindfulness-Based Interventions to Reduce Burnout and Stress in Physicians: A Systematic Review and Meta-Analysis.

作者信息

Fendel Johannes C, Bürkle Johannes J, Göritz Anja S

机构信息

J.C. Fendel is currently researcher, Department for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Medical Center Freiburg, University of Freiburg, Freiburg, Germany. At the time of the study he was researcher, Department of Occupational and Consumer Psychology, Institute of Psychology, University of Freiburg, Freiburg, Germany; ORCID: https://orcid.org/0000-0002-3852-5422 .

J.J. Bürkle is MSc psychologist, Department of Occupational and Consumer Psychology, Institute of Psychology, University of Freiburg, Freiburg, Germany; ORCID: https://orcid.org/0000-0001-7905-1326 .

出版信息

Acad Med. 2021 May 1;96(5):751-764. doi: 10.1097/ACM.0000000000003936.

DOI:10.1097/ACM.0000000000003936

PMID:33496433

Abstract

PURPOSE

To perform a systematic review and meta-analysis of studies evaluating the effectiveness of mindfulness-based interventions (MBIs) in reducing burnout and stress among physicians.

METHOD

The authors searched records in MEDLINE, Embase, PsycINFO, PSYNDEX, Web of Science, CINAHL, and CENTRAL from database inception to August 8, 2019, using combinations of terms for mindfulness, interventions, and physicians. Eligible studies were randomized controlled trials (RCTs) and nonrandomized trials (NRTs), including controlled and noncontrolled before-after studies, all assessing burnout and stress among physicians preintervention and postintervention via validated instruments. Two reviewers independently screened records, extracted data, assessed risk of bias, and rated overall quality of evidence. The authors used random-effects modeling to calculate pooled effect sizes and conducted prespecified subgroup and sensitivity analyses to explore potential moderators.

RESULTS

Of 6,831 identified records, 25 studies (with 925 physicians) were ultimately included. MBIs were associated with significant small reductions in burnout in between-group analyses (5 comparisons: standardized mean difference [SMD] = -0.26; 95% confidence interval [CI] = -0.50, -0.03) and pre-post analyses (21 comparisons: SMD = -0.26; 95% CI = -0.37, -0.15), and with a significant medium reduction in stress in between-group analyses (4 comparisons: SMD = -0.55; 95% CI = -0.95, -0.14) and a significant small reduction in stress in pre-post analyses (17 comparisons: SMD = -0.41; 95% CI = -0.61, -0.20). Versions of established MBIs showed higher effectiveness in reducing stress than other forms of MBIs or a mindfulness app. Reductions were maintained over an average follow-up of 5.3 months. The risk of bias was moderate with RCTs and high with NRTs. The overall quality of evidence was low to very low.

CONCLUSIONS

MBIs can be effective in reducing physicians' burnout and stress. Shortcomings in the quality of evidence highlight the need for high-quality controlled trials providing long-term follow-up data.

摘要

目的

对评估基于正念的干预措施（MBIs）在降低医生职业倦怠和压力方面有效性的研究进行系统评价和荟萃分析。

方法

作者检索了MEDLINE、Embase、PsycINFO、PSYNDEX、Web of Science、CINAHL和CENTRAL数据库中从建库至2019年8月8日的记录，使用了正念、干预措施和医生等术语的组合。符合条件的研究为随机对照试验（RCTs）和非随机试验（NRTs），包括对照和非对照的前后研究，所有研究均通过经过验证的工具在干预前和干预后评估医生的职业倦怠和压力。两名评审员独立筛选记录、提取数据、评估偏倚风险并对证据的整体质量进行评级。作者使用随机效应模型计算合并效应量，并进行预先设定的亚组分析和敏感性分析以探索潜在的调节因素。

结果

在6831条识别出的记录中，最终纳入了25项研究（涉及925名医生）。在组间分析（5项比较：标准化均值差[SMD]=-0.26；95%置信区间[CI]=-0.50，-0.03）和前后分析（21项比较：SMD=-0.26；95%CI=-0.37，-0.15）中，MBIs与职业倦怠的显著小幅降低相关，在组间分析（4项比较：SMD=-0.55；95%CI=-0.95，-0.14）和前后分析（17项比较：SMD=-0.41；95%CI=-0.61，-0.20）中，与压力的显著中度降低和显著小幅降低相关。既定MBIs版本在减轻压力方面比其他形式的MBIs或正念应用程序显示出更高的有效性。在平均5.3个月的随访中，降低效果得以维持。RCTs的偏倚风险为中度，NRTs为高度。证据的整体质量为低至极低。