The Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
The Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
BMJ Open. 2021 Aug 18;11(8):e046599. doi: 10.1136/bmjopen-2020-046599.
Clinician well-being has been recognised as an important pillar of healthcare. However, research mainly addresses mitigating the negative aspects of stress or burnout, rather than enabling positive aspects. With the added strain of a pandemic, identifying how best to maintain and support the well-being, satisfaction and flourishing of general practitioners (GPs) is now more important than ever.
Systematic review.
We searched MEDLINE, PsycINFO, Embase, CINAHL and Scopus from 2000 to 2020.
Intervention studies with more than 50% GPs in the sample evaluating self-reported well-being, satisfaction and related positive outcomes were included. The Cochrane Risk of Bias 2 tool was applied.
We retrieved 14 792 records, 94 studies underwent full-text review. We included 19 studies in total. Six randomised controlled trials, three non-randomised, controlled trials, eight non-controlled studies of individual or organisational interventions with a total of 1141 participants. There were two quasi-experimental articles evaluating health system policy change. Quantitative and qualitative positive outcomes were extracted and analysed. Individual mindfulness interventions were the most common (k=9) with medium to large within-group (0.37-1.05) and between-group (0.5-1.5) effect sizes for mindfulness outcomes, and small-to-medium effect sizes for other positive outcomes including resilience, compassion and empathy. Studies assessing other intervention foci or other positive outcomes (including well-being, satisfaction) were of limited size and quality.
There is remarkably little evidence on how to improve GPs well-being beyond using mindfulness interventions, particularly for interventions addressing organisational or system factors. This was further undermined by inconsistent reporting, and overall high risk of bias. We need to conduct research in this space with the same rigour with which we approach clinical intervention studies in patients.
CRD42020164699.
Dr Diana Naehrig is funded through the Raymond Seidler PhD scholarship.
临床医生的健康已被视为医疗保健的重要支柱。然而，研究主要集中在减轻压力或倦怠的负面影响上，而不是促进积极方面。随着大流行带来的额外压力，现在比以往任何时候都更需要确定如何最好地维持和支持全科医生（GP）的健康、满意度和繁荣。
系统评价。
我们从 2000 年到 2020 年在 MEDLINE、PsycINFO、Embase、CINAHL 和 Scopus 中进行了搜索。
纳入样本中超过 50%的 GP 参与的评估自我报告健康、满意度和相关积极结果的干预研究。应用 Cochrane 风险偏倚 2 工具。
我们检索到 14792 条记录，94 项研究进行了全文审查。我们共纳入 19 项研究。6 项随机对照试验、3 项非随机对照试验、8 项针对个体或组织干预的非对照研究，共 1141 名参与者。有 2 篇准实验文章评估了卫生系统政策变化。提取并分析了定量和定性的积极结果。个体正念干预最为常见（k=9），正念结果的组内（0.37-1.05）和组间（0.5-1.5）效应大小为中等至大，其他积极结果（包括韧性、同情心和同理心）的效应大小为小至中。评估其他干预重点或其他积极结果（包括健康、满意度）的研究规模和质量有限。
除了使用正念干预外，关于如何改善 GP 健康的证据非常少，特别是针对解决组织或系统因素的干预措施。这进一步因报告不一致和整体高风险偏差而受到影响。我们需要以我们对待患者临床干预研究的严谨性在这个领域开展研究。
CRD42020164699。
Diana Naehrig 博士受 Raymond Seidler 博士奖学金资助。
