Research on Mindfulness in Medicine

24 Aug 2017 6:30 PM | Tim Burnett (Administrator)

MINDFULNESS FOR HEALTH CARE PROFESSIONALS - THE RESEARCH

Physicians and other healthcare providers are under extreme and growing risk for burnout, and psychological distress as a result of on-the-job stressors. In 2012, Shanafelt et al reported that nearly half of physicians report at least one symptom of burnout. In 2015, Shanafelt et al did a follow up study that demonstrated burnout and satisfaction with work-life balance in US physicians worsened from 2011 to 2014. They indicate that more than half of US physicians are now experiencing professional burnout.

The evidence is growing that burnout in trainees, as well as in practicing physicians, comes at a cost to the physicians, those they interact with at home and work, and their patients (McClarrerty 2014).  Burnout has the potential to lead to professional consequences such as medical errors, poor judgment and adverse patient outcomes. It also has the potential to lead to personal consequences such as depression, anxiety, substance use, and suicide. (Freischlag & Shanafelt 2009).

While the effects on the individual alone are concerning, the organizational and patient safety impact of burnout can be equally severe.  Research solidly correlates physician burnout with disruptive behavior, increased medical errors, lower patient satisfaction scores, and increased malpractice risk (Freischlag & Shanafelt 2009).   Additionally, burnout adversely impacts quality of care and patient outcomes. And research suggests that when physicians are down and running low on empathy, their patients take longer to recover from illnesses and are less likely to adhere to treatment recommendations (Rakel et al 2011, Canale et al 2012).

Mindfulness training is a part of the solution. Research and program pilot studies using mindfulness based training for physicians, residents, and medical students has demonstrated improvement in quality of life, well-being, symptoms of burn-out, depression, total mood disturbance and anxiety (Krasner & Epstien 2009, Luken & Sammons 2016, Regebr et al 2014, Hassed et al 2009, Rosenzweig et al 2003).

While the most studied and “gold standard” mindfulness training intervention, Mindfulness-Based Stress Reduction (MBSR), has been shown to be quite effective (Kabat-Zinn 1990, 1982, 2002) in increasing resiliency and reducing risk of a long list of psychological and physiological ailments this 8-week, 26 hour, training is difficult to schedule for most clinicians.

Our Mindfulness for Healthcare Professions includes the core elements of MBSR in a briefer and more concentrated format and is similar in scale to several mindfulness training interventions which have proven effective (Fourtney et al 2013, Schoroeder et al 2015).

Preliminary data we’ve collected suggests our course results in a decrease of symptoms of burnout, increased trait mindfulness, and decreased perceived stress. Specifically, the data showed an increase in mindfulness of 10.5%, a decrease in perceived stress of 20.6%, a reduction in depersonalization of 14.7%, and smaller gains in emotional exhaustion (6.4%) and an increased sense of efficacy (7.8%).

REFERENCE

1.     Shanafelt, T. Boone, S, Litjen, T, Dyrbye, L, Sotile, W, Satele, D, West, C., Sloan, Jl, Oteskovich, M. (2012). Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population.  Arch Intern Med, 172(18),1377-1385. doi:10.1001
2.    Shanafelt, T. et al. (2015). Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clinic Proceedings, 90 (12),1600–1613.  
3.    Pantaleoni JL, Augustine EM, Sourkes BM, Bachrach LK. (2014). Burnout in pediatric residents over a 2-year period: a longitudinal study. Acad Pediatr, 14(2), 167–172.
4.    Lee, RT, Ashforth,  BE. (1990). On the meaning of Maslach’s three dimensions of burnout.  J Appl Psychol, 75, 743- 747.
5.     6. McClafferty H, Brown OW. (2014). Section on Integrative Medicine; Committee on Practice and Ambulatory Medicine; Section on Integrative Medicine. Physician health and wellness. Pediatrics, 134(4), 830–835.
6.    Balch C., Freischlag J., Shanafelt T. (2009). Stress and Burnout Among Surgeons Understanding and Managing the Syndrome and Avoiding the Adverse Consequences. Arch Surg, 144(4), 371-6.
7.     Rakel, D., Barrett, B., Zhang, Z., Hoeft, T., Chewning, B., Marchand, L., Schneder, J. (2011). Perception of Empathy in the Therapeutic Encounter:  Effects on the Common Cold.  Patient Education and Counseling Patient Educ Couns, 85(3), 390-7.
8.    Eel Canale, S., DZ, L., Maio, V., Wang, X., Rossi, G., Hojat, M., Gonnella, JS. (2012). The Relationship Between Physician Empathy and Disease Complications:  An Empirical Study of Primary Care Physicians and Their Diabetic Patients in Parma, Italy.  Acad Med, 87(9), 1243-9.
9.    Krassner, Epstein. (2009). Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA, 302(12), 1284-93.
10.  Luken, Michelle and Sammons, Amanda.  (2016). Systematic Review of Mindfulness Practice for Reducing Job Burnout.  Am J Occup Ther,70(2), 7002250020p1–7002250020p10, doi:  10.5014/ajot.2016.016956
11.   Regebr, C et al.  (2014). Interventions to reduce the consequences of stress in physicians: a review and meta-analysis. J Nerv Ment Dis, 202(5), 353-9.  
12.  Hassed, C et al. (2009). Enhancing the health of medical students: outcomes of an integrated mindfulness and lifestyle program. Adv Health Sci Educ Theory Pract, 14(3), 387-98.
13.  T Rosenzweig S,  Reibel DK,  Greeson JM,  Brainard GC, Hojat M. (2003). Mindfulness-based stress reduction lowers psychological distress in medical students. Teach Learn Med., 15(2), 88-92.
14.  Finkelstein, Claudia et al. (2007). Anxiety and stress reduction in medical education: an intervention.  Medical Education, 41(3), 258-64.
15.  Fourtney, Luke et al (2013) Abbreviated Mindfulness Intervention for Job Satisfaction, Quality of Life, and Compassion in Primary Care Clinicians: A Pilot Study.  Annals of Fam Med, 11 (5), 412-420.
16.  Schoroeder, David et al (2015). A Brief Mindfulness-Based Intervention for Primary Care Physicians: A Pilot Randomized Controlled Trial.  American Journal of Lifestyle Medicine,  20 (10), 1-9 DOI: 10.1177/1559827616629121
17.  Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. General Hospital Psychiatry, 4(1), 33–47.
18.  Kabat-Zinn, J. (1990). Full catastrophe living. Using the wisdom of your body and mind to face stress, pain and illness. New York, NY: Bantam Doubleday Dell Publishing.
19.  Kabat-Zinn, J. (2002). Commentary on Majumdar et al.: Mindfulness meditation and health. Journal of Alternative & Complementary Medicine, 8(6), 731–735


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