Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians
Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians
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DOI：
10.1001/jama.2009.1384
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发表时间：
2009-09-23
影响因子：
120.7
通讯作者：
Quill, Timothy E.
中科院分区：
文献类型：
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作者：
Krasner, Michael S.;Epstein, Ronald M.;Quill, Timothy E.
初级保健医生报告的痛苦程度高，这是与倦怠，自然减员，护理质量差。在职业倦怠导致损害之前减少职业倦怠的项目很少;目的确定正念、沟通和自我意识强化教育项目是否与初级保健医生的幸福感、心理困扰、倦怠和与患者相关的能力的改善相关。2007-2008年，在纽约的罗切斯特，70名初级保健医生参加继续医学教育（CME）课程的前后研究。课程包括正念冥想，自我意识练习，关于有意义的临床经验的叙述，欣赏性访谈，教学材料和讨论。为期8周的强化阶段（2.5 h/wk，7 h停药），随后为10个月的维持期（2.5小时/月）。主要结果指标正念（2个分量表），倦怠（3个分量表），同理心（3个分量表），心理社会取向，人格（5个因素）和情绪在基线和2个月、12个月和15个月时测量（6个分量表）。结果在项目和随访过程中，参与者表现出正念的改善（原始评分，45.2至54.1;原始评分变化[Delta]，8.9; 95%置信区间[CI]，7.0至10.8）;倦怠（情绪衰竭，26.8至20.0; Delta = -6.8; 95% CI，-4.8至-8.8;人格解体，8.4至5.9; Delta = -2.5; 95% CI，-1.4至-3.6;和个人成就感，40.2至42.6; Delta = 2.4; 95%CI，1.2至3.6）;同理心（116.6 - 121.2; Delta = 4.6; 95% CI，2.2 - 7.0）;医生信念量表（76.7至72.6; Delta = -4.1; 95% CI，-1.8至-6.4）;总体情绪障碍（33.2至16.1; Delta = -17.1; 95% CI，-11至-23.2）和个性（情绪稳定性，6.5至6.8; Delta = 0.3; 95% CI，0.1至5;情绪稳定性，6.1至6.6; Delta = 0.5; 95% CI，0.3至0.7）。正念的改善与总体情绪障碍的改善相关（r =-0.39，P < .001），医生共情的观点采择分量表（r = 0.31，P < .001），倦怠（情绪衰竭和个人成就感分量表，r分别为-0.32和0.33; P <0.001），人格因素（责任心与情绪稳定性的相关系数分别为0.29和0.25; P < .001）。结论参与正念沟通计划与短期和持续的良好沟通改善相关。与以病人为中心的护理相关的存在和态度。由于前后设计限制了对干预效果的推断，这些发现需要进行涉及各种执业医生的随机试验。JAMA. 2009;302（12）：1284-1293
Context Primary care physicians report high levels of distress, which is linked to burnout, attrition, and poorer quality of care. Programs to reduce burnout before it results in impairment are rare; data on these programs are scarce.Objective To determine whether an intensive educational program in mindfulness, communication, and self-awareness is associated with improvement in primary care physicians' well-being, psychological distress, burnout, and capacity for relating to patients.Design, Setting, and Participants Before-and-after study of 70 primary care physicians in Rochester, New York, in a continuing medical education (CME) course in 2007-2008. The course included mindfulness meditation, self-awareness exercises, narratives about meaningful clinical experiences, appreciative interviews, didactic material, and discussion. An 8-week intensive phase (2.5 h/wk, 7-hour retreat) was followed by a 10-month maintenance phase (2.5 h/mo).Main Outcome Measures Mindfulness (2 subscales), burnout (3 subscales), empathy (3 subscales), psychosocial orientation, personality (5 factors), and mood (6 subscales) measured at baseline and at 2, 12, and 15 months.Results Over the course of the program and follow-up, participants demonstrated improvements in mindfulness (raw score, 45.2 to 54.1; raw score change [Delta], 8.9; 95% confidence interval [CI], 7.0 to 10.8); burnout (emotional exhaustion, 26.8 to 20.0; Delta = -6.8; 95% CI, -4.8 to -8.8; depersonalization, 8.4 to 5.9; Delta = -2.5; 95% CI, -1.4 to -3.6; and personal accomplishment, 40.2 to 42.6; Delta = 2.4; 95% CI, 1.2 to 3.6); empathy (116.6 to 121.2; Delta = 4.6; 95% CI, 2.2 to 7.0); physician belief scale (76.7 to 72.6; Delta = -4.1; 95% CI, -1.8 to -6.4); total mood disturbance (33.2 to 16.1; Delta = -17.1; 95% CI, -11 to -23.2), and personality (conscientiousness, 6.5 to 6.8; Delta = 0.3; 95% CI, 0.1 to 5 and emotional stability, 6.1 to 6.6; Delta = 0.5; 95% CI, 0.3 to 0.7). Improvements in mindfulness were correlated with improvements in total mood disturbance (r = -0.39, P < .001), perspective taking subscale of physician empathy (r = 0.31, P < .001), burnout (emotional exhaustion and personal accomplishment subscales, r = -0.32 and 0.33, respectively; P < .001), and personality factors (conscientiousness and emotional stability, r = 0.29 and 0.25, respectively; P < .001).Conclusions Participation in a mindful communication program was associated with short-term and sustained improvements in well-being and attitudes associated with patient-center care. Because before-and-after designs limit inferences about intervention effects, these findings warrant randomized trials involving a variety of practicing physicians. JAMA. 2009;302(12):1284-1293