Association of Perceived Futile or Potentially Inappropriate Care With Burnout and Thoughts of Quitting Among Health-Care Providers
Association of Perceived Futile or Potentially Inappropriate Care With Burnout and Thoughts of Quitting Among Health-Care Providers
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DOI：
10.1177/1049909118792517
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发表时间：
2019-03-01
影响因子：
1.9
通讯作者：
Prigerson, Holly G.
中科院分区：
文献类型：
--
作者：
Lambden, Jason P.;Chamberlin, Peter;Prigerson, Holly G.
背景资料：无效或潜在不适当的护理（无效/PIC）被认为是影响临床医生健康的一个因素;然而，对这种关联知之甚少。目的：确定无效/PIC提供是否与临床医生幸福感相关。设计：横断面，自填式，在线问卷。设置：两个纽约市医院。参会人员：内科、外科、神经病学或重症监护领域的主治医师、住院医师、护士和医师助理。暴露：提供被认为徒劳的/PIC。测量值：主要结局包括（1）临床医生倦怠，使用医师工作生活研究屏幕测量;（2）临床医生抑郁，使用患者健康问卷测量;和（3）戒烟意图，使用评估戒烟想法和考虑戒烟的严重程度的问题测量。结果：在接受调查的1784名临床医生中，有349人参加了调查。在所有临床医生中，91%的人报告他们已经或可能已经向患者提供了无效/PIC。总体而言，43.4%的临床医生筛查出倦怠综合征阳性，7.8%的筛查出抑郁症阳性，35.5%的临床医生报告说，由于无效/PIC，他们有离职的想法。提供的无效/PIC的数量与倦怠有关（比值比[OR] 3.8 [16-30例患者vs 1-2例患者]; 95%置信区间[CI]：1.1-12.8）和有戒烟想法（OR，7.4 [16-30例患者vs 1-2例患者]; 95%CI：2.0-27），独立于抑郁症、职位、科室和接受护理的垂死患者数量。结论：绝大多数临床医生报告提供徒劳的/PIC，这种护理与临床医生的幸福感，包括倦怠和意图退出的措施。
Background: Futile or potentially inappropriate care (futile/PIC) has been suggested as a factor contributing to clinician well-being; however, little is known about this association. Objective: To determine whether futile/PIC provision is associated with measures of clinician well-being. Design: Cross-sectional, self-administered, online questionnaire. Setting: Two New York City Hospitals. Participants: Attending physicians, residents, nurses, and physician assistants in the fields of internal medicine, surgery, neurology, or intensive care. Exposure(s): Provision of perceived futile/PIC. Measurements: Main outcomes included (1) clinician burnout, measured using the Physician Worklife Study screen; (2) clinician depression, measured using the Patient Health Questionnaire; and (3) intention to quit, measured using questions assessing thoughts of quitting and how seriously it is being considered. Results: Of 1784 clinicians who received surveys, 349 participated. Across all clinicians, 91% reported that they either had or had possibly provided futile/PIC to a patient. Overall, 43.4% of clinicians screened positive for burnout syndrome, 7.8% screened positive for depression, and 35.5% reported thoughts of leaving their job as a result of futile/PIC. The amount of perceived futile/PIC provided was associated with burnout (odds ratio [OR] 3.8 [16-30 patients vs 1-2 patients]; 95% confidence interval [CI]: 1.1-12.8) and having thoughts of quitting (OR, 7.4 [16-30 patients vs 1-2 patients]; 95% CI: 2.0-27), independent of depression, position, department, and the number of dying patients cared for. Conclusions: A large majority of clinicians report providing futile/PIC, and such care is associated with measures of clinician well-being, including burnout and intention to quit.