Category: Critical Care
Keywords: Wellness, ICU, physicians, coping, COVID-19, pandemic (PubMed Search)
This was a cross-sectional survey for the Diversity-Related Research Committee of the Women in Critical Care (WICC) Interest Group of the American Thoracic Society.
Settings: 62 sites in Canada and the US
Participants: Attending physicians who worked in ICUs
· Measure of Moral Distress for healthcare professionals (27 items),
· Maslach burnout inventory (2 items),
· Stanford Professional Fulfilment Index (14-items), Brief Cope scale (14-items)
· 431 participants (approximately 43.3% response rate).
· 334 (65%) participants worked at University-affiliated hospitals
· 387 (89.0%) worked in Adult ICUs.
· Pre-pandemic, clinical days/months was 10.1 (± 14) days, and increased to 13.1 (± 16) days during the pandemic.
2. Measure of moral distress: Average score 95.6 ± 66.9 (maximum 417).
· The highest score (mean 8.5 ± 4.8), for distress, came from the item: “Follow the family insistence to continue aggressive treatment even though it is not in the best interest of the patient.” ((Family wanted to do everything).
3. Stanford Fulfillment Index:
· 387 (91.9%) intensivists found their work meaningful and 365 (86.5%) felt worthwhile at work, although most felt physically (297, 71.6%), emotionally (266 [63.8%]) exhausted.
4. Coping strategies:
· Participants resorted to a wide variety of scoping strategies ranging from Acceptance (90%), Self-distraction (85%) to Substance abuse (32%) and Denial (18%).
· Most physicians (231 [55.9%]) reported that their coping remained the same before and during the pandemic.
· Physicians are quite resilient. The authors found that physicians who worked more days experienced significantly more moral distress but with similar Stanford Professional Fulfillment score.
· This finding was similar to an exploratory analysis from a meta-analysis that showed physicians, among other healthcare workers, were less likely to have severe symptoms of PTSD (2).
· Women and physicians who were persons of color experienced significantly higher moral distress and burn-out.
There was moderate moral distress and burn-out, although physicians who worked in ICUs still achieved moderate professional fulfillment. Up to 20% of ICU physicians used a maladaptive coping strategy
1. Burns KEA, Moss M, Lorens E, Jose EKA, Martin CM, Viglianti EM, Fox-Robichaud A, Mathews KS, Akgun K, Jain S, Gershengorn H, Mehta S, Han JE, Martin GS, Liebler JM, Stapleton RD, Trachuk P, Vranas KC, Chua A, Herridge MS, Tsang JLY, Biehl M, Burnham EL, Chen JT, Attia EF, Mohamed A, Harkins MS, Soriano SM, Maddux A, West JC, Badke AR, Bagshaw SM, Binnie A, Carlos WG, Çoruh B, Crothers K, D'Aragon F, Denson JL, Drover JW, Eschun G, Geagea A, Griesdale D, Hadler R, Hancock J, Hasmatali J, Kaul B, Kerlin MP, Kohn R, Kutsogiannis DJ, Matson SM, Morris PE, Paunovic B, Peltan ID, Piquette D, Pirzadeh M, Pulchan K, Schnapp LM, Sessler CN, Smith H, Sy E, Thirugnanam S, McDonald RK, McPherson KA, Kraft M, Spiegel M, Dodek PM; Diversity-Related Research Committee of the Women in Critical Care (WICC) Interest Group of the American Thoracic Society. Wellness and Coping of Physicians Who Worked in ICUs During the Pandemic: A Multicenter Cross-Sectional North American Survey. Crit Care Med. 2022 Oct 27. doi: 10.1097/CCM.0000000000005674. Epub ahead of print. PMID: 36300945.
2. Andhavarapu S, Yardi I, Bzhilyanskaya V, Lurie T, Bhinder M, Patel P, Pourmand A, Tran QK. Post-traumatic stress in healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatry Res. 2022 Oct 8;317:114890. doi: 10.1016/j.psychres.2022.114890. Epub ahead of print. PMID: 36260970; PMCID: PMC9573911.