A MIXED-METHODS FEASIBILITY AND ACCEPTABILITY TRIAL for MINDFULNESS-BASED WELLNESS AND RESILENCE AMONG INTERDISCIPLINARY PRIMARY CARE TEAMS

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Heather Carpenter
6 years ago
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Scholar Department of Neurology, Oregon Health & Science University Oregon Center for Complementary and

1 A MIXED-METHODS FEASIBILITY AND ACCEPTABILITY TRIAL for MINDFULNESS-BASED WELLNESS AND RESILENCE AMONG INTERDISCIPLINARY PRIMARY CARE TEAMS Dana Dharmakaya Colgan, PhD, C-IAYT Clinical Psychologist & Postdoctoral Scholar Department of Neurology, Oregon Health & Science University Oregon Center for Complementary and Alternative Medicine in Neurological Disorders Michael Christopher, PhD Associate Professor School of Graduate Psychology Pacific University

3 Moving Forward Training models within the work setting that enhance resilience & wellbeing among IPCTs Methods to enhance feasibility for onsite delivery Cultural considerations specific to primary care Utilization of team processes

4 Effective Teams Team Cohesion: Quality & frequency of collaboration and communication protective factor against burnout 1 associated with increased retention rates among nurses 2 associated with reduced stress among physicians 3

5 Effective Teams Mindfulness increased prosocial behaviors intrapersonal skills altruistic orientation 4-6 Team Cohesion 6 Resilience and WEellbeing

6 Moving Forward Objective measurement of adherence to mindfulness practice frequency and intensity of mindfulness practice required to create and sustain effects providers preferences regarding mindfulness and resilience practices

7 Mindfulness-Based Wellness & Resilience odesigned to increase resilience and reduce burnout among primary care teams outilizes empirically-based practices from MBSR and Mindful Practice curricula oembodies theory and science of mindfulness, stress and resilience, self-compassion, and team processes 7-12

8 Unique Features Mindfulness-Based Wellness & Resilience oprovided to intact primary care teams during paid, protected time onine, weekly 60 minute sessions oformal and informal mindfulness exercises are modified and practical to primary care orelevant research findings presented weekly ostress is redefined and values are articulated omindful observing, listening, and speaking is practiced weekly. oteams create strategies to integrate mindfulness and resilience practices into the work day

9 Mindfulness-Based Wellness & Resilience mindfulness compassion, communities, and connecting with values resilience

10 Method Mixed-Methods Research Design Quasi-experiential, waitlist controlled trial conducted in a safety-net primary care medical center

11 Aim One To assess the feasibility and acceptability of Mindfulness-Based Wellness and Resilience (MBWR) among IPCTs.

12 Aim Two To assess the preliminary efficacy of MBWR among IPCTs.

13 The Brief Resilience Scale 13 The Maslach Burnout Inventory 14 Aim Two Quantitative Outcomes The Five Facet Mindfulness Questionnaire-Short Form 15 The Self-Compassion Scale-Short Form 16 The Team Climate Inventory 17 Safety of Participation Factor Expectancy/Credibility Questionnaire 18 Collected at Baseline, Post-MBWR, and 3-Month Follow-up

14 Aim Two Qualitative Outcomes ofocus groups were conducted one week following MBWR. oopen-ended electronical anonymous surveys one week following MBWR. oaudio recordings of interviews were transcribed verbatim and combined with written responses from surveys. oconventional content analysis in which coding categories were derived directly from the text data 19

15 Aim Three To investigate the relationships among formal and informal mindfulness practices and post-training outcomes.

16 Participants INCLUSION CRITERIA 1. Employed by the medical center 2. A member of an IPCT, including medical doctor, nurse, nurse practitioner, behavioral health consultant, physician assistant, medical assistant, or team assistant 3. Willingness to attend five of the eight sessions 4. Consent to complete measures 5. Speaks English EXCLUSION CRITERIA 1. Endorsed active psychosis or suicidality 2. Attended a previous pilot study of MBWR

17 Baseline assessments MBWR Waitlist Control Post-assessments Post-assessments 3-Month Follow-Up 3-Month Follow-Up

18 Results

19 Participants 31 participants 84% identified as female Identified Ethnicity 71% Mexican, Latina, or Puerto Rican 20% White 6% Asian 3% Black

20 Participant Roles Team Assistants 6% Others 10% Pharmacists 3% MD 23% Social Workers 3% Physician Assistants 3% Medical Assistants 29% RN, NP 23%

21 Outcome Measures Feasibility Number of participants recruited 83% of the potential participant pool MBWR class attendance 88% attendance rate All 31 participants were treatment completers Attrition 78% completed the measures

22 Outcome Measures Acceptability Items on a Likert-type scale (0 to 6): a) How much did you enjoy this course? 87 % Extremely or Very Much b) How important was this course? 82 % Extremely or Very Much c) Would you recommend this course to a colleague? 100% Definitely d) Would you participate in follow-up mindfulness sessions? 100% Definitely e) How knowledgeable was the instructor? 100% Extremely/ Very Knowledgeable

23 30 Resilience Pre-MBWR Post-MBWR 3-Month FU MBWR Control Time X Group Interaction F (1,23) = 9.50, p =.005 Main effect of group at post-mbwr d = 1.51, F (1,26) = 9.25, p <.001 Main Effect of group at 3-Month FU d = 2.23, F (1,21) = 20.62, p <.001

24 Mindfulness Pre-MBWR Post-MBWR 3-Month FU MBWR Control Time X Group Interaction F (1,63) = 3.63; p =.06 Main Effect of group at 3-Month FU d = 1.31, F (1,21) = 5.16, p <.03

25 Self-Compassion Pre-MBWR Post-MBWR 3-Month FU MBWR Control Time X Group Interaction F (1, 27) = 8.05, p =.008 Main effect of group at post-mbwr d = 1.94, F (1,25) = 8.35, p <.008 Main Effect of group at 3-Month FU d = 2.23, F (1,21) = 20.62, p <.001

26 Self-Compassion Positively associated with resilience to stress among health care providers 24 Inversely associated with burnout among medical residents 25

27 Post-hoc Analyses Emotional Exhaustion Reducing physician burnout, even by onepoint, is linked with meaningful differences in self-perceived major medical errors 26 reduction in work hours 27 suicidal ideation Emotional Exhaustion ** 10 Physicans Pre Post 3-Month FU ** d.80

28 Post-hoc Analyses Team Cohesion Team Cohesion Is a protective factor against burnout among physicians and health care providers 1, ** Physicans Pre Post 3-Month FU ** d.80

29 Outcome Measures Adherence Informal Practice 60% of participants engaged in informal practices daily Formal Practices Average total listening time over 8 weeks = 37 minutes (1-94 mins)

30 Integrating practices into work day 5 minute mindful breathing practice on the agenda for weekly team meetings Mindful Scrubbing Just This Breath Pulse with Presence Loving Kindness affirmation prior to entering exam room Breath, Body Be Cultivating gratitude Posting Values Mindful Eating or Mindful Walking Remind each other simply by being present with each other.

31 Integrating practices into work day 5 minute mindful breathing practice on the agenda for weekly team meetings Mindful Scrubbing Just This Breath Pulse with Presence Loving Kindness affirmation prior to entering exam room Breath, Body Be Cultivating gratitude and sharing with team Posting Values and sharing with team Mindful Eating or Mindful Walking Remind each other simply by being present with each other.

32 Discussion Acceptability and Feasibility Results suggest that MBWR may be a viable and impactful method to integrate mindfulness, resilience, and teamwork training into the primary care setting. Safety-net primary settings Predominantly Latino providers

33 Discussion Preliminary efficacy Results suggest that the training was successful at enhancing resilience, mindfulness, and self-compassion when compared to wait-list control group illustrate the potential benefits of an institutional commitment to provider wellbeing

34 Discussion Differential Impact of Formal and Informal Practices Results support efforts to integrate and emphasize informal mindfulness practices into the workday

35 Integration, Communication, Trust I breathe deeply for a few seconds before going in a room with a difficult patient and try to maintain curiosity when something is stressful or might cause me to be angry or frustrated. It has been very effective! [I have an] improved ability to manage stressful days with simple techniques to rescue balance. Posting my values has changed with way I relate to my stress. I can now see that my stress response is assisting me to meet the challenges I face when acting on my values.

36 Integration, Communication, Trust It helped us to have better communication with each other, listen to each other and work as team members. I am [able] to speak to my team members more easily and more frequently. I am more comfortable with my teammates. Taking this course as a team has improved our team dynamic. We have more trust among each other.

37 How the training could be improved Longer More frequent Monthly Booster sessions

38 Limitations The results of this study must be interpreted with caution. The small sample size reduced the statistical power. All measures were self-report questionnaires. Study was not randomized.

Hunsinger, PhD Sarah Bowen, PhD Christina Brems, PhD Brian Tucker, PsyD

39 Acknowledgments Many Thanks To Staff at Virginia Garcia Memorial Health Center Eric Olsund, MA James Lane, PhD Eli Dapolonia, MA, MS Mathew Hunsinger, PhD Sarah Bowen, PhD Christina Brems, PhD Brian Tucker, PsyD Wyatt Web Inter-professional Development Research Pacific University

40 Mindfulness-Based Wellness & Resilience mindfulness compassion, communities, and connecting with values resilience

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