Defining Objective Measures of Physician Stress in Simulated Critical Communication Encounters
Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine..
This study had three aims: 1) quantify the difference in stress levels between low and high stress roles during simulated critical communication encounters using objective physiologic data (heart rate variability [HRV]) and subjective measures (State-Trait Anxiety Inventory [STAI]), 2) define the relationship between subjective and objective measures of stress, and 3) define the impact of trainee preparedness and reported self-efficacy on stress levels.
DESIGN: Mixed methods simulation-based study.
SETTING: Single center.
PATIENTS: Pediatric critical care fellows and faculty (n = 12).
INTERVENTIONS: Subjects participated in six simulated scenarios in both high stress "hot seat" and low stress "observer" roles.
MEASUREMENTS AND MAIN RESULTS: Subjective stress was measured using the STAI at baseline and after each scenario. Objective stress was measured continuously using a wearable biometric device measuring HRV. Previous residency communication training and self-confidence surrounding various communication topics were collected via questionnaire. Significant changes in subjective (STAI) and objective stress (HRV) measurements in the low- versus high-stress roles were observed. STAI scores increased 8 points during low stress and 12 points during high stress role (p = 0.021) compared with baseline. Two specific HRV markers, root mean square of successive differences between normal heartbeats, a marker of parasympathetic tone, and the low frequency/high frequency (LF/HF) ratio, a marker of sympathetic activation, were significantly correlated with STAI levels (-0.032, p = 0.001; 1.030, p = 0.002, respectively). Participants who reported increased confidence in discussing code status had a significant decrease in stress response (measured via LF/HF ratio) during both the observer (p = 0.033) and hot seat roles (p = <0.001).
CONCLUSIONS: Communicating life-altering news in a simulated environment is a stressful experience. This stress results in physiologic changes that can be measured continuously using HRV. HRV measurement may serve as a novel method in evaluating the effectiveness of communication training programs and measuring future stress-reduction interventions.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:4 |
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| Enthalten in: |
Critical care explorations - 4(2022), 7 vom: 12. Juli, Seite e0721 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wolfe, Amy H J [VerfasserIn] |
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| Links: |
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| Themen: |
Burnout |
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| Anmerkungen: |
Date Revised 16.07.2022 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1097/CCE.0000000000000721 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM34316017X |
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| 520 | |a Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. | ||
| 520 | |a This study had three aims: 1) quantify the difference in stress levels between low and high stress roles during simulated critical communication encounters using objective physiologic data (heart rate variability [HRV]) and subjective measures (State-Trait Anxiety Inventory [STAI]), 2) define the relationship between subjective and objective measures of stress, and 3) define the impact of trainee preparedness and reported self-efficacy on stress levels | ||
| 520 | |a DESIGN: Mixed methods simulation-based study | ||
| 520 | |a SETTING: Single center | ||
| 520 | |a PATIENTS: Pediatric critical care fellows and faculty (n = 12) | ||
| 520 | |a INTERVENTIONS: Subjects participated in six simulated scenarios in both high stress "hot seat" and low stress "observer" roles | ||
| 520 | |a MEASUREMENTS AND MAIN RESULTS: Subjective stress was measured using the STAI at baseline and after each scenario. Objective stress was measured continuously using a wearable biometric device measuring HRV. Previous residency communication training and self-confidence surrounding various communication topics were collected via questionnaire. Significant changes in subjective (STAI) and objective stress (HRV) measurements in the low- versus high-stress roles were observed. STAI scores increased 8 points during low stress and 12 points during high stress role (p = 0.021) compared with baseline. Two specific HRV markers, root mean square of successive differences between normal heartbeats, a marker of parasympathetic tone, and the low frequency/high frequency (LF/HF) ratio, a marker of sympathetic activation, were significantly correlated with STAI levels (-0.032, p = 0.001; 1.030, p = 0.002, respectively). Participants who reported increased confidence in discussing code status had a significant decrease in stress response (measured via LF/HF ratio) during both the observer (p = 0.033) and hot seat roles (p = <0.001) | ||
| 520 | |a CONCLUSIONS: Communicating life-altering news in a simulated environment is a stressful experience. This stress results in physiologic changes that can be measured continuously using HRV. HRV measurement may serve as a novel method in evaluating the effectiveness of communication training programs and measuring future stress-reduction interventions | ||
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| 700 | 1 | |a du Plessis, Adre J |e verfasserin |4 aut | |
| 700 | 1 | |a Gordish-Dressman, Heather |e verfasserin |4 aut | |
| 700 | 1 | |a Arnold, Robert M |e verfasserin |4 aut | |
| 700 | 1 | |a Soghier, Lamia |e verfasserin |4 aut | |
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