Mindfulness practice, where an individual maintains openness, patience, and acceptance while focusing attention on a situation in a nonjudgmental way, can improve symptoms of anxiety, burnout, and depression. The practice is relevant for health care providers; however, the time commitment is a barrier to practice. For this reason, brief mindfulness interventions (eg, ≤ 4 hours) are being introduced. We systematically reviewed the literature from inception to January 2017 about the effects of brief mindfulness interventions on provider well-being and behavior. Studies that tested a brief mindfulness intervention with hospital providers and measured change in well-being (eg, stress) or behavior (eg, tasks of attention or reduction of clinical or diagnostic errors) were selected for narrative synthesis. Fourteen studies met inclusion criteria; 7 were randomized controlled trials. Nine of 14 studies reported positive changes in levels of stress, anxiety, mindfulness, resiliency, and burnout symptoms. No studies found an effect on provider behavior. Brief mindfulness interventions may be effective in improving provider well-being; however, larger studies are needed to assess an impact on clinical care.
Introduction
Mindfulness is defined as “a way of being in which an individual maintains openness, patience, and acceptance, while focusing attention on an unfolding situation in a nonjudgmental way.”1 Accumulating evidence suggests that mindfulness-based therapies can improve symptoms of anxiety, burnout, and depression.2 Mindfulness training has been associated with an attitude of curiosity, connection to self and patient, attentive listening, error recognition, and clinical insight.3 Individual mindful practice has thus been offered as a method to improve medical decision-making, be it appropriateness of antibiotic treatment,4 placement of urinary catheters,5 or employee outcomes such as work engagement6 and job performance.7 It is not surprising then, that collective mindfulness (ie, collective capacity to discern discriminatory detail about emerging issues),8 is a hallmark of high-reliability organizations and is associated with lower turnover rates,9 improved quality, and safety.10, 11
An important barrier to broad implementation of mindfulness in health care settings is the time required for training and practice. For example, the mindfulness-based stress-reduction program developed by Jon Kabat-Zinn includes 8 weekly 2.5-hour didactic and practice sessions, one full-day silent retreat, and a recommendation for 45 minutes of daily independent meditation practice.12 Consequently, while participation in mindfulness-based stress reduction programs benefits the well-being of providers, one review concluded that attrition due to time and schedule requirements limits impact.13 Abbreviated interventions using principles of mindfulness have been introduced to overcome this barrier.14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27 However, whether these brief interventions improve well-being and provider practice is not known. Therefore, we performed a systematic review to examine the effectiveness of brief mindfulness programs on health care providers in the hospital setting.
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-Heather Gilmartin, PhD, NP, Anupama Goyal, MD, MPH, Mary C. Hamati, BS, Jason Mann, MSA, Sanjay Saint, MD, MPH, Vineet Chopra, MD, MSc
This article originally appeared in the October 2017 issue of The American Journal of Medicine.
