Controlled clinical trial comparing the effectiveness of a mindfulness and self-compassion 4-session programme versus an 8-session programme to reduce work stress and burnout in family and community medicine physicians and nurses: MINDUUDD study protocol

Luis-Angel Pérula-de Torres, Juan Carlos Verdes-Montenegro Atalaya, Javier García-Campayo, Ana Roldán-Villalobos, Rosa Magallón-Botaya, Cruz Bartolomé-Moreno, Herminia Moreno-Martos, Elena Melús-Palazón, Norberto Liétor-Villajos, Francisco Javier Valverde-Bolívar, Nur Hachem-Salas, Luis-Alberto Rodríguez, Mayte Navarro-Gil, Ronald Epstein, Antonio Cabezón-Crespo, Carmen Morillo-Velarde Moreno, collaborative group of the MINDUUDD study, Luis-Angel Pérula-de Torres, Juan Carlos Verdes-Montenegro Atalaya, Javier García-Campayo, Ana Roldán-Villalobos, Rosa Magallón-Botaya, Cruz Bartolomé-Moreno, Herminia Moreno-Martos, Elena Melús-Palazón, Norberto Liétor-Villajos, Francisco Javier Valverde-Bolívar, Nur Hachem-Salas, Luis-Alberto Rodríguez, Mayte Navarro-Gil, Ronald Epstein, Antonio Cabezón-Crespo, Carmen Morillo-Velarde Moreno, collaborative group of the MINDUUDD study

Abstract

Background: Health personnel are susceptible to high levels of work stress and burnout due to the psychological and emotional demands of their work, as well as to other aspects related to the organisation of that work. This paper describes the rationale and design of the MINDUUDD study, the aim of which is to evaluate the effectiveness of a mindfulness and self-compassion 4-session programme versus the standard 8-session programme to reduce work stress and burnout in Family and Community Medicine and Nursing tutors and residents.

Methods: The MINDUDD study is a multicentre cluster randomised controlled trial with three parallel arms. Six Teaching Units will be randomised to one of the three study groups: 1) Experimental Group-8 (EG8); 2) Experimental Group-4 (EG4) Control group (CG). At least 132 subjects will participate (66 tutors/66 residents), 44 in the EG8, 44 in the EG4, and 44 in the CG. Interventions will be based on the Mindfulness-Based Stress Reduction (MBSR) program, including some self-compassion practices of the Mindful Self-Compassion (MSC) programme. The EG8 intervention will be implemented during 8 weekly face-to-face sessions of 2.5 h each, while the EG4 intervention will consist of 4 sessions of 2.5 h each. The participants will have to practice at home for 30 min/day in the EG8 and 15 min/day in the EG4. The Five Facet Mindfulness Questionnaire (FFMQ), Self-Compassion Scale (SCS), Perceived Stress Questionnaire (PSQ), Maslach Burnout Inventory (MBI), Jefferson Scale of Physician Empathy (JSPE), and Goldberg Anxiety-Depression Scale (GADS) will be administered. Measurements will be taken at baseline, at the end of the programs, and at three months after completion. The effect of the interventions will be evaluated by bivariate and multivariate analyses (Multiple Linear Regression).

Discussion: If the abbreviated mindfulness programme is at least as effective as the standard program, its incorporation into the curriculum and training plans will be easier and more appropriate. It will also be more easily applied and accepted by primary care professionals because of the reduced resources and means required for its implementation, and it may also extend beyond care settings to academic and teaching environments as well.

Trial registration: The study has been registered at ClinicalTrials.gov ( NCT03629457 ; date of registration: 13.08.2018).

Conflict of interest statement

Ethics approval and consent to participate

The project has been approved by the Ethics and Clinical Research Committee of the Reina Sofía Hospital in Córdoba (ref. 3845). The written informed consent of the participants will be requested.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Cluster-randomised trial intervention scheme

References

    1. Vilà M, Cruzate C, Orfila F, Creixell J, González MP, Davins J. Burnout y trabajo en equipo en los profesionales sanitarios de Atención Primaria. [Burnout and teamwork in Primary Care health professionals] Aten Primaria. 2015;47:25–31. doi: 10.1016/j.aprim.2014.01.008.
    1. Prieto Albino L, Robles Agüero E, Salazar Martínez LM, Daniel VE. Burnout en médicos de Atención Primaria de la provincia de Cáceres. [Burnout in Primary Care physicians in the province of Caceres] Aten Primaria. 2002;29:294–302. doi: 10.1016/S0212-6567(02)70567-2.
    1. Matía Cubillo AC, Cordero Guevara J, Mediavilla Bravo J, Pereda Riguera MJ, González Castro ML, González Sanz A. Evolución del burnout y variables asociadas en los médicos de Atención Primaria. [Evolution of burnout and associated variables in Primary Care physicians.] Aten Primaria 2012; 44: 532–539.
    1. Benito E, Arranz P, Cancio H. Herramientas para el autocuidado del profesional que atiende a personas que sufren. FMC. 2011;18:59–65.
    1. Grossman P, Niemann L, Schmidt S, et al. Mindfulness-based stress reduction and health benefits. A metaanalysis. J Psychosom Res. 2004;57:35–43. doi: 10.1016/S0022-3999(03)00573-7.
    1. Programas Formativos de Especialidades en Ciencias de la Salud. Ministerio de Sanidad, Consumo y Bienestar Social. At: .
    1. García-Campayo, J, Demarzo M. ¿Qué sabemos del mindfulness?. [what do we know about mindfulness?] Ed. Kairos. Barcelona, 2018.
    1. Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatr. 1982;4:33–47. doi: 10.1016/0163-8343(82)90026-3.
    1. Kabat-Zinn J. Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Dell Publishing; 1990.
    1. Kabat-Zinn J, Torrijos F, Skillings AH, Blacker M, Mumford GT, Levi-Alvares D, Santorelli S, Rosal MC. Delivery and effectiveness of a dual language (English/Spanish). Mindfulness-bassed stress reduction (MBI). Program in the Inner City -a seven-year experience: 1992-1999. Mindfulness Compassion. 2016;1:2–13. doi: 10.1016/j.mincom.2016.09.007.
    1. Pérula Jiménez C, Pérula de Torres C, Pérula de Torres LA, Jiménez García C, Vaquero Abellán M. Mindfulness en enfermería de atención primaria y su relación con el estrés laboral. [Mindfulness in family and community nursing and its relationship with work stress] Nure Investigación. 2017;14:86.
    1. Martín-Asuero A, García de la Banda G. Las ventajas de estar presente: desarrollando una conciencia plena Para reducir el malestar psicológico. [the advantages of being present: developing full awareness to reduce psychological distress] Int J Clin Health Psychol. 2007;7:369–384.
    1. García Campayo J. La práctica del «estar atento» (mindfulness) en medicina. Impacto en pacientes y profesionales. [The practice of “being aware” (mindfulness) in medicine Impact on patients and professionals] Aten Primaria. 2008;40:363. doi: 10.1157/13124130.
    1. Atanes AC, Andreoni S, Hirayama MS, Montero-Marin J, Barros VV, Ronzani TM, Kozasa EH, Soler J, Cebolla A, Garcia-Campayo J, Demarzo MM. Mindfulness, perceived stress, and subjective well-being: a correlational study in primary care health professionals. BMC Complement Altern Med. 2015;15:303. doi: 10.1186/s12906-015-0823-0.
    1. Demarzo MM, Montero-Marin J, Cuijpers P, Zabaleta-del-Olmo E, Mahtani KR, Vellinga A, Vicens C, López-delHoyo Y, García-Campayo J. The efficacy of mindfulness-based interventions in primary care: a meta-analytic review. Ann Fam Med. 2015;13:573–582. doi: 10.1370/afm.1863.
    1. Martín Asuero A, Rodríguez Blanco T, Pujol-Ribera E, Berenguera A, Moix Queraltó J. Evaluación de la efectividad de un programa de mindfulness en profesionales de Atención Primaria. [evaluation of the effectiveness of a mindfulness program in primary care professionals] Gac Sanit. 2013;27:521–528. doi: 10.1016/j.gaceta.2013.04.007.
    1. Brito G. Secular compassion training: an empirical review. J Transpersonal Res. 2014;6:61–71.
    1. Gilbert P. Terapia centrada en la compasión. Características distintivas. [Therapy centered on compassion. Distinctive features.] Editorial Desclée de Brouwer, S.A. Bilbao, 2015.
    1. Tirch DD. Mindfulness as a context for the cultivation of compassion. Int J Cogn Ther. 2010;3:113–123. doi: 10.1521/ijct.2010.3.2.113.
    1. Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. Br J Gen Pract. 2013;63:e76–e84. doi: 10.3399/bjgp13X660814.
    1. Epstein RM. Attending: Medicine, mindfulness, and humanity. New York: Scribner; 2017.
    1. Boellinghaus I, Jones FW, Hutton J. The role of mindfulness and loving-kindness meditation in cultivating self-compassion and other focused concern in health care professionals. Mindfulness. 2014;5:129–138. doi: 10.1007/s12671-012-0158-6.
    1. Amutio-Kareaga A, García-Campayo J, Delgado LC, Hermosilla D, Martínez-Taboada C. Improving communication between physicians and their patients through mindfulness and compassion-based strategies: a narrative review. J Clin Med. 2017;17(6):33. doi: 10.3390/jcm6030033.
    1. Franco JC. Reducción de los niveles de estrés y ansiedad en médicos de atención primaria mediante la aplicación de un programa de entrenamiento en conciencia plena (mindfulness). [reduction of stress and anxiety levels in primary care physicians through the application of a mindfulness training program] Aten Primaria. 2010;42:564–570. doi: 10.1016/j.aprim.2009.10.020.
    1. Aranda G, Elcuaz MR, Fuertes C, Güeto V, Pascual P, Sainz de Murieta E. Evaluación de la efectividad de un programa de mindfulness y autocompasión Para reducir el estrés y prevenir el burnout en profesionales sanitarios de atención primaria. [evaluation of the effectiveness of a mindfulness and self-compassion program to reduce stress and prevent burnout in primary care health professionals] Aten Primaria. 2018;50:141–150. doi: 10.1016/j.aprim.2017.03.009.
    1. Fortney L, Luchterhand C, Zakletskaia L, Zgierska A, Rakel D. Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: a pilot study. Ann Fam Med. 2013;11:412–420. doi: 10.1370/afm.1511.
    1. Klatt MD, Buckworth J, Malarkey WB. Effects of low-dose mindfulness-based stress reduction (MBI-ld) on working adults. Health EducBehav. 2009;36:601–614. doi: 10.1177/1090198108317627.
    1. Braden BB, Pipe TB, Smith R, Glaspy TK, Deatherage BR, Baxter LC. Brain and behavior changes associated with an abbreviated 4-week mindfulness-based stress reduction course in back pain patients. Brain Behav. 2016;6:e00443. doi: 10.1002/brb3.443.
    1. Schroeder DA, Stephens E, Colgan D, Hunsinger M, Rubin D, Christopher MS. A brief mindfulness- based intervention for primary care physicians a pilot randomized controlled trial. Am J Lifestyle Med. 2016;12:83–91. doi: 10.1177/1559827616629121.
    1. Demarzo M, Montero-Marin J, Puebla-Guedea M, Navarro-Gil M, Herrera-Mercadal P, Moreno-González S, Calvo-Carrión S, Bafaluy-Franch L, Garcia-Campayo J. Efficacy of 8- and 4-session mindfulness-based interventions in a non-clinical population: a controlled study. Front Psychol. 2017;8:1343. doi: 10.3389/fpsyg.2017.01343.
    1. Cebolla A, García-Palacios A, Soler J, Guillen V, Baños R, Botella C. Psychometric properties of the Spanish validation of the five facets of mindfulness questionnaire (FFMQ) Rev Eur J Psychiat. 2012;26:118–126. doi: 10.4321/S0213-61632012000200005.
    1. Aguado J, Luciano JV, Cebolla A, Serrano-Blanco A, Soler J, García-Campayo J. Bifactor analysis and construct validity of the five facet mindfulness questionnaire (FFMQ) in non-clinical Spanish samples. Front Psicol. 2015;6:404.
    1. Baer RA, Smith GT, Hopkins J, et al. Using self-report assessment methods to explore facets of mindfulness. Assessment. 2006;13:27–45. doi: 10.1177/1073191105283504.
    1. Neff KD. Development and validation of a scale to measure self-compassion. Self Identity. 2003;2:223–250. doi: 10.1080/15298860309027.
    1. García-Campayo J, Navarro-Gil M, Andrés E, Montero-Marín J, López-Artal L, Demarzo M. Validation of the Spanish versions of the long (26 items) and short (12 items) forms of the self-compassion scale (SCS) Health Qual Life Outcomes. 2014;12:4. doi: 10.1186/1477-7525-12-4.
    1. Sanz-Carrillo C, García-Campayo J, Rubio A, Santed MA, Montoro MJ. Validation of the Spanish version of the perceived stress questionnaire. Psychosom Res. 2002;52:167–172. doi: 10.1016/S0022-3999(01)00275-6.
    1. Maslach C, Jackson SE, Leiter MP. Maslach burnout inventory manual. 3. CA: Consulting Psychologists Press. Palo Alto; 1996.
    1. Gil-Monte PR. Validez factorial del Inventario de Burnout de Maslach (MBI-HSS) entre los profesionales españoles. Rev Saúde Pública. 2005;39:1–8. doi: 10.1590/S0034-89102005000100001.
    1. Alcorta Garza A, González Guerrero JF, Tavitas Herrera SE, Rodríguez Lara FJ, Hojat M. Validación de la Escala de Empatía Médica de Jefferson en estudiantes de medicina mexicanos. Salud Mental. 2005;28:57–63.
    1. Blanco JM, Caballero F, García FJ, Lorenzo F, Monge D. Validation of the Jefferson scale of physician empathy in Spanish medical students who participated in an early clerkship immersion programme. BMC Medical Education. 2018;18(209). 10.1186/s12909-018-1309-9.
    1. Montón C, Pérez-Echevarría MJ, Campos R. Escalas de ansiedad y depresión de Goldberg: una guía de entrevista eficaz Para la detección del malestar psíquico. [Goldberg anxiety and depression scales: an effective interview guide for the detection of psychological distress] Aten Primaria. 1993;12:345–349.
    1. Encuesta Nacional de Salud Española 2017. ENSE, 2017. Metodología. Ministerio de Sanidad, Servicios Sociales e Igualdad. [Spanish National Health Survey 2017. ENSE, 2017. Methodology. Ministry of Health, Social Services and Equality] .
    1. Dobkin PL, Irving JA, Amar S. For whom may participation in a mindfulness-based stress reduction program be contraindicated? Mindfulness. 2012;3:44–50. doi: 10.1007/s12671-011-0079-9.
    1. Silva LC. Muestreo para la investigación en Ciencias de la Salud. [Sampling for research in health sciences] Madrid: Diaz de Santos,1993.
    1. Campbell et al. Sample size calculations for cluster randomised trials. J Health Serv Res Policy. 2000;5:12–16. doi: 10.1177/135581960000500105.
    1. Krasner MS, Epstein RM, Beckman H, Suchman AL, Chapman B, Mooney CJ, Quill TE. Association of an educational program in mindful communication with burnout, empathy and attitudes among primary care physicians. JAMA. 2009;302:1284–1293. doi: 10.1001/jama.2009.1384.
    1. Rodríguez Vega B, Melero-Llorente J, Bayon Pérez C, Cebolla S, Mira J, Valverde C, Fernández-Liria A. Impact of mindfulness training on attentional control and anger regulation processes for psychotherapists in training. Psychother Res. 2014;24:202–213. doi: 10.1080/10503307.2013.838651.
    1. Montero-Marin J, Zubiaga F, Cereceda M, Piva Demarzo MM, Trenc P, Garcia-Campayo J. Burnout subtypes and absence of self- compassion in primary health care professionals: a cross-sectional study. PLoS One. 2016;11:e0157499. doi: 10.1371/journal.pone.0157499.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel