Resilience-Related Resources Predict Physicians' Fatigue, Job Search Behavior, and Productivity Outcomes.

OBJECTIVE: The objective of this research was to assess the relative contribution of three resilience-related dispositional resources (trait mindfulness, core self-evaluations, and optimism) to emergency medicine physicians' fatigue, retention, and productivity. METHODS: We surveyed emergency physicians employed by a national (US) medical staffing organization. The survey included measures of work stressors, resilience resources, job search behavior, and fatigue. We linked the survey responses to objective demographic and productivity measures from the organization's records. RESULTS: A total of 371 respondents completed the survey. Multiple regression analyses demonstrated support for each of the three resilience-related resources as predictors. Relative weights analyses showed that resilience accounted for 14% and 62% of the outcome variance, whereas work demands accounted for between 32% and 56%. CONCLUSIONS: Multiple facets of dispositional resilience are important predictors of emergency medicine physicians' occupational health, retention, and productivity.

Economic Evaluations of Mindfulness-Based Interventions: a Systematic Review.

Objectives: This study includes a systematic review of cost-effectiveness analyses (CEAs) and cost-benefit analyses (CBAs) of mindfulness-based interventions (MBIs). Methods: A literature search was conducted using PubMed, Web of Science, JSTOR, and CINAHL for studies published between January 1985 and September 2021, including an original cost-related evaluation of an MBI. A qualitative assessment of bias was performed using the Drummond checklist. Results: Twenty-eight mindfulness-based intervention studies (18 CEAs and 10 CBAs) were included in this review. Mindfulness-based stress reduction (MBSR) was less costly and more effective when compared with the usual care of cognitive behavioral therapy among patients with chronic lower back pain, fibromyalgia, and breast cancer. MBSR among patients with various physical/mental conditions was associated with reductions in healthcare costs. Mindfulness-based cognitive therapy (MBCT) was also less costly and more effective than the comparison group among patients with depression, medically unexplained symptoms, and multiple sclerosis. MBCT's cost-effectiveness advantage was also identified among breast cancer patients with persistent pain, non-depressed adults with a history of major depressive disorder episodes, adults diagnosed with ADHD, and all cancer patients. From a societal perspective, the cost-saving property of mindfulness training was evident when used as the treatment of aggressive behaviors among persons with intellectual/developmental disabilities in mental health facilities. Conclusions: Based on this review, more standardized MBI protocols such as MBSR and MBCT compare favorably with usual care in terms of health outcomes and cost-effectiveness. Other MBIs may result in cost savings from both healthcare and societal perspectives among high-risk patient populations.

A feasibility study on low-dose mindfulness-based stress reduction intervention among prediabetes and diabetes patients.

OBJECTIVES: To investigate the feasibility of delivering a low-dose mindfulness-based stress reduction (MBSR) intervention among prediabetes/diabetes patients in a clinical setting. DESIGN AND SETTING: This was a single-arm, mixed methods, feasibility study among prediabetes/diabetes patients at a healthcare center in United States. INTERVENTION: The low-dose MBSR intervention was delivered in group format over 4 waves and each wave comprised 8-10 h of 8 sessions over 6-8 weeks. MAIN OUTCOME MEASURES: We evaluated recruitment, adherence, and attrition rates, participants' satisfaction, motivation and barriers of low-dose MBSR. Psychological, behavioral, and physical measures were compared between pre- and post-intervention. RESULTS: We enrolled 19 participants of 34 eligible individuals with a recruitment rate of 55.9%. Among 19 enrolled participants, 4 dropped out after baseline data collection and did not attend any session and 1 attended one session but did not finish post-intervention data collection, resulting in an attrition rate of 26.3%. Among 15 participants attending at least one session, 46.7% attended all sessions and 80.0% attended at least 5 sessions. Qualitative analysis among 11 participants indicated that 90.9% had positive overall experience with the intervention. Compared to pre-intervention, there was a significant reduction in depression score (mean reduction = 5.04, SD = 7.66, p = 0.02), a higher proportion of engaging in flexibility exercises (42.86% vs. 85.71%, p = 0.01) and a lower level of glycosylated hemoglobin (HbA1c) (mean reduction = 1.43%, SD = 2.54%, p = 0.03) at post-intervention. CONCLUSIONS: Delivering a low-dose MBSR intervention to prediabetes/diabetes patients in a primary care setting is feasible. Future studies with randomized controlled design and larger sample are warranted.

A qualitative study on participants' experiences with a community-based mindful walking intervention and mobile device activity measurement.

BACKGROUND: Mindful walking (MW) interventions employ mindfulness training combined with physical activity. Wearable mobile devices have been increasingly used to measure outcomes of physical activity interventions. The purpose of this study was to understand MW participants' attitudes towards MW and the use of mobile devices in health promotion interventions, including barriers and facilitators of intervention engagement and adherence. Few qualitative studies have documented participant experience with these two types of interventions. METHOD: The pilot study involved a randomized MW intervention including 38 participants with self-reported inadequate physical activity. Half of them were randomized to receive MW intervention plus a FitBit device and the other received the FitBit device only. We used a qualitative thematic analysis of the narrative data collected through open-ended survey questions at three time points. Participants in the MW intervention were asked to describe their experiences with MW, while all participants were asked to describe their experience with wearing the FitBit to track their step counts. RESULTS: Participants reported a broad range of perceived benefits and challenges related to adopting the MW intervention and using the mobile device. Participants were generally willing to try to adopt the recommended MW practice and to see value of MW in increasing physical activity and improving overall health. Participants reported using a variety of additional device features beyond goal setting and step counts, indicating using the devices may have been effective in providing additional motivation for participants in meeting physical activity goals in both the control and intervention groups. While most of the feedback about MW (in the intervention group) and the device (all participants) was overwhelmingly positive, a minority of participants reported barriers such as lack of patience with meditation and discomfort with wearing the device. CONCLUSION: Most participants in the MW intervention see the health benefits of this program and most participants using the wearable physical activity tracking device reported the motivational benefits of this device. Issues with the MW intervention (e.g., lack of patience) and the wearable device (e.g., discomfort with wearing) need to be addressed in future interventions.

Study protocol for a randomized controlled trial of mindfulness-based relapse prevention for opioid use disorders.

The opioid misuse epidemic has reached a crisis level in the United States. Though mindfulness-based relapse prevention (MBRP) has been shown as effective in treating substance use disorders, there is limited research on its application to opioid use disorders specifically, and there is a need to understand the underlying mechanisms. This paper outlines a protocol for a randomized controlled trial of MBRP for opioid use disorders. MBRP is a group aftercare program that integrates mindfulness skills training with cognitive-behavioral relapse prevention strategies. We will recruit 240 participants who have completed opioid use disorder treatment, and randomize them to an 8-week MBRP group intervention or treatment as usual (TAU) control group. The TAU control group will complete the intervention after 8 weeks. Assessments will take place at baseline, 8 weeks, and 16 weeks. The primary outcome is frequency of opioid use. The secondary outcomes include craving and withdrawal symptoms, time to first opioid use, adherence to medication-assisted treatment plans, perceived stress, quality of life, posttraumatic stress symptoms, and chronic pain. We will also examine the following potential moderators and correlates of intervention outcomes: comorbid diagnoses, life events history, and MBRP intervention adherence. In addition, we will examine the following mediators of intervention outcome: mindfulness skills, emotion regulation skills, executive functioning skills, savoring, and positive and negative affect. This study will contribute to the evidence base regarding MBRP's efficacy in reducing opioid use, as well as contribute to the understanding of the causal mechanisms and factors that modify treatment outcome for MBRP for substance use disorders.

Factors associated with longer endocrine therapy use by South Carolina Medicaid-insured breast cancer survivors.

PURPOSE: The objective of this study is to determine demographic, clinical, and pharmaceutical factors that are associated with longer endocrine therapy usage duration. METHODS: South Carolina Central Cancer Registry incidence data linked with South Carolina Medicaid prescription claims and administrative data were used. The study included a sample (N = 1399) of female South Carolina Medicaid recipients with hormone receptor-positive breast cancer diagnosed between 2000 and 2012 who filled at least one ET prescription. A series of multiple regression models were built to explore the association of demographic, clinical, and pharmaceutical factors with the endocrine therapy usage duration. RESULTS: Multiple linear regression analysis showed that none of the demographic or clinical factors tested were significantly associated with the endocrine therapy usage duration. However, the type of endocrine therapy taken as well as receipt of the prescriptions that could have been used to alleviate side-effects (adrenals, nonsteroidal anti-inflammatory agents, anti-inflammatory agents, and vitamins) were significantly associated. CONCLUSION: Our study highlights the potential value of concurrent prescriptions for improving the endocrine therapy usage duration, with an optimal intervention point before 14 months post ET initiation. This work informs further research needed to test pharmacologic interventions that may significantly increase the endocrine therapy duration as well as other nonpharmacologic strategies for side-effect management.

Perceptions about mindfulness-based interventions among individuals recovering from opioid and alcohol use disorders: Findings from focus groups.

OBJECTIVES: Mindfulness-based interventions (MBIs) have been used as an intervention to support recovery from alcohol use disorder (AUD) and opioid use disorder (OUD). We sought to identify attitudes and experiences toward standardized MBIs among individuals recovering from these substance abuse disorders (SUD) through a qualitative approach. DESIGN: We conducted three 60-minute focus groups among people with history of SUD (6-months to 3 years in recovery): two groups with those with alcohol use disorder (AUD) history and one with individuals with history of opioid use disorder (OUD). Each group had eight participants. RESULTS: Most participants of the OUD focus group had tried some variations on mindfulness training or meditation-like therapies during treatment. Participants expressed perceived benefits for MBIs' non-pharmacological property, while expressing concerns related to perceived barriers of cost, scheduling conflicts with work and child/family care needs, and possible lack of provider empathy. Gift cards and other rewards were recognized as useful participation and retention incentives for completing the described program; the training itself was perceived as an "incentive" if able to deliver significant benefits related to supporting continued recovery from SUD. An overarching theme across all groups was that participants reported their own altruistic behavior and social connectedness as important motivators to help them maintain recovery. CONCLUSION: The importance of perceived provider empathy and the patient's social connectedness in SUD interventions was underscored as incentives for participation and retention, providing valuable information for the implementation of MBIs among patients recovering from SUD.

A pilot study of mindful walking training on physical activity and health outcomes among adults with inadequate activity.

INTRODUCTION: Mindful walking is a meditation practice that combines physical activity and mindfulness practice. Some mindful walking interventions expect four weeks of attendance (as compared with the traditional 8-week models of mindfulness-based interventions, or MBIs), a practice that could make MBIs more accessible to working-age adults. This study examined whether a 4-week mindful walking intervention increased physical activity and improved mental health outcomes. METHODS: We conducted a randomized experiment among adults with inadequate physical activity (N = 38), whereby the intervention group received a four-week, one-hour-per-week mindful walking intervention and the control group received instructions to increase physical activity. Everyone in both groups received a wrist-worn step count device as participation incentive. Physical activity (as measured by the Rapid Assessment of Physical Activity questionnaire, RAPA) and other health outcomes were assessed with online surveys at baseline (T1), post-intervention (T2), and one month after the intervention (T3). Those mental health outcomes included perceived stress (Perceived Stress Scale), depression (Brief Edinburgh Depression Scale), and Mental Health Inventory (MHI). The primary outcome of device-measured step count was recorded at T1 and T2. Independent two-sample t-tests were used to compare the primary outcomes at T1. Generalized linear mixed models (GLMM) with a random intercept for each subject were used to compare the two groups on the primary outcomes at all time points. The independent variables in the model included a binary variable for group assignment (intervention vs. control), a 3-level categorical variable for time, and their interaction. Age, gender and race/ethnicity are used as covariates in the model. Estimated changes (either differences or ratios between outcomes at time points T1 and T2/T3) are reported to assess change within groups. RESULTS: Both groups exhibited significant improvements in the RAPA measures of physical activity and depression. However, between-group differences were not statistically significant. There was no within-group or between-group difference on device-measured step count, though both groups yielded an average daily step count close to the recommended level of 8,000 steps per day for older adults. The intervention group exhibited a significant reduction in perceived stress, and this reduction was significantly greater than that of the control group at T2 (p = .025) although the difference was insignificant at T3. No significant difference in MHI was found. DISCUSSION: While these adults with inadequate physical activity increased their physical activity, no significant between-group differences in physical activity were identified. Potential reasons for the lack of significant findings could be due to the ceiling effect (the step count device for everyone in both groups might have encouraged more activity in both groups), limited sample size and low-dose 4-week intervention used in this study. On the other hand, it is encouraging to see that this low-dose, short-duration 4-week intervention (as compared with those popular 8-week MBIs) achieved significantly greater stress reduction among the intervention group than among the control group, even though the between-group difference at one-month follow-up was statistically insignificant. Further studies with larger sample sizes and longer follow-up are needed to assess the possible benefits of these short-duration mindful walking interventions.

Endocrine therapy use in the twenty-first century: usage rates and temporal trends illustrate opportunities for improvement for South Carolina Medicaid women.

PURPOSE: This study examines endocrine therapy (ET) non-initiation, non-adherence, and duration by age, race, temporal trend for South Carolina Medicaid-enrolled women diagnosed with estrogen receptor-positive breast cancer between 2000 and 2014 (N = 3830). METHODS: Age, race, relative risk, and median duration of ET use were compared. Temporal trends in ET non-initiation, non-adherence, and duration were observed using linear and logistic regression models, controlling for age and race. RESULTS: Fifty-three percent of women in the sample did not initiate ET, with highest non-initiation rates among African Americans and survivors under age 50. Of those who did initiate ET, 42% were non-adherent with a median ET usage duration of 37 months. Twenty-one percent of initiators continued taking ET for 5 years or more. There was no change in the odds of ET non-initiation from 2000 to 2004 (OR 1.02, p = 0.67). The odds of ET non-initiation decreased from 2005 to 2009 (OR 0.81, p < 0.001) but then increased from 2010 to 2014 (OR 1.08, p = 0.002). There was no change in the odds of ET non-adherence from 2000 to 2006 (OR 1.02, p = 0.53), but from 2007 to 2012, the odds of ET non-adherence decreased each year (OR 0.93, p = 0.02). The average ET usage duration was increasing from 2000 to 2006 (ß = 2.74, p < 0.001) but decreasing from 2006 to 2012 (ß = - 1.46, p < 0.001). CONCLUSIONS: This study provides a realistic picture of the challenges associated with ET usage among South Carolina Medicaid breast cancer patients. It particularly highlights small improvements over time in ET usage rates, indicating more opportunities for improvement in ET initiation, adherence, and duration among younger women of lower socio-economic status.

Enhancing mHealth Technology in the Patient-Centered Medical Home Environment to Activate Patients With Type 2 Diabetes: A Multisite Feasibility Study Protocol.

BACKGROUND: The potential of mHealth technologies in the care of patients with diabetes and other chronic conditions has captured the attention of clinicians and researchers. Efforts to date have incorporated a variety of tools and techniques, including Web-based portals, short message service (SMS) text messaging, remote collection of biometric data, electronic coaching, electronic-based health education, secure email communication between visits, and electronic collection of lifestyle and quality-of-life surveys. Each of these tools, used alone or in combination, have demonstrated varying degrees of effectiveness. Some of the more promising results have been demonstrated using regular collection of biometric devices, SMS text messaging, secure email communication with clinical teams, and regular reporting of quality-of-life variables. In this study, we seek to incorporate several of the most promising mHealth capabilities in a patient-centered medical home (PCMH) workflow. OBJECTIVE: We aim to address underlying technology needs and gaps related to the use of mHealth technology and the activation of patients living with type 2 diabetes. Stated differently, we enable supporting technologies while seeking to influence patient activation and self-care activities. METHODS: This is a multisite phased study, conducted within the US Military Health System, that includes a user-centered design phase and a PCMH-based feasibility trial. In phase 1, we will assess both patient and provider preferences regarding the enhancement of the enabling technology capabilities for type 2 diabetes chronic care management. Phase 2 research will be a single-blinded 12-month feasibility study that incorporates randomization principles. Phase 2 research will seek to improve patient activation and self-care activities through the use of the Mobile Health Care Environment with tailored behavioral messaging. The primary outcome measure is the Patient Activation Measure scores. Secondary outcome measures are Summary of Diabetes Self-care Activities Measure scores, clinical measures, comorbid conditions, health services resource consumption, and technology system usage statistics. RESULTS: We have completed phase 1 data collection. Formal analysis of phase 1 data has not been completed. We have obtained institutional review board approval and began phase 1 research in late fall 2016. CONCLUSIONS: The study hypotheses suggest that patients can, and will, improve their activation in chronic care management. Improved activation should translate into improved diabetes self-care. Expected benefits of this research to the scientific community and health care services include improved understanding of how to leverage mHealth technology to activate patients living with type 2 diabetes in self-management behaviors. The research will shed light on implementation strategies in integrating mHealth into the clinical workflow of the PCMH setting. TRIAL REGISTRATION: ClinicalTrials.gov NCT02949037. https://clinicaltrials.gov/ct2/show/NCT02949037. (Archived by WebCite at http://www.webcitation.org/6oRyDzqei).

Differing effects of mass and interpersonal communication on breast cancer risk estimates: an exploratory study of college students and their mothers.

Research has demonstrated that women tend to overestimate the percentage of all breast cancers that result from genetic predispositions, and this article examines the knowledge of college students, as well as their mothers, on this subject, applying uncertainty management (Brashers, 2001) as the theoretical framework. The authors build on the literature by studying (a) the types of media outlets college students and their mothers use for securing information, and (b) the types of articles and programs within those outlets that may affect risk perceptions. The authors also address associations between these mass communication measures and interpersonal sources of information in the context of risk estimation. Respondents exposed to media reports about the role of genetics in breast cancer, in addition to study participants who had discussed this role within the family, tended to overestimate measures of genetic risk. Conversely, those who had attended to media reports about screening practices tended to offer lower risk estimates, indicating that such reports may have positioned genetics as just one factor in the overall equation of breast cancer risk. The authors discuss the implications of these and other findings for communication scholars and health practitioners.