Hospital clinicians' psychosocial well-being during the COVID-19 pandemic: longitudinal study.

BACKGROUND: Hospital clinicians report poor psychosocial well-being during the COVID-19 pandemic. Few studies have reported data at more than one time point. AIMS: To compare psychosocial well-being among hospital clinicians at two different time points during the COVID-19 pandemic in 2020. METHODS: Participants included doctors, nurses, midwives and allied health clinicians at a multi-site, public health service in Melbourne, Australia. Data were collected via two cross-sectional, online surveys: May to June (wave 1; n = 638) and October to December 2020 (wave 2; n = 358). The Depression, Anxiety and Stress Scale (DASS-21) assessed psychological well-being in the past week. Investigator-devised questions assessed COVID-19 concerns and perceived work impacts. General linear models were used to assess impact of wave on psychological distress. RESULTS: There were no significant demographic differences between the two groups. Both positive (e.g. learning experience) and negative (e.g. risk of getting COVID-19) impacts were reported. In both waves, staff were most concerned about health risks to family members. Wave 2 respondents were significantly more likely than wave 1 respondents to indicate concerns about colleagues having COVID-19, increased workloads, leave cancellation and increased conflict at work (all P < 0.001). Adjusting for sex, age, self-rated health and discipline group, depression, anxiety and stress scores were significantly higher for respondents in the second than the first wave (all P < 0.001). CONCLUSIONS: Psychological well-being of hospital clinicians was significantly worse during the second wave of the COVID-19 pandemic than the first. Sustained occupational and psychosocial support is recommended even when immediate COVID-19 concerns and impacts resolve.

Integrating referral to community-based cancer information and support services in a hospital setting.

PURPOSE: To implement and evaluate a hospital-based referral mechanism to increase patient uptake of community-based cancer information and support services. Feasibility and acceptability of the intervention and education program was evaluated. Changes in usage of Cancer Council Victoria's cancer information and support telephone line were investigated. METHODS: A 6-month study was conducted in one metropolitan and one regional cancer treatment hospital. Clinicians attended an education session regarding referral mechanisms to Cancer Council support services. Clinicians completed a questionnaire, and consenting patients participated in a semi-structured telephone interview for the project evaluation. The number of calls made from patients at study sites was monitored. RESULTS: Fifty-two clinicians were trained and referred a total of 430 patients to the cancer information and support service during the study period. Calls from patients increased by up to 100% per month from baseline following the implementation of the referral mechanism. Staff evaluations showed support for the referral mechanism and its incorporation into routine practice. Interviews were conducted with 45 patients; most remembered receiving the referral and were positive towards the intervention. Common reasons patients gave for not acting on the referral included forgetting, lack of need, timing and burden of information. CONCLUSIONS: There is preliminary evidence that this intervention increases awareness and uptake of community-based cancer information and support services. Ongoing clinician education and improvements in patient-clinician communication are important for effective translation from referral to service uptake. Consideration of the most appropriate time in a patients' care trajectory to introduce a referral is warranted.

Worsening psychological wellbeing of Australian hospital clinical staff during three waves of the coronavirus (COVID-19) pandemic.

Objective This study aimed to assess and compare the psychological wellbeing of Australian hospital clinical staff at three timepoints during the coronavirus disease 2019 (COVID-19) pandemic. Methods An anonymous, online, cross-sectional survey was conducted at three timepoints during the COVID-19 pandemic (T1: May-June 2020; T2: October-December 2020; T3: November 2021-January 2022). The surveys were completed by nurses, midwives, doctors and allied health staff employed at a large metropolitan tertiary health service located in Melbourne, Australia. The Depression, Anxiety and Stress Scale (DASS-21) assessed respondents' psychological wellbeing in the past week. General linear models were used to measure the effects of survey timepoint on DASS-21 subscale scores, adjusting for selected sociodemographic and health characteristics. Results A total of 1470 hospital clinical staff completed at least one survey (T1: 668 (14.7%), T2: 358 (7.9%) and T3: 444 (9.8%)). Respondents' sociodemographic characteristics were similar across the three timepoints and within professional discipline groups. Respondents' psychological wellbeing was worse at T3 compared to the earlier survey timepoints. Adjusting for respondent characteristics, depression, anxiety and stress scores were significantly higher for respondents of the third survey compared to the first (P < 0.001). Conclusions There was a significant and persistent negative impact on the psychological wellbeing of hospital clinical staff in Australia across waves of the COVID-19 pandemic. Hospital clinical staff would benefit from ongoing and continued wellbeing support during and after pandemic waves.

Immediate impact of the COVID-19 pandemic on the work and personal lives of Australian hospital clinical staff.

Objective This study investigated the short-term psychosocial effects of the COVID-19 pandemic on hospital clinical staff, specifically their self-reported concerns and perceived impact on their work and personal lives. Methods Nurses, midwives, doctors and allied health staff at a large metropolitan tertiary health service in Melbourne, Australia, completed an anonymous online cross-sectional survey between 15 May and 10 June 2020. The survey assessed respondents' COVID-19 contact status, concerns related to COVID-19 and other effects of COVID-19. Space was provided for free-text comments. Results Respondents were mostly concerned about contracting COVID-19, infecting family members and caring for patients with COVID-19. Concerns about accessing and using personal protective equipment, redeployment and their ability to provide high-quality patient care during the pandemic were also reported. Pregnant staff expressed uncertainty about the possible impact of COVID-19 on their pregnancy. Despite their concerns, few staff had considered resigning, and positive aspects of the pandemic were also described. Conclusion The COVID-19 pandemic has had a considerable impact on the work and personal lives of hospital clinical staff. Staff, particularly those who are pregnant, would benefit from targeted well-being and support initiatives that address their concerns and help them manage their work and personal lives. What is known about the topic? The COVID-19 pandemic is having an impact on healthcare workers' psychological well-being. Little is known about their COVID-19-related concerns and the perceived impact of the pandemic on their work and personal lives, particularly hospital clinical staff during the 'first wave' of the pandemic in Australia. What does this paper add? This paper contributes to a small but emerging evidence base about the impact of the COVID-19 pandemic on the work and personal lives of hospital clinical staff. Most staff were concerned about their own health and the risk to their families, friends and colleagues. Despite their concerns, few had considered resigning. Uncertainty about the possible impact of COVID-19 on pregnancy was also reported. What are the implications for practitioners? During the current and future pandemics, staff, especially those who are pregnant, would benefit from targeted well-being and support initiatives that address their concerns and help them manage the impact on their health, work and personal lives.

Palliative care and COVID-19 in the Australian context: a review of patients with COVID-19 referred to palliative care.

Objective Palliative care has played a key role in the response to the coronavirus disease 2019 (COVID-19) pandemic in Australia. This review of consecutive patients with COVID-19 referred to the palliative care consultancy service of a tertiary health service in Melbourne describes the palliative care experience with COVID-19 in Australia. Methods The experiences of 55 patients (median age 86 years; interquartile range (IQR) 81-90 years; 55% male; median Charlson comorbidity score 6 (IQR 5-8); 85% with Australia-modified Karnofsky Performance Status ≤50; 67% from residential aged care facilities) were reviewed to collect relevant data points. Results Most patients were referred for end-of-life care with symptoms including dyspnoea (80%) and agitation/delirium (60%). Continuous subcutaneous infusions were commenced in 71% of patients, with the most frequent medications being opioids and benzodiazepines in relatively small doses; 81% required ≤20 mg subcutaneous morphine equivalent and 64% required ≤10 mg subcutaneous midazolam over 24 h. Fifty patients (91%) died in hospital and the median time from palliative care referral to death was 3 days (IQR 1-5 days). Five patients were discharged back to residential aged care facilities. Overall, 80% of referrals were from the aged care team. Conclusion Our patients had similar demographics, symptoms, medication needs and outcomes to patients in similar settings overseas. We found the symptom management of patients with COVID-19 to be generally straightforward. However, the psychosocial needs of patients were predominant and contributed to complexity. This study highlights the need for well-integrated relationships between the palliative care consultancy service and the diverse range of key treating teams involved in the delivery of pandemic health care. What is known about the topic? Palliative care has played a key role in the response to the COVID-19 pandemic in Australia. There is limited research describing the Australian palliative care experience with the COVID-19 pandemic. What does this paper add? Patients with COVID-19 referred to a hospital-based palliative care consultancy service in Australia had similar demographic characteristics, symptoms, medication needs and outcomes to patients with COVID-19 referred to other palliative care services in the UK and the US. There were significant psychosocial issues affecting patients, families and staff in the context of the pandemic. What are the implications for practitioners? This study highlights the need for well-functioning working relationships between the palliative care consultancy service and other hospital teams that can be leveraged at a time of crisis, such as a pandemic, to provide optimal palliative care to patients.

Psychological well-being of Australian hospital clinical staff during the COVID-19 pandemic.

Objective This study assessed the psychological well-being of Australian hospital clinical staff during the COVID-19 pandemic. Methods An anonymous online cross-sectional survey was conducted in a large metropolitan tertiary health service located in Melbourne, Australia. The survey was completed by nurses, midwives, doctors and allied health (AH) staff between 15 May and 10 June 2020. The Depression, Anxiety and Stress Scale - 21 items (DASS-21) assessed the psychological well-being of respondents in the previous week. Results In all, 668 people responded to the survey (nurses/midwives, n=391; doctors, n=138; AH staff, n=139). Of these, 108 (16.2%) had direct contact with people with a COVID-19 diagnosis. Approximately one-quarter of respondents reported symptoms of psychological distress. Between 11% (AH staff) and 29% (nurses/midwives) had anxiety scores in the mild to extremely severe ranges. Nurses and midwives had significantly higher anxiety scores than doctors (P<0.001) and AH staff (P<0.001). Direct contact with people with a COVID-19 diagnosis (P<0.001) and being a nurse or midwife (P<0.001) were associated with higher anxiety scores. Higher ratings of the health service's pandemic response and staff support strategies were protective against depression (P<0.001), anxiety (P<0.05) and stress (P<0.001). Conclusions The COVID-19 pandemic had a significant effect on the psychological well-being of hospital clinical staff, particularly nurses and midwives. Staff would benefit from (additional) targeted supportive interventions during the current and future outbreaks of infectious diseases. What is known about the topic? The outbreak of COVID-19 is having, and will have, a considerable effect on health services. No Australian data about the effect of COVID-19 on the psychological well-being of hospital clinical staff are available. What does this paper add? Australia healthcare providers have experienced considerable emotional distress during the COVID-19 pandemic, particularly nurses and midwives and clinical staff who have had direct contact with people with a COVID-19 diagnosis. In this study, nurses and midwives had significantly higher levels of anxiety, depression and stress during the pandemic than general Australian adult population norms, and significantly more severe anxiety symptoms than medical and AH staff. Despite a lower number of COVID-19 cases and a lower death rate than in other countries, the proportion of Australian hospital clinical staff experiencing distress is similar to that found in other countries. What are the implications for practitioners? Targeted well-being interventions are required to support hospital clinical staff during the current and future outbreaks of infectious diseases and other 'crises' or adverse events.

Prospective analysis of 30-day mortality following palliative chemotherapy at a tertiary cancer centre.

BACKGROUND: Thirty-day mortality after chemotherapy has been suggested as a marker of quality in oncology care. Retrospective audits worldwide have put this figure at between 8.1% and 43%, with previous retrospective Australian audits putting this figure at between 3.4% and 18%. To date, there has not been a prospective cohort study of patients receiving palliative intent chemotherapy at an Australian chemotherapy day unit. AIM: The aim of the study is to benchmark 30-day mortality for patients receiving palliative intent chemotherapy and identify associated factors at an Australian tertiary cancer centre. METHODS AND RESULTS: A prospective cohort study of all patients with a diagnosis of malignancy referred for palliative intent intravenous chemotherapy to the Sunshine Hospital Chemotherapy Day Unit over a 12-month period. The primary outcome was death within 30 days of receiving palliative intent chemotherapy. Other outcome measures included place of death and whether the patient received an outpatient palliative care referral. A total of 314 patients were enrolled in the study, and 98 patients died within the audit period. Of these, 21 (6.6%) died within 30 days of commencing palliative intent chemotherapy, and 60 (18.8%) died more than 30 days after receiving chemotherapy. Of the 34 patients that were referred, but did not start chemotherapy, 18 (52%) died. Multivariable logistic regression found that patients who received an outpatient palliative care referral and received chemotherapy were more likely to die within 30 days, although these did not reach statistical significance. CONCLUSION(S): This prospective cohort study demonstrated that 6.6% of patients died within 30 days of the administration of palliative intent chemotherapy; however, none of the prespecified factors were found to be statistically significantly associated with 30-day mortality.

Tailored chemotherapy information faxed to general practitioners improves confidence in managing adverse effects and satisfaction with shared care: results from a randomized controlled trial.

PURPOSE: General practitioners (GPs) play a critical role in the treatment of patients with cancer; yet often lack information for optimal care. We developed standardized information for GPs about chemotherapy (CT). In a randomized controlled trial we assessed the impact of sending, by fax, information tailored to the particular patient's CT regimen. Primary end points were: confidence treating patients who were receiving CT (confidence), knowledge of adverse effects and reasons to refer the patient to the treatment center (knowledge), and satisfaction with information and shared care of patients (satisfaction). METHODS: Focus group work informed the development of the CT information which focused on potential adverse effects and recommended management strategies. GPs of patients due to commence CT were randomly assigned to receive usual correspondence with or without the faxed patient/regimen-specific information. Telephone questionnaire at baseline and 1 week postintervention assessed knowledge, confidence, and satisfaction. RESULTS: Ninety-seven GPs managed 97 patients receiving 23 types of CT. Eighty-one (83.5%) completed the follow-up questionnaire. GPs in the intervention group demonstrated a significantly greater increase in confidence (mean difference, 0.28; 95% CI, 0.10 to 0.47) and satisfaction (mean difference, 0.57; 95% CI, 0.27 to 0.88) compared with usual care, reflecting a 7.1% and 10.5% difference in score, respectively. No differences were detected for knowledge. GPs receiving the CT sheet found correspondence significantly more useful (P < .001) and instructive (P < .001) than GPs who received standard correspondence alone. CONCLUSION: Information about CT faxed to GPs is a simple, inexpensive intervention that increases confidence managing CT adverse effects and satisfaction with shared care. This intervention could have widespread application.