Hybrid Work from Home Clinical Academic Environment: A One-Year Follow-Up Survey of Attitudes and Beliefs of Members of a Department of Palliative Care, Rehabilitation, and Integrative Medicine.

Context: Palliative, Rehabilitation, and Integrative Medicine (PRIM) department members anonymously reported a positive experience with work from home (WFH) two months after its rapid pandemic transition in March 2020. Data are limited on the stability of such preferences and experiences over time. Objectives: The objectives of this study were to survey the attitudes and beliefs of PRIM employees toward remote work 16 months after the start of the coronavirus disease 2019 (COVID-19) pandemic since vaccines and to determine changes in perceptions of WFH. Methods: All 138 PRIM employees were invited to participate in an anonymous survey from mid-July to mid-August 2021. The 30-question survey included demographics, perceptions toward WFH, and the pandemic. Results: One hundred fifteen (83%) employees completed the survey: 29 (74%) research, 62 (83%) clinicians, and 24 (100%) administrative personnel. Most were female (76%), 30-59 years old (88%), PRIM employees before May 2020 (89%), shared office space (52%), and had received either first or second dose of the COVID-19 vaccine (88%). Overall experience (86%) and emotional response (74%) with WFH were positive and not significantly different from 2020 (p = 0.128 and 0.782, respectively). Positive experience was associated with having adequate equipment (p = 0.002), perception of productivity (p = 0.002), financial advantage (p = 0.002), and time demands caring for dependents (p = 0.038). Clinicians reported less positive response (78%, p = 0.002) and less productivity (49%, p = 0.002) with WFH and higher level of stress (54%, p = 0.026) since COVID-19. Employees continued to support WFH permanently (79%) for two or more days/week (82%). There was continued increased emotional exhaustion (71%) similar to 2020 (p = 0.868), and being asked to work partially or completely from home permanently was favored by 64% versus 97% and 96% of clinicians, research, and administrative, respectively (p = 0.002). Conclusions: Support for WFH was sustained a year later and after three pandemic waves. These findings serve as a model for future rapid work transitions and can help elucidate factors associated with stress and emotional exhaustion in a new post-COVID-19 work environment.

Patient-reported sleep disturbance in advanced cancer: frequency, predictors and screening performance of the Edmonton Symptom Assessment System sleep item.

AIMS: Sleep Disturbance (SD) is a severe debilitating symptom in advanced cancer patients (ACP). However, routine screening of SD is uncommon. The primary aim of this study was to determine the optimal cutoff score for SD screening for Edmonton Symptom Assessment system (ESAS) sleep item using Pittsburgh Sleep Quality Index (PSQI) as a gold standard. We also determined the frequency of SD, obstructive sleep apnea symptoms (OSA) and restless leg syndrome (RLS) and factors associated with SD. METHODS: We prospectively surveyed 180 consecutive ACP. Patients completed validated assessment for symptoms. We determined epidemiological performance, receiver operating characteristics, and correlations of SD. RESULTS: SD according to PSQI was diagnosed in 112/180 (62%), and median (IQR) ESAS sleep was 5 (2-7). ESAS sleep ≥ 4 had a sensitivity of 74% and 80%, and specificity of 71% and 64% in the training and validation samples, respectively for screening of SD. The frequency of OSA was 61%; RLS was 38%. ESAS sleep was associated [r, p-value] with PSQI (0.61, <0.0001), pain (0.4, <0.0001); fatigue (0.35, <0.0001); depression (0.20, 0.006); anxiety (0.385, <0.0001); drowsiness (0.385, <0.0001), shortness of breath (0.24, <0.0014); anorexia (0.32, <0.0001), well-being (0.36, <0.0001). Multivariate analysis found well-being (OR per point 1.34, p=0.0003), pain (OR 1.21, p<0.0037), dyspnea (OR 1.16, p=0.027), and OSA (OR 0.31, P=0.003) as independent predictors of SD. There was no association between SD and survival. CONCLUSIONS: SD is frequent and ESAS SD item ≥ 4 has good sensitivity for SD screening.