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BACKGROUND: Mindfulness has been shown to reduce stress and burnout in medical students and healthcare professionals. This is a quality improvement study which assessed the feasibility of conducting a full-scale evaluation of a mindfulness intervention among UK foundation doctors to reduce stress and burnout. METHODS: This is an uncontrolled before and after study taking place in a single university teaching hospital. The RE-AIM framework which comprises of five dimensions including Reach, Adoption, Effectiveness, Implementation, and Maintenance was used to guide this assessment. The intervention was a 6-week 'Mindfulness in the Workplace' course. The primary measure was change in self-reported levels of stress immediately before and after the course. Additional measures explored the subjective experiences of participating doctors through the use of questionnaires handed out before and after the course. RESULTS: All 20 places on the course were filled from the population of 108 foundation doctors at the trust with an equal number of foundation year 1 (n = 10) and foundation year 2 (n = 10) doctors. Sixteen participants (80%) attended one or more sessions. The median baseline stress score of the participants was 6.5 (range = 2 to 9). The median post-course stress score was 5.0 (range = 2 to 8). The Mann-Witney test indicated that the stress levels of participants were significantly lower at the end of the course compared to baseline, U = 74.50, p = .04. Additional measures suggested that the intervention may be associated with some other potential promising benefits for doctors including greater wellbeing, improved working life, and more satisfactory relationships with patients. Implementation of this intervention requires further work at the institutional level because only 35% of participants completed the full intervention, the main barrier being work commitments. CONCLUSION: This is the first programme of research to evaluate the feasibility of trialling and implementing a modified 'Mindfulness in the Workplace' intervention for foundation junior doctors in the UK. Based on the findings from this study, we conclude that this intervention is promising but further modifications are required such as the use of validated outcome measures and improving delivery aspects before this intervention programme is trialled among foundation doctors in the UK.
RESUMO
More than one third of individuals with chronic obstructive pulmonary disease (COPD) experience comorbid symptoms of depression and anxiety. This review aims to provide an overview of the burden of depression and anxiety in those with COPD and to outline the contemporary advances and challenges in the management of depression and anxiety in COPD. Symptoms of depression and anxiety in COPD lead to worse health outcomes, including impaired health-related quality of life and increased mortality risk. Depression and anxiety also increase health care utilization rates and costs. Although the quality of the data varies considerably, the cumulative evidence shows that complex interventions consisting of pulmonary rehabilitation interventions with or without psychological components improve symptoms of depression and anxiety in COPD. Cognitive behavioral therapy is also an effective intervention for managing depression in COPD, but treatment effects are small. Cognitive behavioral therapy could potentially lead to greater benefits in depression and anxiety in people with COPD if embedded in multidisciplinary collaborative care frameworks, but this hypothesis has not yet been empirically assessed. Mindfulness-based treatments are an alternative option for the management of depression and anxiety in people with long-term conditions, but their efficacy is unproven in COPD. Beyond pulmonary rehabilitation, the evidence about optimal approaches for managing depression and anxiety in COPD remains unclear and largely speculative. Future research to evaluate the effectiveness of novel and integrated care approaches for the management of depression and anxiety in COPD is warranted.