Is the Compassion of Anesthesiologists Associated With Postoperative Pain and Patient Experience? A Prospective Cohort Study.

BACKGROUND: Patient perception of physician compassion may be associated with improved health outcomes, yet it is unclear whether it is associated with postoperative pain reduction or improved patient experience metrics in same-day surgery patients. We hypothesized that higher anesthesiologist compassion during the preanesthesia interview, rated by patients, is associated with lower postoperative pain via the anxiety pathway in same-day surgery patients. We also performed exploratory correlation analysis to assess whether compassion was associated with less opioid consumption and improved patient experience in same-day surgery patients. METHODS: We conducted a single-center, prospective, observational cohort study in American Society of Anesthesiologists (ASA) physical status I to III patients scheduled to undergo same-day surgery with anesthesia. Compassion was scored using a validated 5-item tool. State anxiety (SA) and trait anxiety (TA) were measured using the State-Trait Anxiety Inventory. Pain scores were obtained using a 0 to 10 Likert scale. Daily opioid use was recorded. Patient experience was assessed using the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) and the Surgical Care CAHPS. Mediation analysis was used to assess the association between compassion and pain scores via the anxiety pathway. Spearman correlation was performed to test for association between the compassion score and the secondary outcomes. RESULTS: A total of 147 subjects completed the study with a median age of 50 years and 81% female. Fifty percent underwent breast surgery, 35% abdominal surgery, and the rest underwent gynecological and urological surgeries. The median (Q1-Q3) postoperative pain scores on postoperative days 0 and 3 days later were 4 (1.5-6) and 3 (1-5), respectively.Mediation analysis results showed a same-day anxiety-mediated effect (95% confidence interval [CI]) of compassion on pain of -0.08 (-0.13 to -0.02), attributing to 9% of the total effect. On postoperative day 0, an increase in compassion was associated with a significant average drop in pain of between 0.02 and 0.13. In addition, higher compassion was correlated with better patient experience metrics (ρ= -0.53 [95% CI, -0.64 to -0.39]). CONCLUSIONS: The study results suggest that an anxiety-mediated pathway exists through which compassionate care may help improve the patient's perception of postoperative pain on the day of surgery (before discharge from the hospital). Higher compassion was also associated with better patient experience metrics.

Trait mindfulness and mind-body health in students: The role of gender, race, and ethnicity.

Objective: Trait mindfulness is associated with well-being in college students, yet it is unclear whether these associations are consistent across demographics. Participants: Undergraduate students (n = 534; 33% nonwhite; Apr2018-Sep2019). Methods: A cross-sectional online survey was performed. Pearson correlations tested the relationship between specific facets of trait mindfulness and four domains of mind-body health: stress, well-being, cognitive functioning, and health behaviors. Gender, race, and ethnicity were tested as moderators. Results: In general, higher trait mindfulness is consistently associated with better mind-body health across demographics. However, in men, some health behavior variables correlated more strongly with mindfulness. Among Black students, the relationship between Non-Reactivity and some outcome variables was null or counterintuitive. In Asian students, several predicted associations were significantly stronger. Conclusion: Trait mindfulness corresponds to mind-body health in college students, but relationships may not be universal. Future research is needed to replicate these findings and to examine possible demographic differences in response to mindfulness training.

Perceived Stress Mediates the Relationship Between Trait Mindfulness and Physical Symptoms of Stress: a Replication Study Using Structural Equation Modeling.

Objectives: The mindfulness stress buffering account posits mindfulness may benefit physical health by reducing stress. Previous research supports this account and suggests the non-judging facet of mindfulness may be most strongly associated with physical symptoms of stress, via lower perceived stress. The current replication study used structural equation modeling to analyze relationships between multiple facets of mindfulness, perceived stress, and physical symptoms of stress. Methods: Undergraduate students (n = 534, 68% White, 65% female) completed surveys measuring trait mindfulness (Five Facet Mindfulness Questionnaire-Short Form), perceived stress (Perceived Stress Scale), and physical symptoms of stress (Cohen-Hoberman Inventory of Physical Symptoms). Results: As hypothesized, results showed the negative relationship between four facets of mindfulness (describing, non-judging, non-reactivity, and acting with awareness) and physical symptoms of stress was partially mediated by lower perceived stress. Observing, however, was associated with more physical symptoms of stress. Conclusions: The current findings successfully replicated the results of two previous studies in an independent sample, using a more parsimonious analytic strategy that included all variables in a single path model. Results confirm the stress-buffering effect of trait mindfulness, particularly non-judging. Future research may test whether changes in trait mindfulness, particularly non-judging, explain individual differences in objective measures of stress and physical health.

Does Dispositional Mindfulness Predict Cardiovascular Reactivity to Emotional Stress in Prehypertension? Latent Growth Curve Analyses from the Serenity Study.

OBJECTIVE: Mindfulness stress buffering theory (Creswell & Lindsay, 2014) posits higher dispositional (trait) mindfulness can protect cardiovascular health by buffering physiological stress reactivity - a risk marker for hypertension and cardiac events. Yet, empirical evidence is mixed. This study used baseline data from the Serenity Study - a recently completed, two-site randomized clinical trial - to assess the link between trait mindfulness and cardiovascular stress reactivity in adults with unmedicated prehypertension (n=153, Mage=50, 47% male, 69% White, 28% African-American). METHODS: Latent growth curve modeling was used to determine whether specific facets of trait mindfulness, measured by the Five Facet Mindfulness Questionnaire and the Decentering subscale of the Experiences Questionnaire, predict blood pressure (BP) and heart rate (HR) responses to a brief laboratory stressor (5-min anger recall task). BP and HR taken 1-min apart were used in latent growth curve models. We hypothesized after controlling for known covariates of cardiovascular health, higher trait mindfulness would predict lower cardiovascular reactivity to, and faster recovery from, acute emotional stress. RESULTS: Contrary to predictions, no mindfulness facets predicted cardiovascular reactivity or recovery. CONCLUSIONS: These findings indicate trait mindfulness facets may not independently affect BP and HR responses to acute emotional stress among prehypertensive but otherwise healthy adults with normal stress levels, prior to mindfulness training. Mindfulness-based interventions may therefore be necessary to engender benefits of mindfulness on stress physiology, as a putative biological mechanism of cardiovascular risk reduction and health promotion. Trial registration number and date of registration: NCT02371317, 1/21/2015.

Mindfulness and physical disease: a concise review.

Many of today's most common, chronic, and costly diseases-from high blood pressure, to chronic pain-are related to stress. Mindfulness, considered a state, a trait, and a training, might help treat or prevent stress-related physical symptoms. A concise review of current scientific evidence shows that both higher levels of trait mindfulness as well as mindfulness training are associated with better psychological well-being, coping, and quality of life. Effects on objective measures of disease, however, are often non-significant or await replication. Larger trials with active control groups, clear diagnostic criteria, objective outcome measures, and longer-term follow-up are needed to generate better quality evidence. Yet, many studies do support integrating mindfulness into health care as part of self-care and disease management.