PDF(Pubmed)
Abstract：
BACKGROUND: Burnout poses a substantial, ongoing threat to healthcare worker (HCW) wellbeing and to the delivery of safe, quality healthcare. While systemic and organization-level changes in healthcare are critically important, HCWs also need individual-level skills to promote resilience. The objective of this trial is to test feasibility, acceptability, and efficacy of PARK, an online self-guided positive affect regulation intervention, in a sample of healthcare workers during the COVID-19 pandemic.
METHODS: In the context of the unprecedented rise in burnout during the COVID-19 pandemic, we conducted a randomized waitlist-controlled trial of the Positive Affect Regulation sKills (PARK) program-a five-week, online, self-guided coping skills intervention nested within an ongoing cohort of HCWs. N = 554 healthcare workers were randomly assigned to receive the intervention immediately or to receive the intervention after approximately 12 weeks. Outcomes included change in burnout, emotional wellbeing (positive affect, meaning and purpose, depression, anxiety) and sleep over approximately 12 weeks. Analyses included mixed-effects linear regression models comparing change over time in outcomes between intervention and control conditions.
RESULTS: One third (n = 554) of the participants in the cohort of HCWs consented to participate and enrolled in PARK in April 2022. Compared to those who did not enroll, participants in the trial reported higher burnout, poorer emotional wellbeing, and poorer sleep at baseline (April, 2022; all ps < .05). Intent-to-treat analyses showed that participants randomly assigned to the intervention immediately (PARK-Now) improved significantly on anxiety (within-group change on PROMIS T-score = -0.63; p = .003) whereas those in the waitlist (PARK-Later) did not (within group T-score change 0.04, p = 0.90). The between-group difference in change, however, was not statistically significant (B = -0.67 p = 0.10). None of the other wellbeing outcomes changed significantly in the intervention group compared to the waitlist. Additional as-treated analyses indicated that those participants who completed all 5 of the weekly online lessons (N = 52; 9.4%) improved significantly more on the primary outcome of positive affect compared to those who enrolled in PARK but completed zero lessons (n = 237; 42.8%; B = 2.85; p = .0001).
CONCLUSIONS: Online self-guided coping skills interventions like PARK can be effective in targeted samples and future work will focus on adaptations to increase engagement and tailor PARK for HCWs who could most benefit.
METHODS: In the context of the unprecedented rise in burnout during the COVID-19 pandemic, we conducted a randomized waitlist-controlled trial of the Positive Affect Regulation sKills (PARK) program-a five-week, online, self-guided coping skills intervention nested within an ongoing cohort of HCWs. N = 554 healthcare workers were randomly assigned to receive the intervention immediately or to receive the intervention after approximately 12 weeks. Outcomes included change in burnout, emotional wellbeing (positive affect, meaning and purpose, depression, anxiety) and sleep over approximately 12 weeks. Analyses included mixed-effects linear regression models comparing change over time in outcomes between intervention and control conditions.
RESULTS: One third (n = 554) of the participants in the cohort of HCWs consented to participate and enrolled in PARK in April 2022. Compared to those who did not enroll, participants in the trial reported higher burnout, poorer emotional wellbeing, and poorer sleep at baseline (April, 2022; all ps < .05). Intent-to-treat analyses showed that participants randomly assigned to the intervention immediately (PARK-Now) improved significantly on anxiety (within-group change on PROMIS T-score = -0.63; p = .003) whereas those in the waitlist (PARK-Later) did not (within group T-score change 0.04, p = 0.90). The between-group difference in change, however, was not statistically significant (B = -0.67 p = 0.10). None of the other wellbeing outcomes changed significantly in the intervention group compared to the waitlist. Additional as-treated analyses indicated that those participants who completed all 5 of the weekly online lessons (N = 52; 9.4%) improved significantly more on the primary outcome of positive affect compared to those who enrolled in PARK but completed zero lessons (n = 237; 42.8%; B = 2.85; p = .0001).
CONCLUSIONS: Online self-guided coping skills interventions like PARK can be effective in targeted samples and future work will focus on adaptations to increase engagement and tailor PARK for HCWs who could most benefit.
摘要：
背景：倦怠构成了实质性的，对医护人员(HCW)福祉和安全交付的持续威胁，优质的医疗保健。虽然医疗保健的系统和组织层面的变化至关重要，HCW还需要个人水平的技能来提高韧性。这个试验的目的是测试可行性,可接受性,和PARK的功效，在线自我引导的积极情感调节干预，在COVID-19大流行期间的医护人员样本中。
方法：在COVID-19大流行期间倦怠空前上升的背景下，我们进行了一项为期五周的积极影响调节sKills（PARK）计划的随机候补对照试验，在线,自我指导的应对技能干预嵌套在一个正在进行的HCWs队列中。N=554名医护人员被随机分配立即接受干预或在大约12周后接受干预。结果包括倦怠的变化，情绪健康(积极的影响，意义和目的,抑郁症,焦虑)和睡眠超过大约12周。分析包括混合效应线性回归模型，比较干预和控制条件之间结果随时间的变化。
结果：2022年4月，HCWs队列中三分之一（n=554）的参与者同意参加并加入PARK。与那些没有报名的人相比，试验的参与者报告了更高的倦怠，较差的情绪健康，基线时睡眠较差(4月，2022年；所有PS<0.05）。意向治疗分析表明，立即随机分配到干预（PARK-Now）的参与者在焦虑方面显着改善（PROMIST评分=-0.63；p=.003），而等待名单（PARK-Later）中的参与者则没有（在组T评分变化0.04，p=0.90）。组间差异的变化，然而,无统计学意义(B=-0.67p=0.10)。与等待名单相比，干预组的其他健康结果均无明显变化。其他经过处理的分析表明，与参加PARK但完成零课程的参与者相比，完成所有5个每周在线课程的参与者（N=52;9.4％）在积极影响的主要结果上的改善幅度更大（n=237;42.8％;B=2.85;p=.0001）。
结论：像PARK这样的在线自我指导应对技巧干预措施在有针对性的样本中可以有效，未来的工作将集中在适应上，以增加参与度，并为最可能受益的HCW量身定制PARK。
方法：在COVID-19大流行期间倦怠空前上升的背景下，我们进行了一项为期五周的积极影响调节sKills（PARK）计划的随机候补对照试验，在线,自我指导的应对技能干预嵌套在一个正在进行的HCWs队列中。N=554名医护人员被随机分配立即接受干预或在大约12周后接受干预。结果包括倦怠的变化，情绪健康(积极的影响，意义和目的,抑郁症,焦虑)和睡眠超过大约12周。分析包括混合效应线性回归模型，比较干预和控制条件之间结果随时间的变化。
结果：2022年4月，HCWs队列中三分之一（n=554）的参与者同意参加并加入PARK。与那些没有报名的人相比，试验的参与者报告了更高的倦怠，较差的情绪健康，基线时睡眠较差(4月，2022年；所有PS<0.05）。意向治疗分析表明，立即随机分配到干预（PARK-Now）的参与者在焦虑方面显着改善（PROMIST评分=-0.63；p=.003），而等待名单（PARK-Later）中的参与者则没有（在组T评分变化0.04，p=0.90）。组间差异的变化，然而,无统计学意义(B=-0.67p=0.10)。与等待名单相比，干预组的其他健康结果均无明显变化。其他经过处理的分析表明，与参加PARK但完成零课程的参与者相比，完成所有5个每周在线课程的参与者（N=52;9.4％）在积极影响的主要结果上的改善幅度更大（n=237;42.8％;B=2.85;p=.0001）。
结论：像PARK这样的在线自我指导应对技巧干预措施在有针对性的样本中可以有效，未来的工作将集中在适应上，以增加参与度，并为最可能受益的HCW量身定制PARK。
