A comparison of burnout frequency among oncology physicians and nurses working on the front lines and usual wards during the COVID-19 epidemic in Wuhan, China
Identifieur interne : 000190 ( Pmc/Corpus ); précédent : 000189; suivant : 000191A comparison of burnout frequency among oncology physicians and nurses working on the front lines and usual wards during the COVID-19 epidemic in Wuhan, China
Auteurs : Yuan Wu ; Jun Wang ; Chenggang Luo ; Sheng Hu ; Xi Lin ; Aimee E. Anderson ; Eduardo Bruera ; Xiaoxin Yang ; Shaozhong Wei ; Yu QianSource :
- Journal of Pain and Symptom Management [ 0885-3924 ] ; 2020.
Abstract
The epidemic of Coronavirus Disease 2019 (COVID-19) was first identified in Wuhan, China and has now spread worldwide. In the affected countries, physicians and nurses are under heavy workload conditions and are at high risk of infection.
The aim of this study was to compare the frequency of burnout between physicians and nurses on the front line and those working in usual wards.
A survey with 49 questions total was administered to 220 medical staff members from the COVID-19 front lines and usual wards, with a ratio of 1:1. General information such as age, gender, marriage status, and the Maslach Burnout Inventory-Medical Personnel (MBI), were gathered and compared.
The group working on the front lines had a lower frequency of burnout (13% versus 39%,
Compared to medical staff working on their usual wards for uninfected patients, medical staff working on the COVID-19 front line had a lower frequency of burnout. These results suggest that in the face of the COVID-19 crisis, both front line and usual ward staff should be considered when policies and procedures to support the well-being of health care workers are devised.
Url:
DOI: 10.1016/j.jpainsymman.2020.04.008
PubMed: 32283221
PubMed Central: 7151285
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PMC:7151285Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">A comparison of burnout frequency among oncology physicians and nurses working on the front lines and usual wards during the COVID-19 epidemic in Wuhan, China</title><author><name sortKey="Wu, Yuan" sort="Wu, Yuan" uniqKey="Wu Y" first="Yuan" last="Wu">Yuan Wu</name><affiliation><nlm:aff id="aff1">Department of Radiation Cancer, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China</nlm:aff></affiliation></author><author><name sortKey="Wang, Jun" sort="Wang, Jun" uniqKey="Wang J" first="Jun" last="Wang">Jun Wang</name><affiliation><nlm:aff id="aff2">Department of Thoracic Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China</nlm:aff></affiliation></author><author><name sortKey="Luo, Chenggang" sort="Luo, Chenggang" uniqKey="Luo C" first="Chenggang" last="Luo">Chenggang Luo</name><affiliation><nlm:aff id="aff3">Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China</nlm:aff></affiliation></author><author><name sortKey="Hu, Sheng" sort="Hu, Sheng" uniqKey="Hu S" first="Sheng" last="Hu">Sheng Hu</name><affiliation><nlm:aff id="aff2">Department of Thoracic Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China</nlm:aff></affiliation></author><author><name sortKey="Lin, Xi" sort="Lin, Xi" uniqKey="Lin X" first="Xi" last="Lin">Xi Lin</name><affiliation><nlm:aff id="aff2">Department of Thoracic Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China</nlm:aff></affiliation></author><author><name sortKey="Anderson, Aimee E" sort="Anderson, Aimee E" uniqKey="Anderson A" first="Aimee E." last="Anderson">Aimee E. Anderson</name><affiliation><nlm:aff id="aff4">Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA</nlm:aff></affiliation></author><author><name sortKey="Bruera, Eduardo" sort="Bruera, Eduardo" uniqKey="Bruera E" first="Eduardo" last="Bruera">Eduardo Bruera</name><affiliation><nlm:aff id="aff4">Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA</nlm:aff></affiliation></author><author><name sortKey="Yang, Xiaoxin" sort="Yang, Xiaoxin" uniqKey="Yang X" first="Xiaoxin" last="Yang">Xiaoxin Yang</name><affiliation><nlm:aff id="aff5">Department of Surgery, Wuhan Third Hospital, Wuhan, China</nlm:aff></affiliation></author><author><name sortKey="Wei, Shaozhong" sort="Wei, Shaozhong" uniqKey="Wei S" first="Shaozhong" last="Wei">Shaozhong Wei</name><affiliation><nlm:aff id="aff6">Department of Gastrointestinal Cancer, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China</nlm:aff></affiliation></author><author><name sortKey="Qian, Yu" sort="Qian, Yu" uniqKey="Qian Y" first="Yu" last="Qian">Yu Qian</name><affiliation><nlm:aff id="aff2">Department of Thoracic Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32283221</idno><idno type="pmc">7151285</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151285</idno><idno type="RBID">PMC:7151285</idno><idno type="doi">10.1016/j.jpainsymman.2020.04.008</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000190</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000190</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">A comparison of burnout frequency among oncology physicians and nurses working on the front lines and usual wards during the COVID-19 epidemic in Wuhan, China</title><author><name sortKey="Wu, Yuan" sort="Wu, Yuan" uniqKey="Wu Y" first="Yuan" last="Wu">Yuan Wu</name><affiliation><nlm:aff id="aff1">Department of Radiation Cancer, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China</nlm:aff></affiliation></author><author><name sortKey="Wang, Jun" sort="Wang, Jun" uniqKey="Wang J" first="Jun" last="Wang">Jun Wang</name><affiliation><nlm:aff id="aff2">Department of Thoracic Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China</nlm:aff></affiliation></author><author><name sortKey="Luo, Chenggang" sort="Luo, Chenggang" uniqKey="Luo C" first="Chenggang" last="Luo">Chenggang Luo</name><affiliation><nlm:aff id="aff3">Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China</nlm:aff></affiliation></author><author><name sortKey="Hu, Sheng" sort="Hu, Sheng" uniqKey="Hu S" first="Sheng" last="Hu">Sheng Hu</name><affiliation><nlm:aff id="aff2">Department of Thoracic Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China</nlm:aff></affiliation></author><author><name sortKey="Lin, Xi" sort="Lin, Xi" uniqKey="Lin X" first="Xi" last="Lin">Xi Lin</name><affiliation><nlm:aff id="aff2">Department of Thoracic Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China</nlm:aff></affiliation></author><author><name sortKey="Anderson, Aimee E" sort="Anderson, Aimee E" uniqKey="Anderson A" first="Aimee E." last="Anderson">Aimee E. Anderson</name><affiliation><nlm:aff id="aff4">Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA</nlm:aff></affiliation></author><author><name sortKey="Bruera, Eduardo" sort="Bruera, Eduardo" uniqKey="Bruera E" first="Eduardo" last="Bruera">Eduardo Bruera</name><affiliation><nlm:aff id="aff4">Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA</nlm:aff></affiliation></author><author><name sortKey="Yang, Xiaoxin" sort="Yang, Xiaoxin" uniqKey="Yang X" first="Xiaoxin" last="Yang">Xiaoxin Yang</name><affiliation><nlm:aff id="aff5">Department of Surgery, Wuhan Third Hospital, Wuhan, China</nlm:aff></affiliation></author><author><name sortKey="Wei, Shaozhong" sort="Wei, Shaozhong" uniqKey="Wei S" first="Shaozhong" last="Wei">Shaozhong Wei</name><affiliation><nlm:aff id="aff6">Department of Gastrointestinal Cancer, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China</nlm:aff></affiliation></author><author><name sortKey="Qian, Yu" sort="Qian, Yu" uniqKey="Qian Y" first="Yu" last="Qian">Yu Qian</name><affiliation><nlm:aff id="aff2">Department of Thoracic Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Pain and Symptom Management</title><idno type="ISSN">0885-3924</idno><idno type="eISSN">1873-6513</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Context</title><p>The epidemic of Coronavirus Disease 2019 (COVID-19) was first identified in Wuhan, China and has now spread worldwide. In the affected countries, physicians and nurses are under heavy workload conditions and are at high risk of infection.</p></sec><sec><title>Objectives</title><p>The aim of this study was to compare the frequency of burnout between physicians and nurses on the front line and those working in usual wards.</p></sec><sec><title>Methods</title><p>A survey with 49 questions total was administered to 220 medical staff members from the COVID-19 front lines and usual wards, with a ratio of 1:1. General information such as age, gender, marriage status, and the Maslach Burnout Inventory-Medical Personnel (MBI), were gathered and compared.</p></sec><sec><title>Results</title><p>The group working on the front lines had a lower frequency of burnout (13% versus 39%, <italic>P</italic> < .0001), and were less worried about being infected compared to the usual ward group.</p></sec><sec><title>Conclusion</title><p>Compared to medical staff working on their usual wards for uninfected patients, medical staff working on the COVID-19 front line had a lower frequency of burnout. These results suggest that in the face of the COVID-19 crisis, both front line and usual ward staff should be considered when policies and procedures to support the well-being of health care workers are devised.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Arshad Ali, S" uniqKey="Arshad Ali S">S. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Pain Symptom Manage</journal-id><journal-id journal-id-type="iso-abbrev">J Pain Symptom Manage</journal-id><journal-title-group><journal-title>Journal of Pain and Symptom Management</journal-title></journal-title-group><issn pub-type="ppub">0885-3924</issn><issn pub-type="epub">1873-6513</issn><publisher><publisher-name>Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32283221</article-id><article-id pub-id-type="pmc">7151285</article-id><article-id pub-id-type="publisher-id">S0885-3924(20)30205-0</article-id><article-id pub-id-type="doi">10.1016/j.jpainsymman.2020.04.008</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>A comparison of burnout frequency among oncology physicians and nurses working on the front lines and usual wards during the COVID-19 epidemic in Wuhan, China</article-title></title-group><contrib-group><contrib contrib-type="author" id="au1"><name><surname>Wu</surname><given-names>Yuan</given-names></name><degrees>M.D</degrees><xref rid="aff1" ref-type="aff">1</xref><xref rid="fn1" ref-type="fn">∗</xref></contrib><contrib contrib-type="author" id="au2"><name><surname>Wang</surname><given-names>Jun</given-names></name><degrees>M.D</degrees><xref rid="aff2" ref-type="aff">2</xref><xref rid="fn1" ref-type="fn">∗</xref></contrib><contrib contrib-type="author" id="au3"><name><surname>Luo</surname><given-names>Chenggang</given-names></name><degrees>M.D</degrees><xref rid="aff3" ref-type="aff">3</xref><xref rid="fn1" ref-type="fn">∗</xref></contrib><contrib contrib-type="author" id="au4"><name><surname>Hu</surname><given-names>Sheng</given-names></name><degrees>M.D</degrees><xref rid="aff2" ref-type="aff">2</xref></contrib><contrib contrib-type="author" id="au5"><name><surname>Lin</surname><given-names>Xi</given-names></name><degrees>B.S</degrees><xref rid="aff2" ref-type="aff">2</xref></contrib><contrib contrib-type="author" id="au6"><name><surname>Anderson</surname><given-names>Aimee E.</given-names></name><degrees>M.Sc., Ph.D</degrees><xref rid="aff4" ref-type="aff">4</xref></contrib><contrib contrib-type="author" id="au7"><name><surname>Bruera</surname><given-names>Eduardo</given-names></name><degrees>M.D</degrees><xref rid="aff4" ref-type="aff">4</xref></contrib><contrib contrib-type="author" id="au8"><name><surname>Yang</surname><given-names>Xiaoxin</given-names></name><degrees>M.D</degrees><xref rid="aff5" ref-type="aff">5</xref></contrib><contrib contrib-type="author" id="au9"><name><surname>Wei</surname><given-names>Shaozhong</given-names></name><degrees>M.D</degrees><email>weishaozhong@163.com</email><xref rid="aff6" ref-type="aff">6</xref><xref rid="cor2" ref-type="corresp">$$</xref><xref rid="fn2" ref-type="fn">#</xref></contrib><contrib contrib-type="author" id="au10"><name><surname>Qian</surname><given-names>Yu</given-names></name><degrees>M.D</degrees><email>173653835@qq.com</email><xref rid="aff2" ref-type="aff">2</xref><xref rid="cor1" ref-type="corresp">$</xref><xref rid="fn2" ref-type="fn">#</xref></contrib></contrib-group><aff id="aff1"><label>1</label>Department of Radiation Cancer, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China</aff><aff id="aff2"><label>2</label>Department of Thoracic Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China</aff><aff id="aff3"><label>3</label>Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China</aff><aff id="aff4"><label>4</label>Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA</aff><aff id="aff5"><label>5</label>Department of Surgery, Wuhan Third Hospital, Wuhan, China</aff><aff id="aff6"><label>6</label>Department of Gastrointestinal Cancer, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China</aff><author-notes><corresp id="cor1"><label>$</label>Corresponding authors: Yu Qian, MD, Department of Thoracic Cancer, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 430070. Telephone: 0087-27-87670255. <email>173653835@qq.com</email></corresp><corresp id="cor2"><label>$$</label>Corresponding authors: Shaozhong Wei, MD, Department of Gastrointestinal Cancer, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 430070. Telephone: 0087-27-87670255. <email>weishaozhong@163.com</email></corresp><fn id="fn1"><label>∗</label><p id="ntpara0010">co-first author</p></fn><fn id="fn2"><label>#</label><p id="ntpara0015">co-corresponding author</p></fn></author-notes><pub-date pub-type="pmc-release"><day>10</day><month>4</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>10</day><month>4</month><year>2020</year></pub-date><history><date date-type="received"><day>6</day><month>4</month><year>2020</year></date><date date-type="rev-recd"><day>7</day><month>4</month><year>2020</year></date><date date-type="accepted"><day>7</day><month>4</month><year>2020</year></date></history><permissions><copyright-statement>© 2020 Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder></copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract id="abs0010"><sec><title>Context</title><p>The epidemic of Coronavirus Disease 2019 (COVID-19) was first identified in Wuhan, China and has now spread worldwide. In the affected countries, physicians and nurses are under heavy workload conditions and are at high risk of infection.</p></sec><sec><title>Objectives</title><p>The aim of this study was to compare the frequency of burnout between physicians and nurses on the front line and those working in usual wards.</p></sec><sec><title>Methods</title><p>A survey with 49 questions total was administered to 220 medical staff members from the COVID-19 front lines and usual wards, with a ratio of 1:1. General information such as age, gender, marriage status, and the Maslach Burnout Inventory-Medical Personnel (MBI), were gathered and compared.</p></sec><sec><title>Results</title><p>The group working on the front lines had a lower frequency of burnout (13% versus 39%, <italic>P</italic> < .0001), and were less worried about being infected compared to the usual ward group.</p></sec><sec><title>Conclusion</title><p>Compared to medical staff working on their usual wards for uninfected patients, medical staff working on the COVID-19 front line had a lower frequency of burnout. These results suggest that in the face of the COVID-19 crisis, both front line and usual ward staff should be considered when policies and procedures to support the well-being of health care workers are devised.</p></sec></abstract><kwd-group id="kwrds0010"><title>Key Words</title><kwd>COVID-19</kwd><kwd>medical staff</kwd><kwd>burnout</kwd></kwd-group></article-meta></front><body><sec id="sec1"><title>Key Message</title><p id="p0010">This study focused on the burnout frequency of medical staff working on different workplaces in the epicenter of the COVID-19 pandemic. Our results suggest that in the face of the COVID-19 crisis, both front line and usual ward staff should be considered.</p></sec><sec id="sec2"><title>Introduction</title><p id="p0015">The Coronavirus Disease 2019 (COVID-19) pandemic, first identified in Wuhan, China, and now spread worldwide,(<xref rid="bib1" ref-type="bibr">1</xref>, <xref rid="bib2" ref-type="bibr">2</xref>, <xref rid="bib3" ref-type="bibr">3</xref>, <xref rid="bib4" ref-type="bibr">4</xref>) has raised concerns about the well-being of front-line (FL) health care workers.(<xref rid="bib5" ref-type="bibr">5</xref>, <xref rid="bib6" ref-type="bibr">6</xref>, <xref rid="bib7" ref-type="bibr">7</xref>, <xref rid="bib8" ref-type="bibr">8</xref>, <xref rid="bib9" ref-type="bibr">9</xref>, <xref rid="bib10" ref-type="bibr">10</xref>, <xref rid="bib11" ref-type="bibr">11</xref>, <xref rid="bib12" ref-type="bibr">12</xref>, <xref rid="bib13" ref-type="bibr">13</xref>, <xref rid="bib14" ref-type="bibr">14</xref>) To efficiently stop the spread of disease, general hospitals were deployed to the FL for infected patients with severe symptoms, while several of Wuhan’s sports stadiums and convention centers were renovated into mobile hospitals to treat patients with mild symptoms. Medical staff from different backgrounds were dispatched to these sites to care for more than 40,000 infected patients in the city.(<xref rid="bib15" ref-type="bibr">15</xref>, <xref rid="bib16" ref-type="bibr">16</xref>, <xref rid="bib17" ref-type="bibr">17</xref>)</p><p id="p0020">COVID-19 is transmitted primarily by respiratory droplets and close contact, and health care workers are at high risk of exposure.(<xref rid="bib5" ref-type="bibr">5</xref>, <xref rid="bib12" ref-type="bibr">12</xref>, <xref rid="bib13" ref-type="bibr">13</xref>, <xref rid="bib18" ref-type="bibr">18</xref>) Several studies have also reported that medical staff also experience depression and anxiety due to the COVID-19 outbreak.(<xref rid="bib7" ref-type="bibr">7</xref>, <xref rid="bib12" ref-type="bibr">12</xref>, <xref rid="bib14" ref-type="bibr">14</xref>) Due to increasing patient volumes, medical professionals who are not specialized in infectious disease gathered to support the FL,(<xref rid="bib6" ref-type="bibr">6</xref>) and may experience even greater pressure when facing infected patients. Burnout is receiving increasing recognition as a serious problem among medical professionals.(<xref rid="bib19" ref-type="bibr">19</xref>, <xref rid="bib20" ref-type="bibr">20</xref>, <xref rid="bib21" ref-type="bibr">21</xref>) Currently, no studies have compared the burnout frequency of non-infectious disease specialist health care workers at the FL of the outbreak versus their colleagues practicing in their usual wards (UW).</p><p id="p0025">To support the FL, 173 oncology-specialized physicians and nurses were dispatched from Hubei Cancer Hospital (HCH), a specialized tertiary hospital with 2000 beds in Wuhan. We conducted a survey to explore and compare the burnout frequency of physicians and nurses from HCH who worked in the FL, defined as one designated hospital, Leishenshan Hospital, and three mobile hospitals, versus their colleagues from the same institution who remained in their UW.</p></sec><sec id="sec3"><title>Methods</title><p id="p0030">The Institutional Review Board (IRB) of HCH approved the survey and protocol. Two hundred and twenty physicians and nurses from HCH were invited to enroll in this study. The ratio of FL versus UW was 1:1. The survey was conducted from March 13, 2020 to March 17, 2020. The survey included 15 demographic questions and questions regarding participants’ status in the past two months, and the Maslach Burnout Inventory-Medical Personnel (MBI).(<xref rid="bib22" ref-type="bibr">22</xref>) Participants were assured of complete anonymity. Burnout was defined as a high level of emotional exhaustion (EE) greater than 27), and/or a high level of depersonalization (DP) greater than 10).(<xref rid="bib23" ref-type="bibr">23</xref>) We separately considered the frequency of participants with a low sense of personal accomplishment (PA) less than 31.</p><sec id="sec3.1"><title>Statistical analysis</title><p id="p0035">We applied standard descriptive statistics to summarize the responses to all survey questions, including median, interquartile range (IQR), and range for continuous variables and frequency and proportion for categorical variables. Chi-square test was used to assess the difference of frequencies of burnout between the FL and the UW.</p></sec></sec><sec id="sec4"><title>Results</title><p id="p0040">A total of 190 of 220 (86%) invited participants completed the survey. All cases in the sample were valid to be analyzed. There were 96 participants who worked in the FL. The demographic characteristics of participants are summarized in <xref rid="tbl1" ref-type="table">Table 1</xref>. Most of the participants were from the department of medical oncology.<table-wrap position="float" id="tbl1"><label>Table 1</label><caption><p>Participant characteristics, N=190; N(%)</p></caption><table frame="hsides" rules="groups"><thead><tr><th></th><th>Front line (N=96)</th><th>Usual ward (N=94)</th><th>Total (N=190)</th></tr></thead><tbody><tr><td>Age (median, IQR)</td><td>33 (30, 37)</td><td>32 (28, 36)</td><td>33 (29,37)</td></tr><tr><td colspan="4">Gender</td></tr><tr><td>Female</td><td>69 (72)</td><td>88 (94)</td><td>157(83)</td></tr><tr><td colspan="4">Occupation</td></tr><tr><td>Nurse</td><td>55 (57)</td><td>61 (65)</td><td>116(61)</td></tr><tr><td colspan="4">Married Status</td></tr><tr><td>Married</td><td>64 (67)</td><td>66 (70)</td><td>130(68)</td></tr><tr><td>Single/Separated/Divorced</td><td>32 (33)</td><td>28 (30)</td><td>60(32)</td></tr><tr><td colspan="4">Specialty</td></tr><tr><td>Medical Oncology</td><td>44 (46)</td><td>59 (63)</td><td>103(54)</td></tr><tr><td>Radiation Oncology</td><td>8 (8)</td><td>33 (35)</td><td>41(23)</td></tr><tr><td>Surgery</td><td>37 (39)</td><td>2 (2)</td><td>39(20)</td></tr><tr><td>Other<xref rid="tbl1fna" ref-type="table-fn">a</xref></td><td>7 (7)</td><td>0 (0)</td><td>7(3)</td></tr><tr><td colspan="4">How long have you been practicing?</td></tr><tr><td><1 year</td><td>2(2)</td><td>2(2)</td><td>4 (2)</td></tr><tr><td>1-5 years</td><td>20(21)</td><td>19(20)</td><td>39 (20)</td></tr><tr><td>6-10 years</td><td>34(35)</td><td>36(38)</td><td>70 (37)</td></tr><tr><td>11-15 years</td><td>23(24)</td><td>19(20)</td><td>42 (22)</td></tr><tr><td>>15 years</td><td>17(18)</td><td>18(20)</td><td>35 (19)</td></tr><tr><td colspan="4">On average, for how many hours a week do you work in the past two months?</td></tr><tr><td><10</td><td>10(10）</td><td>10(10)</td><td>20 (11)</td></tr><tr><td>11-20</td><td>22(23）</td><td>6(6)</td><td>28 (15)</td></tr><tr><td>21-40</td><td>46(49）</td><td>56(60)</td><td>102 (54)</td></tr><tr><td>41-60</td><td>12(12)</td><td>18(20)</td><td>30 (16)</td></tr><tr><td>61-80</td><td>3(3）</td><td>2(2)</td><td>5 (2)</td></tr><tr><td>>80</td><td>3(3）</td><td>2(2)</td><td>5 (2)</td></tr><tr><td colspan="4">How often do you work on weekends for the past two months?</td></tr><tr><td>Never</td><td>22(23）</td><td>28(30)</td><td>50 (26)</td></tr><tr><td>Every 2 weeks</td><td>13(14）</td><td>20(21)</td><td>32 (17)</td></tr><tr><td>Every week (one day)</td><td>43(45）</td><td>41(44)</td><td>84 (44)</td></tr><tr><td>Every week (two days)</td><td>18(19）</td><td>5(5)</td><td>23 (13)</td></tr><tr><td colspan="4">Number of Personnel in the team; median (IQR)</td></tr><tr><td>Nurses</td><td>31 (8, 48)</td><td>15 (13,17)</td><td>16 (11, 40)</td></tr><tr><td>Physicians</td><td>13 (10, 20)</td><td>6 (5, 7)</td><td>7 (5, 13)</td></tr></tbody></table><table-wrap-foot><fn><p>Abbreviations: IQR, interquartile range.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tbl1fna"><label>a</label><p id="ntpara0020">Includes both intensive care unit and Chinese medicine.</p></fn></table-wrap-foot></table-wrap></p><p id="p0045">Previous work has suggested that the number of years of experience, the number of hours worked per week, the frequency of working on weekends, and the number of personnel in a person’s team or practice may be associated with burnout.(<xref rid="bib24" ref-type="bibr">24</xref>) Results of these variables for FL and those working in their UW are summarized in <xref rid="tbl1" ref-type="table">Table 1</xref>.</p><p id="p0050">The MBI is the gold standard for evaluating burnout.(<xref rid="bib22" ref-type="bibr">22</xref>, <xref rid="bib25" ref-type="bibr">25</xref>, <xref rid="bib26" ref-type="bibr">26</xref>, <xref rid="bib27" ref-type="bibr">27</xref>) The frequency of burnout is significantly lower in the FL group than in the UW group (13% versus 39%, P < .0001). The frequency of a low level of PA is lower in the FL group than in the UW group (39% vs 61%, P =0.002; <xref rid="tbl2" ref-type="table">Table 2</xref>).<table-wrap position="float" id="tbl2"><label>Table 2</label><caption><p>Comparison of medical personnel in the front line with usual cancer ward; N(%)</p></caption><table frame="hsides" rules="groups"><thead><tr><th></th><th colspan="2">Total (N=190)</th><th></th></tr></thead><tbody><tr><td colspan="4">Burnout Frequency (by Method 2: EE>27 and/or DP>10)</td></tr><tr><td></td><td>12 (13)</td><td>37(39)</td><td><.001</td></tr><tr><td colspan="4">Burnout Frequency (by PA<31))</td></tr><tr><td></td><td>37 (39)</td><td>57(61)</td><td>.002</td></tr></tbody></table><table-wrap-foot><fn><p>Abbreviations: DP, depersonalization; EE, emotional exhaustion; PA, personal achievement.</p></fn></table-wrap-foot></table-wrap></p><p id="p0055">We asked questions about participants’ attitudes toward the effect of COVID-19 (<xref rid="tbl3" ref-type="table">Table 3</xref>). More participants from the FL (76%) strongly disagree or disagree that he/she feels more burnout now compared to before the COVID-19 crisis. Participants continuing to work in their usual wards were more worried about themselves or a family member becoming infected. Both groups indicated similar worry that the COVID crisis will continue for a long time.<table-wrap position="float" id="tbl3"><label>Table 3</label><caption><p>Attitudes toward COVID-19</p></caption><table frame="hsides" rules="groups"><thead><tr><th><hr></hr></th><th>Front line (N=96)<hr></hr></th><th>Usual ward (N=94)<hr></hr></th></tr><tr><th colspan="3">I feel more burnout now as compared to before the crisis of COVID. N(%)</th></tr></thead><tbody><tr><td>Agree/ strongly agree</td><td>14(15)</td><td>29(31)</td></tr><tr><td>Neither agree nor disagree</td><td>9(9)</td><td>20(21)</td></tr><tr><td>Disagree / strongly disagree</td><td>73(76)</td><td>45(48)</td></tr><tr><td colspan="3">I am worried about becoming infected. N(%)</td></tr><tr><td>Agree/ strongly agree</td><td>49 (51)</td><td>72(76)</td></tr><tr><td>Neither agree nor disagree</td><td>18(19)</td><td>7(7)</td></tr><tr><td>Disagree / strongly disagree</td><td>29(30)</td><td>15(16)</td></tr><tr><td colspan="3">I am worried about my family becoming infected. N(%)</td></tr><tr><td>Agree/ strongly agree</td><td>63(65)</td><td>82(87)</td></tr><tr><td>Neither agree nor disagree</td><td>8(8)</td><td>4(4)</td></tr><tr><td>Disagree / strongly disagree</td><td>25(26)</td><td>8(8)</td></tr><tr><td colspan="3">I am worried about this going for too long. N(%)</td></tr><tr><td>Agree/ strongly agree</td><td>43(45)</td><td>57(61)</td></tr><tr><td>Neither agree nor disagree</td><td>21(22)</td><td>23(24)</td></tr><tr><td>Disagree / strongly disagree</td><td>32(33)</td><td>14(14)</td></tr></tbody></table></table-wrap></p></sec><sec id="sec5"><title>Discussion</title><p id="p0060">As COVID-19 spreads worldwide, ncreasing numbers of medical professionals will be needed to address the crisis To our knowledge, this is the first study focusing on and comparing the burnout frequency of medical staff working on the FL versus those working in their UW in the epicenter of the COVID-19 pandemic. In our survey, we observed that participants from the FL had a significantly lower frequency of burnout in the past two months during the COVID-19 crisis. Moreover, FL workers were also less worried about becoming infected despite working directly with infected patients.</p><p id="p0065">Though known risk factors, such as practice size, years of experience, and marital status, were similar between the groups (<xref rid="tbl1" ref-type="table">Table 1</xref>), burnout frequency was lower in FL staff. Several explanations could account for this unexpected trend. One possible explanation is that by directly addressing COVID-19, participants from the FL may have felt a greater sense of control of their situation; control in the workplace is thought to be a major driver of engagement and important for avoiding burnout.(<xref rid="bib22" ref-type="bibr">22</xref>, <xref rid="bib25" ref-type="bibr">25</xref>, <xref rid="bib28" ref-type="bibr">28</xref>) Those working in their usual wards may have perceived less control over new policies and procedures enacted to keep staff and patients safe, and in contrast to facing COVID-19 head-on, these workers may have had a sense that the virus could impact their workplace at any time, regardless of those policies. Additionally, cancer patients are particularly vulnerable to viral infection, and the COVID-19 pandemic has frequently necessitated suspension of cancer treatment and clinical trials;(<xref rid="bib4" ref-type="bibr">4</xref>, <xref rid="bib29" ref-type="bibr">29</xref>) these situations may add additional workplace stress to oncology professionals working in their UW.(<xref rid="bib13" ref-type="bibr">13</xref>, <xref rid="bib30" ref-type="bibr">30</xref>, <xref rid="bib31" ref-type="bibr">31</xref>)</p><p id="p0070">It is also possible that those at the FL may have felt closer to the key decision makers, and may have had access to more timely and accurate information.(<xref rid="bib25" ref-type="bibr">25</xref>, <xref rid="bib28" ref-type="bibr">28</xref>, <xref rid="bib32" ref-type="bibr">32</xref>) Personal accomplishment, a key dimension of burnout that is often neglected in studies of health care workers but is receiving increasing recognition,(<xref rid="bib22" ref-type="bibr">22</xref>, <xref rid="bib33" ref-type="bibr">33</xref>) may have also played a role: the FL staff may have felt a deeper sense of personal achievement as they saw the direct results of their care for patients affected by the COVID-19 crisis, and ultimately saw the abatement of the epidemic in Wuhan.</p><p id="p0075">Much attention is paid to those who work directly with infected patients.(<xref rid="bib11" ref-type="bibr">11</xref>, <xref rid="bib12" ref-type="bibr">12</xref>) In reality, the entire health care system is impacted by COVID-19. Beyond the FL, the working life of physicians and nurses is highly disrupted even in their usual hospital wards. New policies and procedures, the stress of both staff and patients, and the prospect that infected individuals (staff or patients) could be identified in the workplace at any time may be sources of burnout for non-front line staff. Given the known detrimental impact of burnout on patient care and health care worker well-being,(<xref rid="bib34" ref-type="bibr">34</xref>, <xref rid="bib35" ref-type="bibr">35</xref>, <xref rid="bib36" ref-type="bibr">36</xref>, <xref rid="bib37" ref-type="bibr">37</xref>, <xref rid="bib38" ref-type="bibr">38</xref>) our results suggest that the well-being of staff working in their usual workplace may be negatively impacted by the pandemic, and is deserving of future attention and additional research.</p><p id="p0080">The workers surveyed here all hailed from the oncology specialty. Oncology has its own set of risks for burnout,(<xref rid="bib33" ref-type="bibr">33</xref>, <xref rid="bib39" ref-type="bibr">39</xref>, <xref rid="bib40" ref-type="bibr">40</xref>, <xref rid="bib41" ref-type="bibr">41</xref>, <xref rid="bib42" ref-type="bibr">42</xref>, <xref rid="bib43" ref-type="bibr">43</xref>) and those working on the FL were not just in a different setting, but practicing in a tense environment outside the context of their particular expertise.(<xref rid="bib40" ref-type="bibr">40</xref>)</p><p id="p0085">This study has several limitations. First, the study utilized a small group size stemming from the medical staff of a single institution. Second, although participants were assured of their anonymity, worry about identification may have caused participants to score low on burnout questions. Moreover, even with an 86% response rate, selection bias may also have skewed our results if either highly distressed staff members or those who felt little distress chose not to participate. Finally, it is important to note that our survey was conducted in March 2020, when COVID-19 was generally considered to be under control in China; our study has no way to ascertain the burnout status of medical staff members at the onset or peak period of Wuhan’s COVID-19 crisis. Future research should be aimed at specific groups, incorporate more inception points in local epidemics, and collect more comprehensive data on the well-being of medical staff in the COVID-19 crisis.</p></sec><sec id="sec6"><title>Conclusion</title><p id="p0090">Compared to medical staff working in their UW for uninfected patients, medical staff working on the FL had a lower frequency of burnout. 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The authors declare no conflicts of interest.</p></ack></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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